Does Medicaid Cover Long-Term In-Home Care?

A fellow caregiver asked...

Does Medicaid cover long-term in-home care?

Expert Answer

All states provide some kind of long-term care for certain people, including the elderly, who live at home and who would require nursing home care if they didn't receive these services. These programs aren't technically part of Medicaid but are funded by Medicaid through waivers of normal Medicaid rules, which is how they get their designation as Home and Community-Based Services (HCBS) "waiver" programs.

Unlike Medicare coverage of home care or regular Medicaid home care coverage, these programs aren't limited to medical care and their coverage doesn't run out when a person's medical condition stabilizes. (The purpose of these waiver programs is to keep people out of nursing homes for as long as possible.)

Home and Community-Based Services programs can provide:

  • In-home healthcare, including nursing care and physical therapy.

  • Personal care services to help with the normal activities of daily living (ADLs), such as eating, bathing, and dressing.

  • Homemaker services, such as simple cooking, cleaning, and laundry.

  • Meal delivery.

  • Adult day services participation (care, companionship, and activities at an adult day services center).

  • Transportation assistance to and from medical care or other services.

  • Assistive devices, medical equipment, and supplies.

  • Minor home modifications (such as widening a doorway to accommodate a wheelchair, or installing a safety railing in a bathtub).

Eligibility for an HCBS waiver program has two parts. The first involves the need for care. The program must evaluate the applicant's need for medical care and/or assistance with activities of daily living. Usually, the applicant's need for care must be extensive enough that without in-home services, he or she would have to move into a nursing home.

The second part of eligibility is financial. An applicant must have low income and few assets, but these asset and income eligibility levels are usually significantly higher than for regular Medicaid coverage. In most states, an individual can have countable income (for a discussion of countable income, see How Medicaid Works) two or three times higher than for regular Medicaid eligibility. Similarly, an individual usually can have considerably more in assets -- the value of the person's home doesn't count at all -- than for regular Medicaid coverage. Also, in some states, income and assets resting solely in a spouse's name aren't counted.

The exact income and assets eligibility rules and amounts vary from state to state.

If someone qualifies for HCBS coverage of in-home care, in some states there are also programs that can pay a family member to provide some of this home care.

To find out exactly what Home and Community-Based Services are available in your state, and what the eligibility rules are, contact a local office of your state's Medicaid program. To find a local Medicaid office, go to the federal government's Benefits.gov website and choose your state. This takes you to a page with contact information for your state's Medicaid program and information about local offices.