Will Medicaid Pay for Home Care Since Medicare Won’t?

Sep 12, 2017

Will Medicaid Pay for Home Care Since Medicare Won’t?

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There are many people who could use extra assistance at home, but don’t necessarily need medical care. They are relying heavily on their loved ones to help them throughout the day with personal care such as walking to and from the bathroom, bathing, preparing meals, and getting dressed. This dependence on family members can put stress on relationships, as people feel obligated to set their own plans aside to be there to help a loved one. It’s an all too familiar story. The struggle is usually in finding someone else to assist and the stress of how to pay for it. Many people quickly realize that Medicare, which covers people over the age of 65, doesn’t cover home care services that are not considered medical (skilled nursing care physical therapy, etc.). If you fall into that bucket, the question then becomes, will Medicaid pay for home care and how do I know if I qualify?

Will Medicaid Pay for Home Care If…

The answer to the first question, will Medicaid pay for home care, is simple – yes. In all 50 states and Washington D.C. there is at least one program through Medicaid that covers assistance to seniors living outside of nursing homes, whether that is at home, in adult day care, or in assisted living. Some of these programs also include the ability to pay a family member as the caretaker. The second question, on how to know if you qualify, is where things get a little complicated. That’s when the question becomes, will Medicaid pay for home care if… I only need it part time… if my finances don’t meet a certain level… if regulators don’t think that my need is as great as what I think it is... 

Home care is defined as personal care services – non-medical care that is typically provided to people who need help with daily activities such as bathing, eating, and moving around their home safely. This is different than home health care, which requires the caretaker to be a medical professional. Medicaid covers personal care at home as long as Medicaid members meet certain criteria, which depends on the state in which they live. In addition to the person getting approved for these services in their state, based on their level of need, the home health care agency providing said services has to meet certain criteria as well. In 2017, there were a set of health care guidelines issued by the Centers for Medicare and Medicaid that include many patient-protection requirements to make sure that home care is regulated safely. There are more than 5 million CMS members receiving care at-home, whether it be personal or skilled care, and there are 12,600 participating home care agencies across the country. Although Medicaid is a federal program, each state has unique laws and regulations around what its Medicaid program will pay for, so people still need to research how their state decides on whether Medicaid will pay for home care or not.

Will Medicaid Pay for Home Care for Me?

  1. Apply for Medicaid
  2. Research the home-care program in your state
  3. Apply for home care in your state

No Medicaid? How Much Does Home Care Cost Out of Pocket?

Since people are living longer, there are more elderly in need of senior care than ever before. To add to that, more and more people are choosing to receive care at home instead of paying to go into a nursing home for long-term care. Unfortunately, nearly 10 million people over the age of 50 were caring for their aging parents in 2012, according to a study covered by NPR. That number has surely increased over time. These people taking care of their loved ones at home are losing wages at work and missing out on their own life experiences by becoming caretakers. Plus, they’re doing a job that could be covered by federal programs. In essence, they are saving Medicare and Medicaid millions of dollars a year. Yet, for those who don’t qualify for Medicare or Medicaid home-care coverage, out of pocket costs are steep. Although home care is most likely cheaper than going into a nursing home, it still comes at a hefty cost of an estimated $19 - $21 an hour, depending on if the caretaker is considered a home health aide or a homemaker.

If you are looking for home care services, do your research, and make sure that if you can get money to cover these costs, you are receiving it. Start your search for home care here at SeniorCaring.com.

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