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Medicaid and Medicare Home Health Care Coverage

Home health care services allow an individual to remain at home and receive necessary medical care and assistance with personal needs. Discover whether Medicare or Medicaid offers coverage for home health care services. Learn more about receiving coverage for home health care benefits in your state.

Does Medicare Cover Home Health Care?

Medicare provides coverage for home health care if you meet eligibility requirements. You have to meet eligibility for Medicare Part A and/or Part B as well as eligibility requirements to receive home health care services. Your doctor orders the home health care for you. The agency or agencies providing the services coordinate the services ordered by your physician.

Home health care may not mean the same to everyone, so Medicare explains the covered services under your Original Medicare. If you have a Medicare Advantage Plan or Medicare Supplement Plan, check with your plan provider so that you understand home health care service coverage under your plan.

Medicare states that eligible home health care includes a “Wide range of health care services” that you receive at home after you experience an illness or injury. You benefit from the fact that you are in your own home, able to receive care that is just as effective as care provided at a skilled nursing facility or hospital and is less expensive.

Services covered by Medicare potentially include patient and caregiver instruction, injections, wound care after having surgery or for pressure sores, injections, and IV or nutrition therapy. Skilled home health care providers also monitor serious illness and your health status should you or your loved one become unstable.

Eligibility for home health services covered by Medicare depends on a number of factors, such as needing at least one of the following:

  • Physical therapy
  • Speech-language pathology
  • Continued occupational therapy
  • Intermittent skilled nursing care

Another requirement is that you have to be under a doctor’s care and under a plan of care regularly reviewed by a physician. Regular review of your home health care plan helps make sure you receive services needed based on your specific needs.

Your plan of care includes the specific services that you need, how often you need the services, what type of home health professionals should provide the needed services, medical equipment needed, if any, and expected outcome of treatment.

Home health care is not necessarily limited to nurses or aides. Some individuals also receive home health care services from medical social workers or mental health providers.

When you receive Medicare-covered home health care services, you have rights and protections, including having a family member or legal guardian act for you if you are unable, the right to receive a copy of your plan of care and participate in decisions about your home health care.

Where Can I Find Medicare Home Health Care Near Me?

Hospital doctors sometimes order home health care for patients upon discharge from the hospital. Primary care doctors order home health care for some patients to keep the patient in the comfort of their own home and to help reduce costs to the patient.

The doctor or his assistant works with Medicare-approved home health care agencies and community providers to make sure you receive services needed under your home health care plan.

If you have Original Medicare, you pay $0 out-of-pocket for home health care services. You do pay the regular 20 percent for necessary durable medical equipment.

When an individual needs senior care services that keep them at home, Medicare-home health care providers often meet health care needs of Medicare recipients.

Does Medicaid Cover Home Health Care?

Medicaid covers home health care for eligible Medicaid recipients. Individuals have to meet both federal and state regulations to receive covered home health care services.

Medicaid does not limit the services simply to the term “Home health care.” Services are often listed under “Home and Community-based Services,” or “health home.”

The term health home is possibly confusing because it sounds like care is provided at a specific type of home. The New York Department of Public Health probably explains it best by saying that a “Health home is not a physical place…”

A health home refers to a group of providers that provide care for Medicaid home health care individuals receiving services in their own home. This potentially includes health care, social service providers, and community mental health providers.

Medicaid covers a wide variety of home health-related services. The agency reports that in 2014, 53 percent of Medicaid spending for long-term care went to home and community-based services.

Where Can I Find Medicaid Home Health Care Near Me?

The individual states have options regarding who provides home health care. Medicaid explains that states have the leeway to target specific groups of recipients to receive certain services, such as seniors.

Not all home health care agencies accept Medicaid. All states are required to provide some home health care services under Medicaid.

An April 5, 2018 memo from the Centers for Medicare & Medicaid Services (CMS) requires that states implement a final rule, which in part prohibits states from making unreasonable demands in order for an eligible recipient to receive home health care services.

Check with your local state Medicaid office to learn more about home health care in your state.

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Scott founded Select Home Care Portland in 2009 and has been helping seniors live their best life at home or in their local senior community ever since. As an advocate for seniors, the primary philosophy has been to listen, educate and provide… Learn More About Scott Witt

Since graduating from Harvard with an honors degree in Statistics, Jeff has been creating content in print, online, and on television. Much of his work has been dedicated to informing seniors on how to live better lives. As Editor-in-Chief of the personal… Learn More About Jeff Hoyt

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