Does Medicaid or Medicare cover a CNA to care for the blind?

Patricia white asked...

Will Medicaid or Medicare pay for CNA as a caregiver for and elderly adult, who is blind, to cook, clean and assist with daily living?

Expert Answer

Medicare and Medicaid are both set up to provide medical coverage, and unfortunately neither program provides much in the way of non-medical assistance with the activities of daily living (ADLs). However, Medicaid -- if someone meets the financial eligibility standards -- might provide very limited part-time assistance.

Medicare home health care coverage is available only to someone who is confined to her home and has 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 other acute episode. If someone receives Medicare-covered skilled nursing or therapy at home, Medicare can also pay for a very limited amount of personal care -- assistance with ADLs -- as well, but only for as long as the nursing care continues. Once a patient's condition has become stable, Medicare no longer covers care at home. So, if someone's need for care is for a non-acute permanent condition, such as blindness, and the care needed is solely non-medical assistance with ADLS, Medicare won't provide any home care at all.

Medicaid coverage for home care is a bit broader than Medicare's. But unlike Medicare, eligibility for Medicaid depends on having very low income and few assets. Also, Medicaid rules vary somewhat from state to state, so the exact extent of Medicaid coverage for home care depends on the particular home care program of the state Medicaid program where the person lives. In general, Medicaid can provide regular, part-time home care to someone whose physical condition restricts the ability to care for herself. Medicaid might pay for an aide -- possibly but not necessarily a Certified Nurse's Assistant (CNA) -- from a Medicaid-certified home care agency to visit someone several times a week to help with various kinds of medical and non-medical care tasks, which can include assistance in 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 the person's condition and needs, and the rules of the Medicaid program in her state. But Medicaid will not provide daily assistance with household tasks such as cooking and cleaning.

To find out more about Medicaid eligibility and home care coverage rules in a particular 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 your state.

Another possibility for some home care assistance with ADLS is PACE, the Program of All-Inclusive Care for the Elderly, which helps frail elders stay at home when they otherwise would need nursing home care. To qualify for PACE, the program must determine that the applicant meets the state's Medicaid standard for requiring nursing facility care. If someone qualifies, PACE can provide personal care, supportive services, and meals, as well as medical care. Most PACE services are offered at an adult day health center, but some services can be provided at home. PACE is only available in certain states and areas, and an applicant must have very low income and few assets -- each local PACE program sets its own specific financial limits.

To learn more about the PACE program, visit the Medicare web site page that describes the PACE program. To find out if there is a PACE program near where you live, go to the Medicare PACE program locator web site page, which lists all the programs.