Does Medicare Pay For Home Health Care?

Home health care services can be an invaluable way of helping a loved one remain independent at home while receiving necessary medical support. Depending on the type of healthcare service you need, Medicare and/or Medicaid may cover these options; however, before making any definitive decisions about which home health care option would best meet your needs there are a variety of considerations you need to keep in mind before making your choice.

Medicare does provide some home health services; however, these are often limited in duration and follow hospital stays. Many individuals with Medicare also purchase private “Medigap” insurance policies to cover some or all of their home healthcare costs, including the costs for home health aides or personal care services.

New York state offers several home care programs tailored specifically for certain populations and eligibility criteria, such as Personal Care Services Program (PCSP). PCSP provides assistance with daily activities like bathing and meal preparation as well as home attendant and housekeeping services, personal emergency response systems and transportation assistance.

Individuals enrolled in Medicaid have more options for receiving home care services, thanks to Medicaid waivers. These alternative long-term care programs enable people to access home health care and support services outside institutional settings like nursing homes.

Medicaid home care services vary between states, yet almost all provide some form of in-home healthcare options for Medicaid beneficiaries. Most programs fall into either two categories – state plans which must be available to everyone eligible or waiver programs like an 1115 demonstration waiver or 1915(c) waiver which must provide services only when certain criteria have been met.

Home health care programs typically provide home health aide and personal care services, home-delivered or congregate meals, nutritional counseling and supplements, transportation escorts to medical appointments or non-emergency errands and assistive technology devices that help individuals live safely at home, such as electronic monitoring systems or call-and-respond devices. Many programs also cover medication costs as well as costs related to home-based therapies like physical, occupational or speech therapy.

Additionally, some managed care programs available to Medicaid participants, such as Program for All-Inclusive Care of Elderly People (PACE) and Managed Long Term Care (MLTC), include home healthcare components. Services may be provided through either an Individual Personal Care Assistance Service Plan (ICASPP) or Consumer Directed Personal Assistant Programs (CDPAPS).

Medicaid funding comes from both federal and state sources, so its rules for what services it covers can differ based on your location. Therefore, it is vital that you consult with your physician prior to applying for any home healthcare services – the application and enrollment processes may take multiple steps; having them help guide and guide the way will streamline and simplify them significantly.