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Will Medicaid Pay for Home Health Care by a Family Member?
Date Updated: December 16, 2024
Written by:
Sarah has produced thousands of articles in diverse niches over her decade-long career as a full-time freelance writer. This includes substantial content in the fields of senior care and health care. She has experience writing about wide-ranging topics, such as types of care, care costs, funding options, state Medicaid programs and senior resources.
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.
Medicaid won’t pay for home health care by a family member. Although the federal insurance program funds medically necessary home health services via state plans, trained aides and medical professionals must deliver services. In contrast, many states allow informal family caregivers to receive payment for performing nonmedical home care tasks.
Home Health Care Overview
Home health care supports seniors to remain at home rather than moving to an institutional setting, such as a nursing home. It includes clinical and rehabilitative care for those with chronic conditions or recovering from severe illnesses, injuries or hospital procedures. Providers tailor support plans to meet individuals’ needs and periodically review arrangements to ensure services remain appropriate and beneficial.
Teams include aides, nurses and therapists, and seniors also benefit from the expertise of dietitians and medical social workers. Typical home health care services encompass:
- Occupational therapy
- Physical therapy
- Speech therapy
- Nutritional oversight
- Medication administration
- Part-time skilled nursing services, such as IV therapy, catheter care and wound management
- Personal care assistance
- Medical transportation
- Medical social services
Medicaid Coverage of Home Health Care and Home Care
Regular state Medicaid plans include home health care coverage for those who meet eligibility criteria. A doctor must prescribe services and deem them medically essential, and financial assistance ends when seniors no longer have clinical needs. Therefore, seniors must demonstrate a functional need for medically focused in-home support. They must also meet conditions related to income and assets, local residency and citizenship. Medicaid funding relies on individuals using approved professional service providers.
In contrast, home care coverage remains optional, meaning rules vary among states. Some jurisdictions cover non medical at-home care through traditional Medicaid, and others use waiver programs. Typical services include homemaker support and companionship. Many states allow family members to receive payment for helping their loved ones with practical day-to-day tasks, or programs fund assistance from professional agencies.
Paying for Home Health Care
Medicaid pays for home health care for eligible seniors when they receive services from certified agencies. Some seniors qualify for financial assistance via Medicare. Similarly, professionals must perform doctor-ordered services rather than loved ones. However, Medicare only funds personal care in limited situations. Other payment options include VA benefits, long-term care insurance and private pay.