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How Many Hours of Home Health Care Does Medicaid Cover?
Date Updated: January 10, 2025
Written by:
Lauren is an experienced copywriter with a passion for crafting impactful narratives in the senior care industry. Her work covers essential topics such as assisted living and dementia care, providing valuable insights to readers. Collaborating with leading senior care provider websites such as Caring.com, PayingforSeniorCare.com, and AssistedLiving.org has deepened her appreciation for senior living and elder healthcare. Lauren’s goal is to empower seniors and their families with the knowledge needed for informed long-term care decisions.
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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.
The number of hours of home health care that Medicaid covers varies based on an individual's medical and personal care needs. A comprehensive assessment conducted by a health care professional determines the extent of support required and amount of hours covered. This ranges from part-time assistance to 24-hour oversight.
Understanding Medicaid's Coverage for Home Health Care
Medicaid's home health care benefits offer financial assistance to cover care costs for those who require medical care and support services at home. Home health care enables individuals to live independently while receiving assistance in a comfortable and familiar environment. Coverage specifics can vary by state, as each state administers its own Medicaid program within federal guidelines. Consult your state's Medicaid program website, or contact a Medicaid planner to understand which benefits are available in your location.
Medicaid home health care coverage typically includes services such as:
- Skilled nursing care
- Assistance with activities of daily living
- Medical supplies and equipment
- Home modifications to improve safety and accessibility
- Therapy services (physical, speech and occupational)
- Transportation (medical and nonmedical)
- Personal emergency response systems and medical alerts
Extent of Medicaid Home Health Care Coverage
Medicaid coverage for home health care hours depends on assessed individual needs. For example, a person requiring extensive medical care consistent with that provided in a nursing home will most likely receive more hours of home health care than someone with less intensive needs. States often evaluate seniors carefully to determine the right amount of care and service hours their benefits will cover.
Through this process, a health care professional evaluates the individual's health condition, daily living requirements and general care needs. Evaluations can include questionnaires, medical tests and physical examinations to determine factors such as physical mobility, cognitive ability and overall function. A Medicaid caseworker may also conduct an on-site functional assessment to confirm the level of care an individual requires. Based on this assessment, Medicaid allocates the number of hours of care necessary to ensure adequate support.
Accessing Additional Support
If basic Medicare coverage doesn't meet an individual's full scope of needs, Medicaid's broader long-term care benefits and waiver programs offer additional aid. Designed to keep individuals out of institutional settings, these alternative programs include more flexible benefits and can cover extended hours of home health care. Again, the extent of services depends on the specific programs available in your state:
- Home and Community-Based Services waivers
- Programs of All-Inclusive Care for the Elderly
- The Community First Choice program
Exploring all available resources remains crucial to ensure adequate financial support to cover home health care costs. Consulting with a Medicaid planner or a case manager can help you maximize the benefits available through these programs. Your local Aging and Disability Resource Center serves as a supplementary outlet for unbiased Medicaid information, benefits counseling and assistance with preparing applications.