Medicaid covers home health care in all 50 states. And while coverage is sure to vary from one state’s Medicaid program to another, below is an overview of some general information pertaining to Medicaid’s coverage of home health care.
Home health care provides seniors with an alternative to institutionalization. Individuals who require regular care can age in place in the comfort and familiarity of their own home in the presence of loved ones.
For Medicaid programs, home health care is a lower cost option than paying for beneficiaries to stay in and receive care in nursing homes or other institutions.
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Medicaid often allows beneficiaries to choose their own caregiver. Beneficiaries can designate a family member or friend as their paid primary caregiver who will be reimbursed by Medicaid for their service. Select states even allow a spouse to be hired as the primary caregiver.
You also do not have to be in your own home to receive home health care benefits from Medicaid. Home care coverage may be extended to the home of a friend or relative, adult foster care home or assisted living home.
Federal law requires all state Medicaid programs to provide home health benefits. Personal care coverage – such as help with eating, dressing and bathing – is not included as a federally mandated benefit, but many state Medicaid programs choose to cover these services on their own.
Some of the home health care services that may be included by Medicaid include:
In addition to regular Medicaid coverage of home health care, there are also a few specialized Medicaid programs that beneficiaries can utilize to receive home health benefits. These include:
Any recipients of home care benefits must first be eligible for and enrolled in their state Medicaid program. Eligibility is based partly on income and assets and varies from state to state. The Medicaid programs described above also have their own eligibility criteria that can differ by state.
In addition to meeting state financial limits, there is also a certain level of care needed in order to be eligible for Medicaid home care coverage. A functional need threshold, or medical need, is required for eligibility. Exact requirements vary by state, but an assessment of the individual must demonstrate that they need assistance for a specified number of activities of daily living or instrumental activities of daily living.
Medicaid programs may have medical need requirements that differ slightly from the regular state Medicaid program.
Contact your state Medicaid program to learn more about how your home health care may be covered by Medicaid and how you might qualify for a Medicaid program offering home care benefits.
You could potentially be eligible for Medicare and Medicaid. If you are, you're considered “dual eligible.” In this case, you may qualify for a certain type of Medicare Advantage plan called a Dual Eligible Special Needs Plan (D-SNP).
You can compare plans online to find out if D-SNPs are available where you live.
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Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
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