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Medicaid home health care
Posted: August 16, 2023
Last updated date: August 17, 2023
Medicaid home health care services help elderly people stay living in their own homes. Typically, people who are able to live at home prefer that to being in a nursing home or care facility. But some people may need a little extra help to live safely at home. That’s where Medicaid in-home care comes in.
Does Medicaid cover home health care?
The federal government requires all 50 states to offer some kind of home health benefits through Medicaid. But Medicaid programs change from state to state. As a result, the amount of in-home care and what types of Medicaid home health care services are available depends on where you live.
Also, the term home care may apply to other places besides someone’s personal home. Medicaid in-home care can be provided at the home of a friend or relative, an adult foster care home or an assisted living facility.
The federal government requires all 50 states to offer some kind of home health benefits through Medicaid
What home health services are covered by Medicaid?
State Medicaid programs may cover a wide range of services. There are also different ways that states choose to cover Medicaid home health services. Even if certain in-home care services aren’t covered by a state’s regular Medicaid plan, they may still be offered through Home and Community Based Services (HCBS) programs.
The chart below shows the types of Medicaid home health services that are typically available in most states.
Medicare in-home care service
|Home health care
|Medical care delivered at home by doctors, nurses or other trained medical providers
|Home care/personal care
|Help with activities of daily living, such as bathing, grooming, dressing, eating and mobility
|Help with general household chores like housekeeping, laundry, grocery shopping and preparing meals
|Physical, speech and occupational therapy
|Adult day care/adult day health
|Although it’s delivered in a community-based setting rather than at home, adult day care can provide meals, personal care assistance and social activities to help seniors live more independently
|Wheelchair ramps, walk-in bathtubs, grab bars, stairlifts and other modifications to help improve accessibility and safety at home or for a vehicle
|Medical Equipment and Supplies
|Wheelchairs, walkers and other medically necessary equipment and supplies
|Meals delivered at home or served in a group setting, nutritional counseling and nutritional supplements
|Personal Emergency Response Services
|Electronic monitoring or call-and-respond services that allow people to spend time alone without direct supervision
|Rides or escorts to medical appointments, the pharmacy as well as non-medical needs
|For people who have a life expectancy of 6 months or less, Medicaid may pay for hospice at home
|Family and caregiver support
|Training, respite care (breaks from caregiving) and other support to help caregivers succeed in their role
Some in-home care services like skilled nursing care and occupational, physical or speech therapy are delivered by medical professionals. Other services, such as doing chores around the house and making meals, can be provided by family members, friends or paid caregivers.
How many hours of home health care does Medicaid cover?
As stated before, the rules for Medicaid depend on the state where you live. How much care you can get may also depend on the type of Medicaid program you’re enrolled in. The level of home health care Medicaid provides is typically based on the needs of individual. Some Medicaid programs may pay for a personal care assistant to come in for several hours a day on multiple days of the week. Other programs may only cover adult day care for a few days each week.
How to qualify for home health care Medicaid
There are 2 main requirements you’ll need to meet to qualify for Medicaid home health care services:
- Financial requirements — Each state has limits for how much you can earn or the value of what you own. But the limit to qualify for HCBS services may be higher than for regular Medicaid.
- Medical need — Most state Medicaid programs require recipients to show they need in-home medical care or help with bathing, dressing, eating and other activities of daily life. To qualify for HCBS programs, recipients typically need the same level of care as provided in a nursing home.
Dual Special Needs Plans also provide extra support
There are other ways to get extra help to make life easier. If you qualify for both Medicaid and Medicare, you could get a Dual Special Needs Plan (D-SNP). A D-SNP plan works together with your Medicaid health plan. You’ll keep all your Medicaid benefits. Plus, you’ll get many extra benefits that Original Medicare doesn’t cover.* Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy). See if you qualify for a Dual Special Needs Plan.
*Benefits and features vary by plan/area. Limitations and exclusions apply.
What type of plan am I eligible for?
Answer a few quick questions to see what type of plan may be a good fit for you.
Find Medicaid plans in your area
Medicaid or dual-eligible plan benefits can change depending on where you live. Search using your ZIP code to find the right plan to meet your health care needs.