Does Medicare Cover Home Health Care for ALS Patients?

Yes, Medicare covers home health care for ALS patients who meet eligibility criteria. The national insurance program funds ongoing intermittent medical, therapeutic and personal care assistance for those with long-term conditions, such as ALS. Care hour caps apply; those needing more intensive support should consider alternative care types.

People must satisfy general Medicare requirements plus additional measures to qualify for home health coverage. Individuals with ALS don’t need to meet minimum Medicare age criteria; rather, they automatically qualify for Part A and Part B the first month after claiming Social Security Disability Insurance (SSDI). Unlike many conditions, ALS has no waiting period to claim SSDI — individuals with an eligible tax history qualify immediately after providing proof of diagnosis.

To qualify for Medicare home health coverage, individuals must be homebound. It doesn’t mean they can never leave their home. However, leaving the house must be difficult because of their condition, go against medical advice or require great effort. Coverage also depends on medical necessity. A physician must state that care is essential for an individual’s condition and prescribe services. Medicare-certified agencies then create tailored care plans with input from medical professionals, social workers and families.  

Most people with ALS stay at home with family support. Home health care has many benefits for those impacted by ALS. As conditions progress, individuals require clinical and therapeutic care beyond the practical assistance relatives provide. Home health care teams visit people in their private residences to provide intermittent skilled nursing and therapies. Common home health care services for those with ALS include:

 

• Management of feeding tubes and ventilators
• Continence care
• Medication administration
• Wound care
• Family caregiver education
• Training to use assistive devices
• Occupational therapy to maximize skills and promote independence
• Physical therapy to improve function and manage pain
• Speech therapy to manage disordered swallowing and enhance communication
• Medical social services to identify community support initiatives
• Personal care to assist with toileting, maintaining hygiene and dressing

Medicare only covers aide assistance, such as help with bathing and grooming, for those who also receive skilled services.

Public insurance only covers up to 35 hours of weekly care, and Medicare-certified agencies must deliver services. If desired, people use other resources to pay for additional care hours. However, in certain situations, Medicaid and VA benefits cover up to 24/7 care at home for eligible individuals. Alternatively, nursing homes provide around-the-clock clinical assistance and supervision.

With the exception of limited personal care, Medicare doesn’t cover nonmedical in-home support, such as housekeeping. Individuals who need greater assistance with everyday tasks or lack adequate family assistance may consider home care support alongside home health services. Those in the latter stages of disease progression may switch to hospice care in their homes, stand-alone hospice facilities or nursing homes.