Will Medicaid Pay for 24-Hour Home Care?

No, Medicaid won't pay for 24-hour home care. Non Medical in-home care coverage varies among states, with some funding services through their traditional plans and others featuring waiver programs. None offers around-the-clock assistance. However, some states fund 24/7 at-home skilled nursing care rendered by home health care providers.

In-home care services support older adults to remain at home as they age. Those who qualify for Medicaid assistance receive funding for a set number of hours. If they need additional support, such as around-the-clock care, they must use other means to pay for extra hours. Alternatively, they can consider residential settings, such as assisted living communities. Home care doesn’t include medical or rehabilitative services, such as skilled nursing, physical therapy or speech-language assistance.

Covered home care services include:

• Domestic assistance, such as help with housework, laundry and basic yard work
• Meal preparation and grocery shopping
• Running errands and escorting seniors to appointments
• Local transportation
• Medication reminders
• Help with personal care, such as bathing, brushing teeth, dressing and trimming beards
• Companionship and in-home recreation

Although eligibility rules, services and funded care hours vary across the nation, Medicaid pays for part-time in-home care for qualifying individuals. Some state Medicaid plans include home care. However, most areas pay for home care through Home and Community-Based Services Waivers or Section 1115 Demonstration Waivers, which expand coverage to those who don’t qualify for assistance under traditional programs. Neither operates on an entitlement basis, meaning seniors may need to wait for funding.

To qualify for Medicaid or waivers, seniors must have limited income and assets and meet level-of-care requirements. Conditions relating to in-state residency and citizenship also apply. Some states pay a family member to handle in-home support, although individuals can still use agency aides. Some states pay professional home health care companies to provide medically necessary 24/7 home health care for situations such as stroke recovery or living with dementia.  

According to Genworth’s Cost of Care Survey, hourly in-home care costs around $30 in 2024. However, this represents the national median rate, with precise fees differing across the country. For example, agencies charge about $45 per hour in New Mexico, $38 in Maine, $34 in Nebraska, $25 in Wisconsin and $22 in Alabama.

Medicare doesn’t pay for most aspects of nonmedical home care. However, it covers limited personal care assistance for those who need skilled home health care services. The program doesn’t pay for any 24-hour care in a person’s private residence. VA benefits cover home care and home health care. Although benefits don’t cover 24/7 nonmedical support, veterans may qualify for 24-hour home health care services. Other payment options include private funds, long-term care insurance and reverse mortgages.