What is Respite Care?
Respite care provides informal (unpaid) primary caregivers a break from providing care for a loved one. These caregivers, who are often the care recipient’s spouse or adult child, tend to provide care for long hours, day-after-day with no breaks. This role is often stressful, taxing (physically, mentally, and emotionally), and can lead to caregiver burnout. Respite care provides temporary relief in order for these caregivers to continue to work outside of the home, run personal errands, rest and recharge, or even take a vacation.
Respite care can be provided on an emergency or short-term basis, either in-home or out-of-home (i.e., adult day care, assisted living residence, nursing home facility). Care might be provided for as little as a few hours to a couple of weeks. Respite care providers generally provide supervision, companionship, personal care assistance (i.e., bathing, dressing, toileting, mobility, eating), homemaker services (i.e., preparing meals, laundry, light housecleaning), transportation (i.e., to medical appointments and social activities), medication management, and sometimes basic medical care (i.e., wound care, monitoring of vital signs). Furthermore, some providers are trained to handle behaviors associated with Alzheimer’s disease or a related dementia, like wandering, agitation, and confusion.
Will Medicaid Pay for Respite Care?
Yes, Medicaid will pay for respite care. Medicaid recognizes the importance of supporting unpaid family (and non-family) caregivers, and therefore, Medicaid-funded respite care is available in nearly all states, as well as the District of Columbia. That said, Illinois does not offer respite care for caregivers of persons who are aged. While neither does Kansas, this benefit may be available for seniors and persons with disabilities as a Medicaid managed care supplemental service option. In other words, one’s managed care health plan may provide respite care as an “add on” benefit. Additionally, West Virginia does not offer Medicaid-funded respite care for persons who are aged or disabled. However, Medicaid in all three states will pay for adult day care, which could serve as a form of respite care.
Medicaid Programs that Pay for Respite
Medicaid Waivers
Medicaid-funded coverage of respite care is most commonly provided through 1915(c) HCBS Waivers, also called Home and Community Based Services Medicaid Waivers. These waivers provide long-term services and supports to specific groups of persons (i.e., aged, disabled, those with Alzheimer’s disease and related dementias) to help them live at home or in the community (rather than require institutionalization). Access to 1915(c) Medicaid Waivers may be restricted to specific geographic regions within a state. Furthermore, the number of participant slots are limited and when they have been filled, a waitlist forms.
States may also provide respite care via 1115 Demonstration Waivers, which allow states to test new approaches to their Medicaid program. This may include expanding the availability of HCBS, like respite care. As with 1915(c) HCBS Waivers, access to benefits may be restricted to a specific number of persons, which mean waitlists for assistance may exist.
Medicaid State Plan
Another avenue through which respite care might be provided is via a state’s Regular Medicaid / Medicaid State Plan, through which benefits are an entitlement. Unlike with Medicaid Waivers, the number of participant slots are not limited, and if one meets the eligibility criteria, they will receive assistance without being put on a waitlist. The 1915(i) Home and Community Based Services State Plan Option allows states to provide Home and Community Based Services, including respite care, outside of a Medicaid Waiver. States may also provide respite care via the 1915(k) Community First Choice (CFC) Option, through which Home and Community-Based Attendant Services and Supports may be provided.
Eligibility Criteria for Medicaid-Funded Respite Care
The eligibility requirements to receive Medicaid-funded respite care varies based on the state and the specific Medicaid program. For respite care via a Medicaid Waiver, general eligibility criteria for a single applicant in 2025 are as follows: 1) Income at or under $2,901 / month (300% of the SSI Federal Benefit Rate) 2) Assets under $2,000 3) Require a Nursing Facility Level of Care (NFLOC).
For a single applicant to receive respite care via the Medicaid State Plan, the 2025 eligibility criteria is generally as follows: 1) Based on the state, income must be at or under $967 / month (100% of the SSI Federal Benefit Rate) or $1,304 / month (100% of the Federal Poverty Level). 2) Assets under $2,000 3) Have a medical need for respite care. Note: Respite care via Community First Choice requires a Nursing Facility Level of Care.
See state and program-specific Medicaid eligibility criteria (including eligibility criteria for married couples).
How Much Respite Care Will Medicaid Provide?
The amount of Medicaid-funded respite care that Medicaid will pay for varies based on the state, as well as the Medicaid program through which one receives assistance. Generally, there is a cap (a limit) set on the amount of hours / days of respite care that can be received. For instance, Arkansas’ ARChoices in Homecare Waiver permits up to 1,200 hours of in-home / facility-based respite care, or in other words, 50 days. In California, respite care is a potential available Medi-Cal (Medicaid) managed care Community Support. Eligible persons are permitted up to 336 hours (14 days) per calendar of year in-home / in-facility respite care services. Via New York’s Nursing Home Transition & Diversion Waiver, respite care is provided in blocks of 24-hours and limited to 30 days / year. Tennessee’s TennCare CHOICES in Homecare Waiver allows 216 hours per calendar year of in-home respite care and 9 days per calendar year of in-patient (i.e., assisted living, nursing home) respite care. Note: Some states set the limit for respite care based on an assessed need for assistance.