For many aging seniors, continuing to live independently in their home can become challenging if they require medical care. Medicaid covers home health care services for qualifying seniors who require medically necessary, short-term care. Some Medicaid programs also offer coverage for nonmedical home care services. However, individual states administer their own Medicaid programs, which makes coverage and eligibility requirements different for in-home care in each state.
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Yes. Medicaid covers the costs of the following home health care services for seniors who qualify:[01]
The above services are provided in a patient’s residence by licensed health care professionals, such as a registered nurse, licensed vocation nurse, or an occupational, physical, or speech therapist.
Medicaid eligibility differs from state to state. In most states, home health care is a guaranteed benefit for seniors who require a nursing home level of care.
Nursing home level of care is often determined by an assessment of a person’s physical ability to perform daily tasks, their medical needs, and behavior. Also considered is an individual’s financial status, and states typically rely on income thresholds set by the Social Security Administration. In 2024, an individual qualifies for Social Security Income (SSI) if their monthly income is less than $1,971.[02]
Some state Medicaid programs cover private duty nursing for individuals who require more advanced medical care, like 24/7 nursing care. These 24-hour skilled nursing services might be covered in the event a patient needs a feeding tube, IV medications, or mechanical ventilation.[01]
Eligibility criteria for these private duty nursing programs vary by state, but a common requirement is a stated medical need for round-the-clock skilled nursing services. In a number of states, Medicaid only covers part-time home health care with a limited number of service hours per day.
No, unlicensed family caregivers won’t be paid for home health care services. A home health care provider must meet a number of federal and state licensing requirements to be covered by Medicaid.
Medicaid-covered home health care agencies are supervised by a doctor or registered nurse and primarily offer skilled nursing and therapy services designed to meet your loved one’s medical needs.[03] The agency could be publicly operated, a nonprofit organization, or a private company. Medicaid pays those providers directly to provide care.
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Yes, Medicaid can cover the costs of nonmedical home care, but specific services, coverage, and eligibility requirements vary from state to state.
Although they may seem similar, home care and home health care provide different services to seniors.
Medicaid typically pays an approved home care agency directly for all services necessary to keep a senior living in their own home. In-home care services covered by Medicaid vary, but often include help with activities of daily living and other tasks like the following:
To qualify for in-home care through Medicaid, at a minimum, seniors must be 65 or older and meet their state’s specific financial requirements. In-home care is typically covered under home and community based services (HCBS) which, unlike home health care, is not an entitlement program. This means that enrollment in HCBS programs is not guaranteed and participants may be placed on a waitlist.
Because each state has different eligibility requirements, it’s important to review your loved one’s state Medicaid page.
Yes. In some states, Medicaid pays family members for the home care services they provide. For a family member, getting paid to provide care services can make the duty of caregiving more feasible.
Medicaid can also provide in-home care assistance for seniors who want to take direct responsibility for their care, which is referred to as self-directed care.[04]
Home and community based services (HCBS) are designed to help Medicaid recipients continue to live in their own homes or communities instead of an institutional setting like a nursing home.[05] Generally, these services are intended for seniors, people with physical disabilities, mental illness, and intellectual or developmental disabilities.
HCBS are commonly provided through Medicaid waivers, which are a way for states to offer programs not traditionally covered by Medicaid, like nonmedical home care, adult day care, and assisted living. Nearly every state offers an HCBS waiver, however, it’s important to note that unlike state Medicaid plans which are entitlement programs, participation in waivers is usually capped. This means that many waiver programs have a waitlist.
Because each state provides HCBS in a different way, the requirements to qualify for these programs vary. Check the Medicaid state waivers list for more information on specific waivers in your state.
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If you’re looking for home care or home health care for an elderly loved one, reach out to their state’s Medicaid office for more information. Individual state offices can provide guidance on eligibility requirements and applying for coverage. You can also contact your local Area Agency on Aging, which can direct you to resources that help seniors remain in their homes.
For seniors who do not qualify for Medicaid but are still interested in learning more about the benefits of in-home care, A Place for Mom can help. Our Senior Living Advisors can help your family explore home care options in your area that fit your budget — all at no cost to you. Please note that A Place for Mom cannot refer to Medicaid-only facilities or home care agencies.
The duration Medicaid will cover home health care differs per state. For example, New York provides coverage for part-time, intermittent care. To review your state, use the Medicaid state profile page.
The actual amount Medicaid will pay for home health care varies by state but it does cover services such as IV therapy, wound care, and skilled nursing, according to the Congressional Research Office.
Yes, Medicaid will pay for home health care for individuals with dementia who are eligible and require nursing home level of care, according to the Centers for Medicare and Medicaid Services.
To use Medicaid to pay for home health care, services must be prescribed by a doctor and provided by a Medicaid certified home care agency, according to the Centers for Medicare and Medicaid Services.
Yes, many state Medicaid plans will pay for home health care aides to provide nonmedical supports outlined in an eligible senior care plan as long as the senior is also receiving medical services.
Yes, in many states, Medicaid plans will cover short-term home health care services to help an eligible senior recover from a surgery at home.
Congressional Research Office. (2022, September 15). Medicaid coverage of long-term services and supports.
Social Security Administration. (2024). Who can get SSI?
Centers for Medicare and Medicaid Services. (2022, September 6). Home health providers. CMS.gov.
Centers for Medicare & Medicaid Services. Self-directed services. Medicaid.gov.
Centers for Medicare & Medicaid Services. Home & community based services. Medicaid.gov.
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