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How Do You Qualify for Medicaid Coverage of Home Health Care?
Date Updated: December 16, 2024
Written by:
Ashlee Shefer is a freelance copywriter, content writer, and digital marketer who specializes in senior care, mental health, health care, and other wellness-related topics. She has one year of experience writing both short- and long-form content related to senior resources, assisted living, nursing homes, and home care, including blog posts, research-based articles, resource guides, product reviews, facility blurbs, finances, and care costs.
Reviewed by:
Gene Altaffer has a Masters in Gerontology from the University of Southern California and has worked in many avenues along the continuum of long-term care, assisting thousands of clients and their families since 1995. He also sold long-term care insurance from numerous carriers while also assisting families with retirement planning. Gene helps seniors navigate their Medicare plans, ensuring they understand their benefits and options.
You qualify for Medicaid coverage of home health care if you demonstrate a medical need for services as verified by a doctor to maintain quality of life. Medicaid coverage and eligibility requirements vary by state. However, most states offer a regular Medicaid plan and waivers that cover in-home support as an alternative to nursing home care.
What Home Health Care Services Does Medicaid Cover?
Medicaid covers a variety of home health care services to promote aging in place. Although exact coverage depends on the state and Medicaid plan, common services include:
- Skilled nursing care
- Assistance with daily living activities, including bathing and dressing
- Physical, speech and occupational therapy
- Durable medical equipment
Medicaid also covers additional at-home support services, including:
- Home modifications, such as wheelchair ramps and non slip flooring
- Transportation to medical appointments
- Medication administration
- Personal emergency response services, such as medical alerts
Eligibility Requirements for Medicaid Coverage of Home Health Care
Each state has its own eligibility requirements for home health care Medicaid coverage. However, these requirements typically include being a resident of the state in which you apply for aid and demonstrating a financial and functional need. To qualify for your state's regular Medicaid program, you must meet certain income and asset limits. Most states use federal poverty level income numbers issued by the Department of Health and Human Services to determine this limit.
Additionally, you must display a medical need for home health care to maintain safety and quality of life. States require you to submit a physician-administered assessment that documents your condition and recommended home health care services. State eligibility requirements for Medicaid waivers, such as the Home and Community-Based Services waiver, may differ.
How Do You Qualify for Medicaid Waivers for Home Health Care?
Many states offer Medicaid waivers alongside their regular state plan for further coverage. HCBS waivers commonly cover home health care services for individuals requiring a level of care similar to what's provided in nursing homes. You must submit physician verification documenting your need for care.
HCBS waivers differ from regular Medicaid because they often target a specific population within a community, such as by age or diagnosis. States also choose the maximum number of people they allow to receive aid under the waiver program.