Does Medicaid Cover Home Care?

In most states, Medicaid will pay for some forms of in-home care and hospice care. However, since Medicaid is a state program, each state has different rules for who can qualify for this service and how it is paid. Many states divide Medicaid coverage into different programs for the elderly, adults with disabilities, children with disabilities, and hospice care. It's important to talk to your caseworker or other advocate about the requirements for your particular state.

Medicaid is a state-based healthcare program for people with low income and limited assets. It will pay for basic health care and home care depending on your income and what other types of insurance you have available. If you receive Medicare and/or Supplemental Security Income (SSI) related to a disability, you should contact your caseworker to find out if you also qualify for Medicaid in your state.

Home care is a broad term that covers a variety of services. It can be short-term, as in the case of someone recovering from surgery, or long-term for people with chronic illnesses or disabilities. These programs allow people who are elderly or disabled to live in their own homes as an alternative to nursing facility care. Services might include nursing and medical care, help with self-care activities such as bathing and toileting, light housework and cooking, and help with shopping and errands. Determining which services are needed for an individual involves a case coordinator, nurse, and family members, and a doctor's order is usually required to receive services.

There are two broad categories of home care. The first is for individuals who are able to make their own healthcare decisions and do not have a guardian. This is generally referred to as consumer-directed services, and in most cases the individual requiring care will hire and train their own home healthcare providers.

The second type of services are for disabled children or disabled adults who have a guardian to make their healthcare decisions. The guardian is the primary coordinator of services, and many times these types of services are provided through a home care agency. Medicaid will generally pay for both types of care, but certain requirements must be met. Your Medicaid caseworker or agency coordinator will tell you what the requirements are for your state.

In some cases where a Medicaid recipient is on a Managed Care Program, a special waiver may be required to receive home care services. Special rules may also apply to disabled children receiving services. If Medicaid denies your request, you have a right to know the reason for the denial and a right to appeal the decision. Contact your case coordinator, Medicaid caseworker, healthcare advocate or ombudsman for more information about the procedures in your state.