Summary
“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. The available types of Medicaid-funded long-term care benefits provided in the home are quite broad. This includes obvious services, such as home health care, and less obvious ones, such as non-medical assistance with Activities of Daily Living (i.e., eating, dressing, bathing, mobility). Furthermore, supports such as personal emergency response systems and home modifications to enable aging in place are available.
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. This includes some medical care, a variety of non-medical supportive services, and even physical changes to the home to accommodate for aging or disability challenges. The list below is alphabetized to easily find potential benefits. Not every state or Medicaid program will offer all of these benefits.
• Assistive Technology and Devices – Physical products or software that assists beneficiaries. This 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 (i.e., eating, bathing, dressing, mobility, toileting), Instrumental Activities of Daily Living (i.e., cooking, cleaning, transportation, laundry), and 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 individuals who live in nursing homes to return to living at home or in the community.
• 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 safer and more accessible.
• Financial Management Services – for persons self-directing their own care
• Home Delivered Meals
• Home Health Care
• Homemaker Services
• Non-Medical Transportation
• Nursing Services
• Personal Emergency Response Systems (PERS)
• Respite Care
• Structured Family Caregiving – the care recipient lives with a caregiver and is provided personal care assistance and homemaker services. The caregiver, which in some cases may include a spouse, is paid to provide care. While they can live in the care recipient’s home, they could also live in the home of the caregiver.
• Vehicle Modifications
What, How and for Whom 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 – Most people think of Nursing Home Medicaid (Institutional Medicaid) when they think of 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. Waivers are specifically designed to help individuals avoid institutionalization by providing services at home or in the community. Every state has HCBS Waivers, although they are different both in name and in the specific services they provide. Waivers generally have the same eligibility requirements as Nursing Home Medicaid, but unlike Nursing Home Medicaid, waivers are not entitlements. Each waiver program is approved for a specific number of enrollees, and when maximum capacity has been reached, a waitlist begins. This means that one can meet all eligibility criteria, but because there is no room in the program, they will not immediately receive assistance.
3) Aged, Blind and Disabled Medicaid – Often referred to as ABD, this type of Medicaid also provides long-term care at home. Most commonly, personal care services are provided. While additional benefits may be available, potential services and supports are much more limited than those provided via Medicaid Waivers. Furthermore, eligibility requirements are typically more restrictive than for Medicaid Waivers. However, ABD Medicaid benefits are entitlements, so anyone who is eligible will receive assistance. Waitlists do not exist.
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. The types of assistance required and how much of it is needed 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 allows the care recipient input or choice with regards to their care providers. They may be able to select who provides them with personal care assistance from a state-provided list of care workers or they may be able to hire friends or family members, including spouses (in some cases), to provide them with such care.
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Learn more about paying family members as caregivers.
Read about how to apply for Medicaid.