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Medicaid and Home Care
The Relationship between Medicaid and Home Care Services

Seniors are grateful to have caregivers for companionship and assistance to help with daily living. Friendships blossom and safety increases for older adults aging in place at home and having a caregiver around to assist in chores.

In some cases, professional caregivers see elderly clients struggle paying for home care services. It's disheartening to experience older adults with big needs but have very little in the way of money. There are few resources available to the elderly that help them pay for caregiving at home.

One thing that a family member can do is to search the agencies in the local community to locate financial assistance to help pay for home care. If the older adult has trouble paying for, seek from Medicaid. Unlike Medicare, Medicaid home care coverages are not limited to medical care and the coverage doesn't run out when a an older person's medical condition stabilizes.

They're called Medicaid waiver programs and the purpose for them is to keep people out of nursing homes for as long as possible.

Medicaid and Home Care

Qualifying for the Home and Community Based Services waiver program depends on two things.

1. The need for care. The applicant must have a need for medical care and/or assistance with activities of daily living at home.

2. The applicant's need for care must is extensive and without services, the individual would have to move into a nursing home.

Medicaid Home and Community Based Waiver Programs
State Home and Community Based ProgramsState Home and Community Based Programs

What does the Home Based Waiver Programs Offer?

  • In-home healthcare, including nursing care and physical therapy.
  • Personal care services to help with the normal activities of daily living: eating, bathing, medication assistance, transferring, and dressing.
  • Homemaker services: cooking, cleaning, and laundry.
  • Meal delivery.
  • Adult day services: 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).

Find your state's Information on Medicaid.

The Four Types of Waivers

Waivers are state vehicles to test new or existing ways to deliver and pay for health care services in Medicaid and the Children's Health Insurance Program (CHIP).

1. Section 1115 Research & Demonstration Projects: States can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and CHIP.

2. Section 1915(b) Managed Care Waivers: States can apply for waivers to provide services through managed care delivery systems or otherwise limit people's choice of providers.

3. Section 1915(c) Home and Community-Based Services Waivers: States can apply for waivers to provide long-term care services in home and community settings rather than institutional settings.

4. Concurrent Section 1915(b) and 1915(c) Waivers: States can apply to two types of waivers to provide a continuum of services to the elderly and people with disabilities, as long as all Federal requirements for both programs are met.

Read more on the Medicaid Waiver Programs.

Home Care Services Paid for by Medicaid

The waiver programs allows for the coverage of Long Term Care Services over a continuum of settings. These offer Institutional Care and Home and Community Based Services and Supports.

Institutional Benefits

  • The institutions refer to residential facilities that take over the care of those admitted.
  • The care includes room and board.
  • The service bills and reimburses in a bundled payment. Services like physical therapy are separately covered or bundled as part of the services given.
  • Residential facilities licensed and certified by each state, according to federal standards.
  • Residential facilities are subject to survey at regular intervals and must maintain certification and license to operate.
  • Eligibility calculates differently for residents which, for some applicants, tied to the need for institutional level of care.

Community Based Long-Term Services & Supports

The Centers for Medicare and Medicaid Services works in partnership with all states, consumers, the health care and providers to create a person-centered long-term support system. For people living with disabilities and chronic conditions, it allows choice, control and access to many quality services that help maximize the outcomes.

Goals on the Community Based Long-Term Services & Supports are: independence, health and quality of life.

Person-driven

Program allows older people, people living with disabilities or chronic illnesses to decide:

  • Where they want to live and with whom
  • To gain control over the services received and who provides the services
  • To work and earn money
  • To include friends and supports to help them participate in community life

Effective and Accountable

  • The programs offer quality services to improve the quality of life.
  • Allows shared accountability and responsibility between public and private partners
  • Personal accountability and planning for long-term care needs
  • And gives greater use and awareness of private sources of funding

The system achieves economy and efficiency by managing a package of services appropriate for the beneficiary and paid for by the appropriate party.

The system delivers services from various funding streams to provide seamless packages of support, and makes use of health information technology to provide transparent information to consumers, providers and payers.

For more information on Community Based topics.

It's HCBS programs intent to make available the services and supports needed by older adults and to assist an individual to remain in or return to the community. These programs do not individually provide 24-hour-per-day help. This means that in many cases it's necessary and desirable for individuals to use other paid and unpaid supports at their disposal.

Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.