Home health care refers to an array of services provided to senior and disabled residents living at home. This may include skilled nursing or therapy services like medication management or bathing assistance as well as personal care aide services like meal preparation or cleaning. To receive these services under Medicaid (a joint Federal/State program for low income people), individuals must meet specific financial and functional criteria; individuals can also access them through private plans like long term care insurance or Medicare Advantage Plans.
Answering the question “does medicaid cover home health care” depends on which kind of Medicaid plan someone enrolls in. Traditional or institutional Medicaid only covers in-home healthcare services prescribed by a doctor and provided through certified home health agencies; however, many states offer waiver programs as part of regular Medicaid that cover these types of services as well.
These waiver programs offer an array of in-home services with more flexible eligibility criteria, and may cover home attendant services, personal care services, environmental accessibility modifications, respite care services and medical equipment and supplies.
Many Medicaid recipients can also qualify for home healthcare services through programs like Program of All-Inclusive Care for Elderly Persons (PACE) and Managed Long Term Care (MLTC). Individuals enrolling in these types of plans must sign a managed care contract that fulfills certain requirements before availing themselves of its benefits.
Alongside managed care options, many states offer homecare programs that enable beneficiaries to hire their own caregivers and pay them directly. This model of providing healthcare is known as consumer directed care (CDC), participant directed care (PDC), cash and counseling or self-directed homecare, depending on where it operates. While its benefits can differ depending on state regulations, most such programs require beneficiaries to meet with social workers first to develop care plans and set appropriate wage rates for caregivers.
The New York State Office for the Aging administers several different home care programs for Medicaid enrollees in New York state. These programs are often intended to help elderly and individuals with disabilities live independently at home and prevent long-term institutional care needs. For more information about these programs, contact your county Department of Social Services. Individuals looking for more information on the programs available through New York should visit this page. Those seeking clarification of how they can appeal denials or reductions of home care services should read through this article, while people with mobility and other disabilities who cannot travel for a Fair Hearing due to significant hardship or medical disadvantage can receive an interim increase in home care hours until they can request such an event.