Financial Help: Medicaid Home Care Coverage

Many people live with high medical needs, chronic diseases, or disabilities that challenge daily living. Home care services provide access to high-quality healthcare and daily help at more affordable costs than hospital or facility care.

Yet, for many families, those costs and the cost of health insurance are still beyond their income limits. Enter Medicaid: a critical financial aid for home care services. 

Understanding Medicaid

Medicaid is the largest health insurance program in the United States, covering over 77 million Americans. Only certain groups of people qualify for the program, which differs from Medicare. 

What Is Medicaid?

Medicaid is a combined state and federal health program that provides free or low-cost health care for individuals and families with limited income or other resources. The federal government has general rules for coverage, but each state runs its own program, so benefits and eligibility vary.

In general, eligibility for Medicaid falls under financial or medical criteria. Under federal law, certain groups of people must be eligible in every state, including:

• Low-income families
• Qualifying pregnant women
• Qualifying children
• Disabled children or adults
• Those who receive Supplemental Security Income (SSI)

Some states cover additional groups or specific conditions. 

Medicaid vs. Medicare

Where Medicaid covers health insurance for those with limited income, Medicare is a federal program for adults age 65 and older and younger adults living with disability, end-stage renal disease, or ALS. 

The Centers for Medicare & Medicaid Services (CMS) runs the Medicare program, which is the same across every state. People with Medicare coverage pay monthly premiums, deductibles, and copays. 

Medicaid Coverage for Home Care

Medicaid home care coverage varies by state. However, the Medicaid program provides general home care services under a few programs: regular Medicaid or Medicaid state plan, home and community-based services (HCBS) waivers, and section 1115 demonstration waivers.

These programs typically offer home care services, including:

• Homemaker services, such as cooking, light house cleaning
• Personal care services, such as grooming, feeding, toileting, exercise
• Skilled nursing 
• Respite care
• Transportation
• Meal delivery
• Adult day health care
• Home modifications
• Medical alerts

New York State recently expanded coverage and provides home care services through different programs. Qualifying individuals can access:

• Personal care, such as personal assistants and housekeeping services
• Managed long-term home care, such as nursing, home health aides, physical therapy, and homemaker services
• Assisted living services, such as room, board, personal care, housekeeping, and supervision
• Long-term home healthcare

Eligibility for Medicaid Home Care Coverage

Qualifying for Medicaid home care services falls under two general categories: financial eligibility and medical or functional need. 

Financial Eligibility Requirements

To qualify for Medicaid home care coverage, individuals must first be eligible for Medicaid, which means they have limited income and assets. In 2024, the income and asset limits in New York are as follows:

• A monthly income of $1,732
• Total asset limit of $31,175

Medical Eligibility Criteria

Some people may also qualify for Medicaid home care based on a medical or functional need. To qualify, they must complete a needs assessment to identify that they cannot live safely and independently at home without help or modifications to their home. 

The assessment evaluates five activities of daily living, including:

• Mobility
• Dressing
• Eating
• Personal hygiene
• Toileting 

Individuals who cannot complete these activities safely or independently may qualify for home care or personal assistant services, such as those from Amazing Home Care. 

Benefits of Medicaid Home Care Coverage

Those with limited income or resources may struggle to find medical care and help. Medicaid is an essential solution in these cases. 

In particular, Medicaid home care services provide financial relief to families. Home care services may be expensive without coverage or have costly deductibles or copays under other plans. Medicaid coverage provides low-cost or free services, delivering essential medical care without the financial burden.

Medicaid also helps families and individuals gain access to professional medical services in the comfort of their own homes. Many people don’t need continual care in a residential facility, while others prefer to age or live at home. These services help that happen, easing the challenges of daily living with support and dignity. 

Challenges and Considerations

Sometimes individuals and families experience barriers or challenges to accessing Medicaid care. Some of the most common include:

• HCBS Waiver waiting lists
• Confusing variations in coverage and services by state
• The application and approval process itself

Staying ahead is essential to a successful and uninterrupted transition into home care services and requires careful planning. Learn about state-specific regulations, eligibility requirements, documentation, assessments, and other needs that drive the approval process for best results. 

Additional Financial Aid and Resources

Other financial resources may help individuals and families pay for living expenses and medical or home care. Veterans Affairs, for example, provides benefits to veterans and their surviving spouses and children, which include pension and disability compensation, medical care, and a variety of caregiver support programs.

Federal Supplemental Security Income (SSI) also pays a monthly income to adults with limited income. In addition, individuals may qualify for food, housing, utilities, community dining, prescription, and other benefits. NY Connects is a database of state programs and is an excellent place to search for resources. 

Expert Support with Amazing Home Care

Medicaid home care coverage is an essential resource and solution for many individuals and families. Finding care can be challenging, but professional advice and assistance can help. For expert and personalized support, contact Amazing Home Care.