Can Medicaid or Medicare provide part-time home care?

A fellow caregiver asked...

Can Medicaid or Medicare provide a part-time caregiver to my 75 year-old mother with osteoporosis?

Expert Answer

Medicare coverage for home care is extremely limited. In order to qualify for Medicare-covered home care, your mother must be confined to her home and have a medical need for doctor-prescribed skilled nursing care or rehabilitative physical or speech therapy. The skilled nursing or rehabilitation care must be needed part-time only, to help her recover from a specific illness, injury, or acute condition. Once a patient's condition has become stable, Medicare no longer covers care at home. If what your mother needs is non-medical assistance because of her general frailty from osteoporosis, Medicare won't cover it. (However, if your mother did receive some Medicare- covered skilled nursing or therapy at home, Medicare could also pay for a limited amount of personal care for her, as well.)

Medicaid coverage for home care can be quite a bit broader than Medicare's. Medicaid rules vary somewhat from state to state, so the exact extent of Medicaid coverage for home care where your mother lives will depend on the particular home care program of her state's Medicaid program. But in general, if your mother financially qualifies for Medicaid, it can provide her with regular, part-time home care if her osteoporosis limits her ability to care for herself. To qualify, she might need her doctor's certification that her condition creates a need for care. If so, Medicaid might pay for an aide from a Medicaid-certified home care agency to visit your mother several times a week and help her with various kinds of medical and non-medical care tasks. This could include what's called occupational therapy, which is assistance learning how to accomplish daily personal care and household tasks safely. The frequency and length of the home care visits, and the kinds of care provided, would be determined by your mother's condition and needs, and the rules of the Medicaid program in her state.

To find out more about Medicaid eligibility and home care coverage rules in your mother's state, you can go online to any search engine and enter "Medicaid" and the name of the state. Or, you can call the Eldercare Locator toll-free at 800-677-1116 and ask them for contact information to the Medicaid program for the state where your mother lives.