Make the best senior care decision
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.
Although they may seem similar, home care and home health care provide distinctly different services to seniors.
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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. 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.
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. 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.
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. 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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Some state Medicaid programs cover 24-hour home health care, usually for skilled nursing services from licensed professionals such as registered nurses. 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.
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. They could be a publicly operated agency, a nonprofit organization, or a private company. Medicaid pays those providers directly.
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.
Centers for Medicare & Medicaid Services. Home & community based services. Medicaid.gov.
Centers for Medicare & Medicaid Services. Home & community based services authorities. Medicaid.gov.
Centers for Medicare & Medicaid Services. Self-directed services. Medicaid.gov.
Congressional Research Office. (2022, September 15). Medicaid coverage of long-term services and supports.
Centers for Medicare & Medicaid Services. (2022, September 6). Home health providers. CMS.gov.
The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.