Is Home Care Possible with Medicare or Medicaid?

Do Medicare or Medicaid Cover Home Care?

Neither Medicare nor Medicaid are designed to pay for long-term home care, but there are important exceptions through which you can gain home care benefits from both programs. It’s important to be aware of what resources are available to you or your parent before you make decisions about beginning home care.

Medicare Offers Very Limited Support at Home

In order to receive home care through Medicare you need a doctor to certify that you are housebound and need intermittent skilled care. You are considered housebound if you meet these two standards:

  1. You need the help of another person or specialized medical equipment (crutches, wheelchair, or walker) to leave your home OR your doctor certifies that your illness could get worse if you leave your home.
  2. It is difficult for you to leave your home, and generally you do not. You may attend religious services infrequently and still be considered housebound.

In addition to being considered housebound, you also have to require intermittent skilled care. Skilled care can only be provided by a doctor or a nurse. Home care duties like help with bathing or laundry do not qualify as skilled care. Instead, skilled care covers the insertion or removal of catheters, physical therapy, speech therapy, etc.

Talk to Your Doctor About Medicare

Talk to your doctor about whether you or your parent needs skilled care, but essentially, if a family member or home care professional could provide the care, it does not count as skilled care. This is why, unfortunately, most seniors are not eligible for home care coverage through Medicare.

Medicare Time frames for Home care Coverage

The term intermittent means that skilled care is not needed 24/7. Instead, the skilled care can be needed from once every two months to as much as once a day. This care is only covered for a three week period. However, if your need for skilled care goes beyond three weeks the care can be extended, so long as you are still expected to recover in a predictable amount of time.

This three-week time frame means that coverage for skilled care at home does not extend to seniors with a long-term illness like Alzheimer’s or dementia.

Medicare’s Hospice Benefit Provides Some Relief

Medicare’s hospice benefit does pay for home care and many other services, but only individuals who are suspected to be within their last six months of life are eligible to receive these benefits. In fact, many families are surprised to learn that hospice does not offer as much home care as people expect, and certainly doesn’t adequately cover the needs of most families.

Medicaid Has More Options for Home care

For many families, Medicaid can offer more options for home care. Medicaid is considered a last resort, and you may not be able to access the program unless you have no other options. However, in many states (but not all) Medicaid can allow you to pay for home care from Personal Care Services (PCS) through the Program of All-Inclusive Care for the Elderly (PACE).

The federal government has left much of the rules around home care to the states, so each has dealt with issues of home care differently. Paying for Senior Care has an excellent list of homecare resources, per state, which can greatly help you navigate this process. When doing so, it’s important to remember each state may define “home health care,” “home care,” and “homemaker services” differently.

Medicaid may pay a family member to provide home care services, depending on the state and area that you live. Once approved for Medicaid you can sign-up for self-directed services which allow you to choose your care provider and hire your family member. It’s important to note that all but eight states prohibit current spouses and legal guardians from being hired to provide care, although adult children, grandchildren, and former spouses are often eligible to hire.

Your professional care manager can direct you to the appropriate paperwork and help you navigate this confusing system. Contact our team of professional care managers and senior living experts for support and guidance about your home care options.

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