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7 Things to Know About Medicaid-Sponsored Home Care

Written by Chacour Koop
5 minute readLast updated November 29, 2022
Reviewed by Letha Sgritta McDowellLetha Sgritta McDowell is an attorney practicing in both Virginia and North Carolina. She is a fellow of the American College of Trusts and Estates Council, a certified elder law attorney, and a past president of the National Academy of Elder Law Attorneys.

For many aging seniors, continuing to live independently in their home becomes challenging as they need more help with everyday activities. Others may even require medical care but prefer not to enter a nursing home. Medicaid can provide assistance with home care and home health care, making these services more affordable. Even though Medicaid is a program that’s subject to federal standards, each state administers its own Medicaid program. As a result, Medicaid coverage and eligibility requirements for in-home care and home health care are different in every state.

Key Takeaways

  1. Home care and home health care are different. Generally, home care is help with everyday tasks, while home health care is provided by medical professionals.
  2. Medicaid can help seniors pay for both types of care. Though eligibility requirements and services vary, each state provides assistance with home care and home health care.
  3. The services are often provided through home and community based Medicaid waivers. Waivers are a way states provide services not normally covered by Medicaid.
  4. Medicaid may pay family members to provide home care. However, each state has different rules, and some don’t offer this benefit.

What’s the difference between home care and home health care?

Although they may seem similar, home care and home health care provide distinctly different services to seniors.

  • Home care offers nonclinical care and assistance with everyday tasks like cooking, cleaning, and grocery shopping.
  • Home health care offers medical care from licensed health care professionals at a patient’s residence. This can include services like medication management, IV therapy, wound dressing, and other services typically available in a hospital setting.

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What are home and community based services?

Home and community based services (HCBS) are designed to help Medicaid recipients continue to live in their own homes or community instead of an institutional setting like a nursing home.[01] Generally, these services are intended for 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. Nearly every state offers an HCBS waiver, and several include these types of services in their Medicaid state plans.

Because each state provides HCBS in a different way, the requirements to qualify for these programs vary. However, an important component is typically whether the recipient requires a nursing facility level of care, which is usually determined through an assessment.

Does Medicaid cover in-home care?

A graphic list of in-home care services whose costs may be covered by Medicaid, including meals, housekeeping, and nursing

Yes. Included services, coverage amounts, and eligibility requirements vary state to state, but Medicaid can cover the costs of assistance services delivered by home care agencies. Typically, when Medicaid provides assistance for in-home care, it does so through a home care agency and pays them directly for all services necessary to keep the recipient living in their own home. This might include help with meals, housekeeping, and activities of daily living.

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.[03] In some states, Medicaid allows family members to get paid for the home care services they provide. For a family member, getting paid to provide home care services can make the duty of caregiving more feasible.

Does Medicaid cover home health costs?

Medicaid can cover the costs for home health services for recipients that need them. To qualify for Medicaid home health care, the services must be medically necessary.[04] At a minimum, home health care must include nursing services, home health aide services, and medical supplies.

The payment amounts, additional covered services, and other eligibility requirements vary from state to state. In a number of states, Medicaid only covers part-time home health care with a limited number of service hours per day.

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Will Medicaid pay for 24-hour home health care?

Some state Medicaid programs cover 24-hour home health care, usually for skilled nursing services from licensed professionals such as registered nurses.[04] Eligibility varies by state, but a common requirement is a need for round-the-clock skilled nursing services.

A senior requiring 24-hour home health care might rely on technology and more advanced medical services. As an example, this could include the use of a feeding tube, IV medications, or mechanical ventilation.

Will Medicaid pay for home health care by a family member?

A home health provider must meet a number of requirements to be covered by Medicaid, so unlicensed family caregivers won’t be paid for home health services. Medicaid 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.[05] They could be a publicly operated agency, a nonprofit organization, or a private company. Medicaid pays those providers directly.

How do you find home care?

If you’re looking for home care or home health care for an elderly loved one, you can find important information on Medicaid’s list of state links, or you can contact your local Area Agency on Aging. Each state’s Medicaid office can provide resources about eligibility and applying for coverage. A local Area Agency on Aging can help coordinate and offer services to help seniors remain in their homes.

SHARE THE ARTICLE

  1. Centers for Medicare & Medicaid Services. Home & community based services. Medicaid.gov.

  2. Centers for Medicare & Medicaid Services. Home & community based services authorities. Medicaid.gov.

  3. Centers for Medicare & Medicaid Services. Self-directed services. Medicaid.gov.

  4. Congressional Research Office. (2022, September 15). Medicaid coverage of long-term services and supports.

  5. Centers for Medicare & Medicaid Services. (2022, September 6). Home health providers. CMS.gov.

Meet the Author
Chacour Koop

Chacour Koop is a copywriter at A Place for Mom. He researches and writes articles about senior living and healthy aging, with a focus on memory care. Before writing about senior living, he was a reporter with bylines appearing in The Associated Press, Miami Herald, and Sacramento Bee, along with dozens of other publications. He earned a degree in journalism from Eastern Illinois University and a master’s degree in public affairs reporting from the University of Illinois Springfield.

Edited by

Danny Szlauderbach

Reviewed by

Letha Sgritta McDowell

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