Reviewed by Letha Sgritta McDowellLetha Sgritta McDowell is an attorney practicing in both Virginia and North Carolina. She is a fellow of the American College of Trusts and Estates Council, a certified elder law attorney, and a past president of the National Academy of Elder Law Attorneys.

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Continuing to live independently at home can become challenging for many seniors as they age. For those who prefer to age at home over moving to a senior living community, in-home care can be a reasonable option. In some cases, even seniors who require regular medical care can live safely at home with the support of home health care services. But the costs of senior care can put a strain on many family budgets. Fortunately, Medicaid has several programs to help eligible seniors pay for home care and home health care services.

Key Takeaways

State benefits vary, but Medicaid can help seniors pay for different types of home care. Each state determines its own eligibility requirements, but all provide some level of assistance.
In some states, Medicaid waivers provide services not covered by the state Medicaid plan. Home- and Community-Based Services waivers are the most common programs that extend services to certain qualified individuals.
Self-directed services in some states allow beneficiaries to choose their own care providers. While each state has different rules, this option may allow family members to provide some care services.
In-home care and home health care are different. Home care typically supports seniors with personal care tasks while home health care involves skilled services provided by medical professionals.

Does Medicaid cover in-home care?

Yes, Medicaid programs in many states cover some personal care services and other nonmedical care such as companion care and homemaking services. Specific services that are covered vary from state to state and may be available through a state’s regular Medicaid program, Medicaid waivers, or both.

For example, the Personal Care Services (PCS) program in Alaska is a state Medicaid plan option that provides supports to seniors in their homes that include assistance with bathing, dressing, and grooming.^[01]

California’s Multipurpose Senior Services Program is an example of a Medicaid Home- and Community-Based Services (HCBS) waiver that offers several nonmedical in-home care options. Through this Medi-Cal in-home care program, seniors can receive assistance with tasks like personal care, meal preparation, and laundry.^[02]

Does Medicaid cover home health care?

Yes, Medicaid covers home health care for seniors who meet their state’s specific financial and functional eligibility criteria.

Home health care services that may be covered include the following:

Wound care
Medication administration
General health monitoring
Adult day health care
Occupational, physical, and speech therapy services

Certain services that support activities of daily living may also be covered while a senior is receiving doctor-prescribed health care at home.^[03]

States may cover additional services, so it’s important to check with your loved one’s state Medicaid agency to learn more about home health care eligibility requirements and benefits.

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Will Medicaid pay for 24-hour home care?

Most Medicaid programs don’t cover 24-hour care in a senior’s home, which for some can be a deciding factor when choosing between home care and a nursing home. Generally, Medicaid’s mandatory home health care benefit only provides part-time or intermittent services. However, each state can determine the specific amount, duration, and scope of these services.

For example, Medicaid-covered home health care for eligible seniors in Ohio is limited to “intermittent services.” The state defines this as no more than eight hours of service per day and no more than 14 hours of service per week.^[04]

For individuals who require intensive skilled services, some states provide optional private duty nurse programs. However, while each state sets its own limits, private duty nursing is typically capped at less than 24 hours per day.^[05]

Colorado’s private duty nurse program is one example. Residents who qualify for the state’s regular Medicaid plan, Health First Colorado, may be eligible to receive up to 23 hours of care per day. To qualify, the care needs to be considered medically necessary and a care plan must be ordered by a doctor and developed by a home health agency.^[06]

Medicaid programs that help cover in-home care

Medicaid is run cooperatively by the federal government and individual state governments. States must adhere to federal guidelines but are given autonomy to create and administer their own Medicaid programs. As a result, Medicaid coverage and eligibility requirements for in-home care and home health care are different in every state.

Rules and plan features vary, but Medicaid programs typically deliver benefits in two ways:

Managed care requires a beneficiary to receive services through a Medicaid managed care organization and approved providers.
Self-directed services allows Medicaid beneficiaries to choose who delivers their care and where it’s received.^[10] This could include paying a family member to provide care in a senior’s home.

Some states may offer a combination of managed and self-directed care programs.

The following are examples of types of programs that may cover long-term care at home, depending on your loved one’s state of residence.

State Medicaid

State Medicaid plans are entitlement programs, which means that all individuals who meet the eligibility requirements are guaranteed enrollment and benefits. A state’s Medicaid plan must include two federally mandated long-term care service and support benefits:

Nursing home care
Home health care

State Medicaid plans can also include additional benefits, such as Home- and Community-Based Services. HCBS benefits provide long-term care for individuals living in their homes and communities who would otherwise require institutional care.^[03]

HCBS Medicaid Waivers

Waivers allow states to expand Medicaid benefits to certain groups of people who may not otherwise qualify. However, waivers are not entitlement programs. Enrollment is usually capped and may be limited to certain service areas. Even if a senior is eligible for an HCBS waiver program, there may be a long waiting list to receive benefits.^[07]

Program of All-Inclusive Care for the Elderly (PACE)

For seniors who have Medicare, Medicaid, or both, PACE provides a comprehensive package of services — including adult day care services, meal services, and certain health benefits — that can help them continue living in their own homes.^[08]

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How to qualify for home health care or home care covered by Medicaid

Qualifying for Medicaid-covered home health care or home care services depends on the following factors:

Age and/or disability status
Where a senior lives
Medicaid programs and eligibility criteria in a senior’s state of residence
Countable income, assets, and possibly medical expenses
Functional and cognitive abilities
Medical needs ^[11]

For more information about a state’s specific Medicaid programs that cover home care, contact your loved one’s state Medicaid agency.

Types of home care

Choosing a home care option will depend on your loved one’s specific needs. Home care is typically categorized into two primary types:

Home health care provides medical services like physical therapy, wound care, and medication administration in a senior’s home. These services are provided by a health care professional, such as a registered nurse, nurse practitioner, or occupational therapist, and must be prescribed by a doctor.
In-home care, also called personal care, offers nonmedical services that can include assistance with activities of daily living (ADLs), companionship, transportation, and light housekeeping.

Support and information for state-specific Medicaid questions

Applying for Medicaid can be complicated because financial, medical, and functional eligibility criteria vary from state to state. Contacting your loved one’s state Medicaid office, local Area Agency on Aging, or a trusted elder law attorney is the best way to get state-specific information about Medicaid coverage for in-home care. These resources can help you and your family explore available care options and methods of payment.

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References

Alaska Department of Health. Personal care services.
California Department of Health Care Services. (2022, June 27). Multipurpose senior services program.
Centers for Medicare and Medicaid Services. Mandatory and optional Medicaid benefits.
Ohio Department of Medicaid. Home health services.
Congressional Research Service. (2022, September 15). Medicaid coverage of long-term services and supports.
Colorado Department of Health Care Policy and Financing. (2023, April). Private duty nursing.
Centers for Medicare and Medicaid Services. Home and community-based services.
Centers for Medicare and Medicaid Services. Program of All-Inclusive Care for the Elderly.
Centers for Medicare and Medicaid Services. Managed care.
Centers for Medicare and Medicaid Services. Self-directed services.
Centers for Medicare and Medicaid Services. Medicaid eligibility.

Meet the Author

Kevin Ryan

Kevin Ryan is a copywriter at OurParents. He has written about Medicaid and Medicare, and focuses on creating content for caregivers. Previously, Kevin worked as a freelance writer, a special education teacher, and a counselor for adults with developmental disabilities. He earned a bachelor's degree from the University of Colorado Boulder.

Edited byKristin Carroll

Reviewed byLetha Sgritta McDowell

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom (of which OurParents is a trademark) and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.

6 Things to Know About Medicaid and Home Care