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Will Medicaid Pay for 24-Hour Home Care?

Will Medicaid Pay for 24-Hour Home Care?

Will Medicaid pay for 24-hour home care? It’s an important question that many caregivers are asking. After all, there are several reasons your loved one may need 24-hour home care. Could be that they’re recovering from a major operation, or they’re critically ill, or prone to falling. Or perhaps, they prefer the comfort of their home to a nursing home.

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Unfortunately, hiring home care assistance can be expensive. Given that many senior citizens qualify for Medicaid, it’s no surprise that you’re wondering if the service covers 24-hour home care.

Key Takeaways

  • Home care and home health care are different. Home care provides non-medical personal assistance like cooking, transportation, and light housekeeping while home health care offers home medical care like skilled nursing, injury treatment, and rehabilitative therapy.
  • Medicaid does not usually pay for 24-hour home care. However, it will pay for 24-hour home health care if the person’s medical condition requires continuous care.
  • Medicaid allows beneficiaries to choose who delivers their care services. As a result, they can choose to be taken care of by a family member.

Will Medicaid Pay for 24-Hour Home Care?

Medicaid is a federal and state initiative. The extent of coverage varies across different states. Under Medicaid coverage, eligible individuals may have access to some in-home care services, however, the time duration is limited and Medicaid will not usually pay for 24-hour home care. 

Home Care vs. Home Health Care

It is easy to confuse “home care” with “home health care.” And while they may be similar in some aspects, their differences are very distinct.  Home health care differs from home care in that it usually involves a more skilled medical practitioner. 

Home care covers non-medical services such as cooking, light housekeeping, grocery shopping, transportation, and other personal care tasks. 

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Home health care covers medical personal assistance and is usually handled by licensed medical practitioners.  Examples of home healthcare services include IV therapy, pain management, skilled nursing, and injury treatment. 

When Will Medicaid Cover Home Health Care?

Some states pay for 24-hour home health care when the beneficiary is in critical condition or needs a skilled nurse’s attention around the clock. Examples of such individuals are seniors who require advanced medical services like breath support, IV medications, and the use of a feeding tube.  

Medicaid generally has a list of approved service providers who in addition to Medicaid managed care organizations deliver home assistance services. However, beneficiaries are usually allowed to choose who they want to provide their home care. This allows them to choose qualified family members as their homecare providers.

What Medicaid Programs Offer Home Care?

Different states run several Medicaid-funded programs. However, not all programs provide home health care coverage.  Medicaid programs that offer home care coverage include regular state Medicaid, and Home and Community Based Services (HCBS) Medicaid Waiver.

Regular State Medicaid

Under the regular state Medicare, the federal government mandates beneficiaries to be entitled to nursing home care and home health care. This means that persons who are eligible for Medicaid have the right to home health care benefits should the need arise. 

Non-medical home care eligibility on the other hand differs slightly across states. The federal government doesn’t make it mandatory, still, most states offer assistance with non-medical tasks like eating, dressing, and bathing.

Home and Community Based Services (HCBS) Waiver

Home and Community Based Services option allows seniors and beneficiaries who would otherwise be admitted to nursing homes the option of staying in their homes and receiving assistance. For example, the HCBS allows qualified persons to receive in-home care like adult daycare services, home modification, and skilled nursing services. 

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Please note that Medicaid Waivers are not part of the state’s normal Medicaid plan. Rather, they’re an opportunity for individuals who would not normally qualify for Medicaid to access its benefits. As a result, Medicaid Waivers are not a right, and oftentimes, there is a long waitlist to receive these benefits. 

HCBS waivers generally offer more benefits than regular Medicaid. Some of these extended services include:

  • Companionship care
  • Adult Day Care
  • Personal emergency response
  • Daily living activities  and instrumental daily living activities assistance
  • Home medical equipment

Enrollment for HCBS waivers is usually restricted to a certain number and typically applies to selected regions. 

Community First Choice (CFC) Options

The Community First Choice (CFC) option also covers in-home assistance. It’s usually available to people who should be institutionalized but have chosen to stay at home instead.

Such people have access to qualified personnel to help with activities like meal preparation, mobility,  bathing and toiletry, and housekeeping. 

Who is Eligible for Home Care Under Medicaid Coverage?

Individuals who qualify for Medicaid automatically qualify for a certain level of home health care if they need it. However, Medicaid is a state-regulated program meaning the eligibility requirements and the extent of home care coverage vary depending on the state. 

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Still, there are some common denominators that all states factor in. They are:

  • State of residence
  • Age
  • Disability status
  • Medical needs
  • Financial status
  • The eligibility requirements and Medicaid programs available in that state 
  • Functional and cognitive abilities

As stated earlier, each state has its unique guidelines and eligibility requirements. The eligibility requirements for financial status, functionality, and medical status vary widely. 

For more detailed information, you should visit your loved ones’ state Medicaid agency, contact their local Area Agency on Aging, or speak to an elder law attorney. You can find your state’s contact information on Medicaid’s Beneficiary Resources page

How To Apply for Medicare Home Care Coverage

The details of applying for Medicaid homecare coverage differ per state. However, here is a general guideline you can expect to follow:

  • Gather Your Loved One’s Documents: The first step in applying for Medicare home care coverage is ensuring you have all the necessary documents ready. This usually includes identification, declaration/proof of assets, proof of income, and medical documentation to prove your loved one’s need for home care.
  • Fill Out The Application: Once you’ve successfully gathered the necessary documents, you can proceed to fill out the application form. This process may vary slightly depending on the state your loved one resides in. Ensure you provide the correct information in the form.
  • Submit the Form Alongside the Required Documents: Before submitting the form and documents, crosscheck again to ensure that the information on the form is correct and the requested documents are complete.
  • Prepare for an Interview and Assessment: Sometimes, Medicaid will send a representative to interview and assess your loved one to ascertain their eligibility further and gather more information about their needs. 
  • Expect Feedback: Once the Medicaid office has reviewed the application, it will inform your loved one if their application has been approved or denied.

Relief Recap

So, will Medicaid pay for 24-hour home care? It’s a complicated question. Many guardians and seniors alike find the process confusing. For more state-specific information, you should contact your state Medicaid office, speak to a trusted elder attorney, or reach out to your local Area Agency on Aging