Medicaid has several programs to help eligible seniors pay for home health care and in-home care services. Medicaid covers health care and long-term care services for low-income seniors and people with disabilities.
Finding the right home care options for a loved one and determining how to pay for care can be complicated. Read on to learn more about the different Medicaid programs that can help eligible seniors receive the care they need while remaining in their own homes.
What types of home care does Medicaid cover?
Each state offers different Medicaid programs that provide seniors with financial assistance to pay for the following distinct types of home care services.
Home health care provides medical services like physical therapy, wound care, and medication administration in a senior’s home. These services are prescribed by a doctor and provided by a health care professional such as a licensed nurse or occupational therapist.
In-home care provides nonmedical services that include assistance with activities of daily living, companionship, and light housekeeping.
Read: Home Care vs. Home Health Care: What’s the Difference?
What Medicaid programs cover long-term care at home?
Navigating Medicaid can be complicated as each state is free to create its own programs and set eligibility requirements within federal guidelines. These are the basic types of Medicaid programs that cover long-term care at home:
- State Medicaid — Each state’s regular Medicaid plan includes two federally mandated long-term services and supports benefits: nursing home care and home health care. The state plan also includes any additional benefits a state has chosen to provide. These might include Home and Community-Based Services (HCBS) options such as the Community First Choice (CFC) option and the section 1915(i) HCBS state plan option. These HCBS benefits provide long-term services and supports to individuals living in their own homes and communities who would otherwise require care in an institution.
A state’s regular Medicaid plan is an entitlement program, which means that all individuals who meet the eligibility requirements are guaranteed enrollment and benefits.
- HCBS Medicaid Waivers — Waivers allow states to expand Medicaid benefits to certain groups of people. Since they aren’t part of a state’s regular Medicaid plan, waivers aren’t considered entitlement programs. Enrollment is usually capped and may be limited to certain service areas. Even if a senior meets the eligibility requirements for an HCBS waiver, there may be a long waiting list to receive benefits.
- Program of All-Inclusive Care for the Elderly (PACE) — For seniors who have Medicare, Medicaid, or both, PACE provides a comprehensive package of services that can help them continue living in their own homes.
Specific rules and features vary by state, but these Medicaid programs typically deliver benefits in two different ways: managed care or consumer-directed care. With managed care, a beneficiary must receive services through a Medicaid managed care organization and approved providers. Consumer-directed care allows Medicaid beneficiaries to choose who delivers their care and where it’s received. (This could include paying a family member to provide care in a senior’s home.) Some Medicaid programs may deliver a combination of managed and consumer-directed care.
Does Medicaid cover home health care?
Yes, Medicaid covers home health care for seniors who meet their state’s unique financial and functional eligibility criteria.
Types of home health care services covered may include the following:
- Wound care
- Administering medication
- General health monitoring
- Adult day health care
- Occupational, physical, and speech therapy services
States may cover additional services, so it’s important to check with the local Medicaid office to learn more about home health care eligibility requirements and benefits.
Does Medicaid cover in-home care?
Yes, Medicaid programs in many states cover some personal care services and other nonmedical care such as companion care and homemaking services. Specific services vary from state to state and may be available through a state’s regular Medicaid program, through Medicaid waivers, or both.
For example, the Community First Choice program in Texas is a state Medicaid plan option that provides long-term supports and services like assistance with bathing, dressing, and grooming to eligible seniors in their homes.
California’s Multipurpose Senior Services Program is an example of a Medicaid HCBS waiver that provides seniors several nonmedical in-home care options. Through this Medi-Cal in-home care program, seniors can receive assistance with tasks like personal care, meal preparation, and laundry.
For more information about a state’s specific Medicaid programs that cover home care, contact the state's Medicaid agency.
Will Medicaid pay for 24-hour home health care?
Most Medicaid programs don’t typically cover 24-hour care in a senior’s home. Such a high level of care is usually only available to beneficiaries who need intensive skilled nursing services. Some states provide this through an optional private duty nursing program.
For example, Colorado residents who qualify for the state’s regular Medicaid plan, Health First Colorado, may be able to receive up to 23 hours of care per day through the Private Duty Nurse program. To qualify, the care needs to be considered medically necessary. A senior’s care plan must be ordered by a doctor and developed by a home health agency.
Generally, Medicaid’s mandatory home health care benefit only provides part-time or intermittent services. However, each state can determine the specific amount, duration, and scope of these services. Some are more generous than others.
For example, Medicaid-covered home health care for eligible seniors in Ohio is limited to "intermittent services." The state defines this as no more than eight hours of service per day and no more than 14 hours of service per week.
How to qualify for home health care or home care covered by Medicaid
Whether a senior qualifies for Medicaid home health care or home care will depend on the following factors:
- Their age and/or disability status
- Where they live
- Medicaid programs and eligibility criteria in their state
- Their countable income, assets, and possibly medical expenses
- Their functional and cognitive abilities
- Their medical needs
Financial, medical, and functional eligibility criteria for Medicaid vary widely from state to state and program to program. Understanding in-home care requirements and how to apply for Medicaid can be complicated. The best way to get started is by contacting your loved one’s local Area Agency on Aging or a trusted elder law attorney who’s knowledgeable about Medicaid in their state. These resources can help you and your loved one explore available care options and methods of payment.
Reviewed by Certified Elder Law Attorney Letha McDowell.
Sources:
Policy Basics: Introduction to Medicaid (https://www.cbpp.org/research/health/introduction-to-medicaid)
Home and Community Based Services (https://www.medicaid.gov/medicaid/home-community-based-services/index.html)
Medicaid Coverage of Long-Term Services and Supports (https://crsreports.congress.gov/product/pdf/R/R43328)
Community First Choice (CFC) 1915 (k) (https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/community-first-choice-cfc-1915-k/index.html)
Self-Directed Services (https://www.medicaid.gov/medicaid/long-term-services-supports/self-directed-services/index.html)
Program of All-Inclusive Care for the Elderly (https://www.medicaid.gov/medicaid/long-term-services-supports/program-all-inclusive-care-elderly/index.html)
Institutional Long-Term Care (https://www.medicaid.gov/medicaid/long-term-services-supports/institutional-long-term-care/index.html)
State-Directed Care vs. Self -Directed Care (https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/infograph-Medicaid-State-Directed-vs-Self-Directed-%5BOctober-2015%5D.pdf)
Medicaid and Home Health Care & Non-Medical, In-Home Care (https://www.medicaidplanningassistance.org/in-home-care/)
Home Health Services (https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/home-health-services/home-health-services)
Medicaid Eligibility (https://www.medicaid.gov/medicaid/eligibility/index.html)