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Does Medicare or Medicaid Cover Respite Care?

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Respite care is professional, short-term care provided to an older adult so their primary caregiver can rest. If you're providing only light assistance to your loved one, such as help with cooking and cleaning, and it's safe to leave them alone, you may not need respite care. Or perhaps you can divide the work with other members of your family so that you all get some much needed time off. But if you're shouldering the burden of providing intensive hands-on support, respite care is essential to preventing caregiver burnout.

So how exactly do you pay for respite care? If your loved one has Medicare or Medicaid, you might wonder whether this type of care is covered. Below we'll take a closer look at Medicare and Medicaid coverage for respite care, along with other ways to pay so that you can take a much-deserved break from caregiving.

Does Medicare Cover Respite Care?

Medicare only covers respite care for people who qualify for Medicare hospice care. In this case, Medicare may pay for respite care, along with room and board, in a Medicare-certified inpatient hospice facility.1 The stay may be no longer than five days in a row, and you may be responsible for paying five percent of the cost for inpatient care. More than one stay is allowed, but Medicare states that these should be “occasional.”

To qualify for Medicare hospice care, a hospice doctor and the person's primary doctor (if you have one) must certify that they have a terminal illness and are expected to live no more than six months. In addition, the person must have chosen palliative hospice care rather than treatment for the illness. Medicare does not pay for respite care under any other circumstances.

FYI: Learn more about what Medicare does and doesn't cover, as well as how to enroll, in our complete Medicare guide.

Does Medicaid Cover Respite Care?

Medicaid isn't as straight-forward as Medicare. Individual states administer Medicaid, so there is no single set of rules. In general, though, many states offer respite care under Medicaid's Home & Community-Based Care Services (HCBS) waiver program.2 Depending on where you live, your loved one might qualify for in-home care or care in a designated facility.

To find out whether your loved one qualifies for respite care under Medicaid, look for your state's profile on the Medicaid HCBS program page and contact your state's agency directly. Then directly contact your state's Medicaid agency.

How Else Can I Pay for Respite Care Without Medicare or Medicaid?

If Medicare or Medicaid won't pay for respite care, don't give up. There are several other options that may help cover expenses. Each has its own list of covered services, as well as eligibility requirements. In addition, private pay may be an option, especially if the needed care is relatively simple and you only need it for a short time. For a closer look at respite care costs and ways to pay, head to our respite care cost guide.

  • Long-term care insurance: This private insurance pays for the costs associated with aging or disability. Those who already need respite care likely won't pass underwriting for a new policy, but if your loved one already has long-term care insurance, respite care may be covered. Every insurer is different, so call and ask for details about coverage.
  • ARCH National Respite Network: Although they don't provide funding directly, ARCH has compiled information on state coalitions3 that may have access to local respite care funding programs.
  • VA benefits: Respite care is a standard part of VA medical benefits, so all enrolled veterans qualify if a determination is made that they need the service. Qualified veterans get 30 days of respite care per year, which may be divided between in-home care of up to six hours in duration (each visit counts as a day of care) and nursing home care for those who need overnight care.
  • Private pay: Many people can't afford to pay out of pocket for extended respite care. However, some adult day care centers and respite care workers charge by the hour or the day. If you need care briefly and sporadically, paying out of pocket may be a reasonable option, especially if medical care is not required.

Where Can I Find Medicaid And Medicare Respite Care Near Me?

Talk to your loved one's doctor. He or she may work with Medicaid and Medicare regularly and may have some suggestions for local facilities. Alternatively, you can find Medicare providers on the Medicare website or ask your state's Medicaid department for a list of approved local respite care services.

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Written By

Sarah Goldy-Brown

Writer & Researcher

Sarah covers a range of senior lifestyle topics, from reviews of walk-in tubs and hearing aids to overviews of Medicare and Medicaid. Her close relationship with her grandparents gave her a firsthand look at the evolving life needs of older adults, and… Learn More About Sarah Goldy-Brown

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Citations
  1. Medicare.gov. (2021). Hospice care.

  2. Medicaid.gov. (2021). Home & Community-Based Services 1915(c).

  3. ARCH. (2021). State Respite Coalitions.