In the time of Coronavirus, many families are concerned about a loved one moving into a nursing home or assisted living / memory care residence. 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. The types of Medicaid-funded long-term care services provided in the home are quite broad (a complete list is found below). In-home long term care includes 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.
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 these services.
• 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 (eating, bathing, dressing, etc.), instrumental activities of daily living (cooking, cleaning, transportation, laundry, etc.), 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 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 safer and more accessible.
• 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
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 – Most people think of nursing home Medicaid or 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 being placed in a nursing home 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 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. This means 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 ABD, this type of Medicaid also provides long term care at home services. However, what is available is much limited than what is available through Medicaid Waivers. Furthermore, eligibility requirements are typically more restrictive than for Medicaid Waivers. On the plus side, ABD Medicaid benefits are entitlements, so anyone who is eligible will receive assistance. Wait-lists 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 assistance with their activities of daily living from a state-provided list of care workers or they may be able to hire family members or friends to provide them with such care.