Long Term Care at Home from Medicaid: How it Works

Last updated: April 29, 2020

 

Summary

In the time of Coronavirus, many families are concerned about a loved one moving into a nursing home or assisted living / memory care. Given the high infection rates in those types of residences, questions arise such as “what is long term care at home?” and “Does Medicaid pay for it?”.

The short answer is yes, Medicaid has several programs that provide long term care at home and Medicaid does pay for them. The types of long-term care services provided in the home by Medicaid are quite broad (a complete list is found below). They include obvious services such as home health care, and less obvious ones such as non-medical assistance with activities of daily living (eating, dressing, bathing etc) and financial assistance for home modifications to enable aging in place.

  Medicaid pays for a variety of care services for elderly individuals in their homes. However, being eligible does not guarantee everyone with a need will receive these services.

Unfortunately, while Medicaid does pay for long term care at home, not everyone will be eligible and not everyone who is eligible is guaranteed to receive assistance.

 

What Services are Included in Long Term Care at Home?

Long term care at home includes many different types of assistance, some medical care and a variety of non-medical support services and physical changes to the home to accommodate for aging or disability challenges. The list below is alphabetized, not in order of importance and not every state or Medicaid program will offer all these services.

• Assistive Technology and Devices – physical products or software that assists beneficiaries and includes everything from adaptive keyboards to wheelchairs to self-stabilizing spoons to neutralize hand tremors.
• Attendant Care / Personal Care – assistance with activities of daily living (eating, bathing, dressing etc.) and instrumental activities of daily living (cooking, cleaning, transportation, laundry, etc.) plus medication management
• Care / Case Management – assistance managing caregivers scheduling and coordination of benefits
• Caregiver Training
• Chore Services –assistance with household chores from something as simple as changing a lightbulb to more exerting tasks like yardwork or shoveling snow.
• Community Transition Services – assistance helping individual who live in nursing homes to return to living at home.
• Companion Services
• Durable and Home Medical Equipment
• Environmental Accessibility Adaptations (Home Modifications) – walk-in tubs, stair-lifts, wheelchair ramps and many other modifications to a home to make it more accessible and safer
• Financial Management Services
• Home Delivered Meals
• Home Health Care
• Homemaker Services
• Non-Medical Transportation
• Nursing Services
• Personal Emergency Response Systems (PERS)
• Respite Care
• Special Medical Equipment
• Transportation

 

What, How and for Whom to Medicaid Pays

To understand how Medicaid pays for long term care at home and for whom, it is important to understand that there are three different Medicaid programs relevant to seniors and long term care.
1. Nursing Home Medicaid – when most people think of Medicaid, they think of nursing home Medicaid or Institutional Medicaid. This program is an entitlement. Everyone who is eligible, receives assistance, but it does not pay for long term care at home.

2. Medicaid Waivers – also called Home and Community Based Services (HCBS) Waivers, these programs pay for long term care at home. In fact, waivers are specifically designed to help individuals avoid being placed in a nursing home by providing services at home. Every state has HCBS Waivers, although they are different both in name and in the specific services they provide. For the most part, waivers have the same eligibility requirements as Nursing Home Medicaid but there is one important difference. Waivers are not entitlements. Each waiver program is approved for a specific number of enrollees and often a waiver program is full. What this means is that one can be completely eligible but because there is no room in the program, they will not receive assistance. Instead they will be placed on a wait-list.

3. Aged, Blind and Disabled Medicaid – often referred to as simply as ABD, this type of Medicaid also provides long term care at home services, although not nearly as many as are available through Medicaid Waivers. The eligibility requirements are typically more restrictive than Medicaid Waivers. On the plus side, ABD Medicaid benefits are entitlements, so anyone who is eligible will receive assistance. Wait-lists do not exist.

  Waivers and ABD Medicaid both offer long term care at home, but have different eligibility criteria. See Waiver and ABD eligibility rules for each state here.

Regardless of whether one is receiving long term care at home from a Waiver program or from ABD Medicaid, the process is similar. Once accepted into the program, a medical professional will assess the beneficiaries’ care needs. What types of assistance they need and how much of it will be determined.

Who provides that care depends on the Medicaid program and the state in which the beneficiary resides. In some cases, the Medicaid program will assign the individual with care providers. In other cases, an approach called “self-direction” is taken. Self-directed or participant-directed care means the care recipient has input or choice with regards to their care providers. This means, they may be able to select who provides them with assistance with their activities of daily living. It may be that they can choose from a list of care workers provided by the state or it may mean that they can hire family members or friends to provide them with long term care assistance in their homes.

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