Even though Medicaid is a federal program, each state administers its own Medicaid program within the federal government’s guidelines, so Medicaid coverage for in-home care is different for every state. To learn about Medicaid in your state, look throughMedicaid’s list of state links or contact your local Area Agency on Aging.
Before diving into the ins and outs of Medicaid-sponsored home care, it’s important to know the difference betweenhome care and home health:
Read on for answers to five common questions about Medicaid-sponsored home care and home health.
Home and Community Based Services (HCBS)allow Medicaid recipients to receive necessary services in their own homes or as part of their existing community. Eligibility for HCBS depends on the state you’re applying in, but it’s generally based on whether the recipient would otherwise need care in an institutional setting, like a nursing home.
Many seniors are reluctant to move into nursing homes, especially if they’re currently living in a senior community or if they expect their health problems to improve over time. For these individuals, in-home care — including necessary medical care and help with day-to-day tasks — is often preferable.
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 sponsors home care, it does so through a home care agency and pays them directly for all services necessary to keep the recipient thriving in their own home, including help with meals, housekeeping, and activities of daily living.
Again, Medicaid payment amounts, covered services, and eligibility requirements vary state to state, but Medicaid can cover the costs for home health services for recipients that need them. Recipients’ primary doctors often assess their need for these services. In a number of states, home health only covers part-time care with a limited number of service hours per day.
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Some state Medicaid programs cover 24-hour home care, usually forskilled nursing services from licensed professionals, such as registered nurses. Eligibility varies by state, but a common requirement is the need for around-the-clock skilled nursing services.
When Medicaid sponsors home health services, the participant’s doctor coordinates with plan-participating home health providers. These providers are licensed medical professionals who can meet your loved one’s medical needs, and Medicaid pays those providers directly. 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.
However, in some states, Medicaid allows relatives to get paid for home care services they provide. Medicaid payments to family home care providers vary by state, but some do have programs in place that cover these payments instead of paying a home care agency. For many seniors, aging in place is preferable since they can receive the help they need surrounded by the comforts of their own homes, and for a family member, getting paid to provide home care services can make the duty of caregiving more feasible.
Sources
Administration on Aging. Area agencies on aging. Eldercare Locator.
Centers for Medicare & Medicaid Services. Beneficiary resources. Medicaid.
Centers for Medicare & Medicaid Services. Home & community based services. Medicaid.
Centers for Medicare & Medicaid Services. (2022, January 19). Home health providers.
Mercer, M. (2021, October 25). Can you afford a home-care worker? AARP.
Ohio Department of Medicaid. Home health private duty nursing.
Ohio Department of Medicaid. Home health services.