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Does Home Care Accept Medicaid or Medicare?

Does Home Care Accept Medicaid

Key Summary

Whether Medicaid and Medicare can pay for Home Care or Home Health Care is a question we are often asked, and the answer varies by state. Government programs do not usually cover general support services in full, but can be used for certain aspects of care.

Home Care can bring comfort to older adults who are not ready to move to a senior living community; it gives them a little extra help without having to leave the place they know as home. We all recognize that over time we become creatures of habit and the suggestion to leave a long-term lifestyle behind is often met with upset and confusion. Adding to these concerns is the question of why Home Care is called for in the first place, and how it will be paid for.  

We’re often asked whether Medicaid and Medicare can be used to pay for Home Care or Home Health Care services. In general, these government programs do not cover general support services in full, but can be used for certain aspects of care. We’ll take a deeper look into all of these questions below. 

Does Medicaid Cover Home Care/Home Health Care?  

The federal government and individual state governments are both responsible for Medicaid funding to some degree; while the ground rules are defined federally, there is room for flexibility state by state. This means the answer varies by location too. We highly encourage seniors to consult with their home state’s programs. With that said, there are some generalities that are broad enough to assist seniors and families seeking guidance.  

Here are some basics:  

  • Medicaid State Plans will cover Home Care in two forms in the majority of locations: As Personal Care or Personal Attendant Services. This is the type of Medicaid most people are more familiar with. 
  • Medicaid Waivers do cover Home Care. The goal of the Medicaid Waiver is to enable older adults to stay at home instead of moving to a nursing home. 
  • Institutional Medicaid does not pay for Home Care; it is for use in long-term care facilities including nursing homes. 

Typically, but not in all instances, the following are covered by state Medicaid programs:  

  • Home Health Care, which is administered by trained, licensed medical professionals such as physicians or nurses.  
  • Home Care/Personal Care, which is non-medical assistance with tasks like bathing, dressing, and other daily activities. 
  • Home modifications to increase accessibility including ramps. 
  • Medical equipment for use at home. 
  • Personal Emergency Response Systems (PERS) which are electronic devices that enable beneficiaries to reach out to EMS if required. 

Does Medicaid Pay for Home Health Care?  

When it comes to Home Health Care, this is the type of care that is most likely to be covered by Medicaid. This includes specialized care provisions where a doctor has certified that services like IV therapy, medication management, and wound dressing should be provided by a licensed care professional. Depending on the state, many Home Health services may be covered.  

Even though Referah isn’t in the Home Care or Home Health Care counseling space, we certainly don’t mind providing you with some guidance. Our goal is to help you find the right care for you, irrespective of where you are in this journey. You can learn more in our article “Who are the best Home Care providers?” 

Will Medicaid Pay for 24-Hour Home Care? 

Utilizing Home Care offers seniors the ability to live as independently as possible, at least for the short-term, until a move to an Assisted Living or Memory Care Community becomes necessary. Home Care helps seniors with many day-to-day tasks including bathing, dressing and preparing meals. This type of support even includes light housekeeping, and making sure that prescribed medications are being taken as directed. 

Whenever Home Care is indicated, the question that arises quickly is: Who pays for it? Is it something that is covered by Medicaid, especially if 24-hour care is needed? This again depends on the state requirements, and is broken down by Home Care and Home Health Care designations, with the latter most likely to be covered. However, Home Health Care is normally only covered for a certain number of hours per day, whereas some Skilled Nursing services could be covered for up to 24 hours.  

Will Medicaid Pay for Home Health Care by Family Members? 

Who administers care is a key determining factor for Medicaid coverage. Home Health Care services must be provided by licensed professionals who administer care according to direction and planning from a coordinating doctor. Therefore, family members who are unlicensed to provide care cannot be covered under Medicaid. Certain states do, however, allow for a family member to receive some coverage for providing Home Care services. 

Does Medicare Cover Stay at Home Care?  

Generally, Medicare does not pay for things like around-the-clock care, home meal preparation or delivery from an outside source, light housekeeping (including laundry and shopping), or personal care such as help with bathing, dressing and going to the bathroom. Normally, Medicare Part B could cover some of the items mentioned, but the senior would have to be under the care of a physician who maintains an ongoing review of how well the services are working to the benefit of the patient. Additionally, the physician would have to certify to Medicare that the senior is, indeed, homebound or has extreme difficulty exiting the home environment. 

Is Home Health Care Covered Under Medicare Part A or B? 

If a senior checked the boxes discussed above, then Medicare Part A and B would pay, and even include some part-time Skilled Nursing care (for vital signs, IV maintenance, etc.), occupational therapy, physical therapy, medical social services, and speech/language pathology. Part B would also pay for some medical equipment that’s located in the home. According to Medicare.gov, Medicare does pay for “part-time or intermittent home health aide services.” This is understandably confusing. It means that a Home Health Care worker may provide personal care services that a home health aide provides. The difference is that, for reimbursement, you must be getting Skilled Nursing services as well. 

Talk with a Senior Living Expert 

When you look at the basics of what’s provided for by both Medicare and Medicaid, the initial response would be to opt for Medicaid, but remember that there are some pretty severe entrance requirements for Medicaid eligibility—and many of them are dependent on an almost-total forfeiture of personal assets. Again, local and state rules apply for Medicaid, so visiting state websites is essential to making your decision.  

Everyone is all-too-familiar with the complexities of government funding, especially when guidelines vary from state to state. The good news is that Referah counselors can provide more specific guidance to help you row your way through these murky waters. We can also help if you decide it’s better to consider a long-term solution in a community-based setting. Contact us today to receive a consultation and discuss the best option for you or your loved one.  

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