Menu
We want the best for our family, but figuring out the financial side of things can be a major headache. Luckily, Medicaid home care might be an option. It gives financial assistance to those who need help with care, whether at home or in a facility.
Many people are unaware of their eligibility, what benefits they qualify for, or how the application process works. This article will explain Medicaid home care and answer some frequently asked questions about it.
Medicaid home care provides financial help for long-term care services. This is for eligible individuals who wish to receive care in their homes rather than in nursing facilities. The program is jointly funded by the federal government and state governments.
This is why eligibility and benefits differ by state. However, all states must offer some level of home health coverage for individuals who need a nursing facility level of care, based on this Congressional Research Office report.
While Medicaid home care services vary by state, here are some common services:
Financial Criteria
This means both income and assets. These factors are evaluated to see if the person applying falls within the established limits. Limits vary based on the applicant’s state. In 2024, some common guidelines for monthly income and assets include:
| Program Type | Income Limit | Asset Limit |
|---|---|---|
|
Regular/State Plan Medicaid |
$943/month (SSI limit) or $1,255/month (Federal Poverty Level) |
$2,000 |
|
HCBS Waivers/Institutional Medicaid |
$2,829/month (300% of SSI) |
$2,000 |
Keep in mind that these are general guidelines. States have individual rules on which income and assets are included. Certain assets, like a primary home, car, or personal belongings may be exempt.
Functional Need
To qualify, a person has to demonstrate a level of need for help with daily living activities (ADLs). This assessment determines if the person genuinely needs in-home support. You can’t just apply and automatically be approved.
An assessment will likely be conducted to see if there’s a genuine need for help. They may look at things like difficulties with mobility, transferring between a bed and chair, eating, or toileting.
If you need more comprehensive in-home care than traditional Medicaid covers, Home and Community Based Services (HCBS) waivers are worth exploring. These federal programs are designed for individuals who would typically need to be in a nursing facility but wish to remain in their home. HCBS waivers offer many services, though availability varies greatly by state.
Here are a few ways that HCBS waivers may be used to provide a greater range of supports:
Want to apply? Here are a few key steps:
By gathering the required documents and then starting the process early, you’ll be prepared to get financial help when the time comes.
Many people are curious if they can pay family members for caregiving. In some states, Medicaid allows this through “Consumer-Directed Care” programs. Consumer direction means the recipient chooses their own caregiver. Medicaid generally requires agencies to employ caregivers, and sometimes, family members will work through these agencies to get paid.
It’s critical to reach out to your state’s Medicaid agency to verify the guidelines in your location.
Here’s how it generally works:
The short answer? Yes. For many families caring for someone with dementia at home can feel like a rollercoaster. Medicaid might be able to ease some of the burdens that come with it. Learn more about benefits for people with dementia from the Centers for Medicare and Medicaid Services.
Medicaid offers services designed specifically for people who are dealing with Alzheimer’s disease and dementia. To qualify for Medicaid home care support with dementia, individuals usually need a diagnosis showing they require a nursing home level of care. They must also meet financial requirements. This might mean assistance with personal care like dressing and bathing, meal preparation, medication reminders, or even specialized therapies like memory care.
In these circumstances, home health services from registered nurses, therapists, or home health aides may also be included in the program benefits. The Centers for Medicare and Medicaid Services explains this in more detail.
If all this info seems overwhelming, you’re not alone. Here’s another great resource: the Area Agency on Aging, a national network that provides guidance on all types of services for seniors. They’ll answer questions about eligibility, different care options, legal and financial considerations, and more.
Don’t hesitate to reach out for advice or assistance in understanding these different aspects of senior care programs in your area.
In most cases, Medicaid does not pay a spouse to provide caregiving under its long-term care homecare programs. However, some states offer exceptions under certain waiver programs or consumer-directed care models where participants can hire family members as caregivers, though restrictions may apply to spousal compensation. It’s important to check state-specific rules regarding spousal pay for caregiving.
Medicaid long-term care homecare programs generally cover a range of services, including assistance with activities of daily living (ADLs), personal care, homemaker services, medical equipment, nursing care, and in some cases, respite care for primary caregivers. The exact services covered depend on the state and the specific Medicaid program.
Yes, owning a home does not automatically disqualify you from Medicaid homecare services. However, the value of your home may be considered in asset eligibility calculations, with limits varying by state. In most cases, Medicaid allows the primary residence to be exempt as long as the equity is below a certain threshold, and the applicant or spouse continues to live in the home.
Some states have waiting lists for Medicaid homecare services, especially for waiver programs that offer home and community-based services (HCBS). This is due to limited funding and the high demand for in-home care. The length of the waitlist can vary significantly by state and program.
If your income exceeds Medicaid’s eligibility limits, some states offer Medicaid spend-down programs or Qualified Income Trusts (QITs), which allow individuals to “spend down” their excess income on medical expenses or put it in a QIT. Each state has different rules, so consulting with a Medicaid planner is advised.
Medicaid typically does not cover 24-hour homecare unless medically necessary. While it may provide services for several hours a day or week depending on the needs assessment, around-the-clock care is generally not covered under standard Medicaid homecare programs. Alternative programs or private pay options may be needed for more extensive care.
If your care needs increase while receiving Medicaid homecare services, you can request a reassessment. Medicaid may adjust the number of hours or types of services provided based on the new level of need. However, the availability of additional services may depend on the state’s Medicaid program and funding.
Some Medicaid programs, such as consumer-directed care models, allow participants to choose their own caregiver, including family members (though often excluding spouses in most states). This provides greater flexibility in who provides care, but it requires following the program’s guidelines, such as caregiver training and documentation of services.
Medicaid may seek to recover costs through estate recovery after a recipient’s death, particularly for long-term care services provided under Medicaid. However, the primary home is typically protected while the recipient or their spouse is alive, and there may be other exemptions or strategies to protect the home from recovery, depending on state-specific rules.
Yes, New York’s Medicaid program offers multiple ways to get financial help with home care services. They’ve got the Consumer Directed Personal Assistance Program (CDPAP), which lets you hire even some family members, and the Home Health Care program, which delivers medical care in your home.
The best place to learn about the available programs and how to apply is to reach out to your local Department of Social Services. They will also let you know if you qualify. You can use this helpful List of local CECs or call 1-800-300-1506.
Virginia’s Medicaid program, known as Medallion, can pay for home care, including in-home caregivers, through several options. One common one is Elderly or Disabled with Consumer Direction waivers. However, keep in mind that Virginia’s program generally requires agencies to be involved, even for Consumer-Directed care. Virginia is one of the 23 states that currently does not permit Medicaid payments directly to spouses. Check Virginia’s Department of Medical Assistance Services (DMAS) website or call them for the most up-to-date info.
Florida’s Medicaid program can cover some costs for home care but doesn’t typically pay for 24-hour home care unless there’s a demonstrated medical need for round-the-clock skilled nursing. In such cases, services such as IV medications or a feeding tube might necessitate 24-hour care.
To be sure, it’s best to contact Florida’s Agency for Health Care Administration (AHCA) to determine your eligibility and care needs.
Similar to other states, New Jersey’s Medicaid program can pay for home care, including home health and personal care. 24-hour care, while sometimes an option, doesn’t typically pay for 24-hour home care. New Jersey’s program also features a robust Self-Directed Home Care (SDHC) Program, giving control over care.
Choosing care for a loved one is tough. Knowing whether Medicaid home care will foot the bill can feel like navigating a maze. By getting educated and exploring available programs, you’ll gain control and maybe find financial peace of mind. Medicaid home care could offer help that’s a good fit. But, each state has their own ways of running the program, so connecting with your state’s agency will help. If figuring things out gets too much, just remember this: help is out there, and there’s no shame in using it.