Medicaid’s Home Health Care Benefit

Medicaid’s Institutional Care Program provides three main benefits: a skilled nursing facility benefit, an assisted living facility benefit, and a home health care benefit. As individuals near their elder years, they typically wish to remain in their homes for as long as possible given the comfort provided by familiar surroundings. Medicaid’s home health care benefit helps individuals achieve this goal by providing supports and services that help individuals safely remain at home.

In addition to the provision of home health care aides for around twenty hours per week, Medicaid’s home health care benefit also covers the cost of: adult day care, transportation to adult day care, transportation to doctors and hospitals, personal emergency response device (such as Life Alert), physical, occupational and speech therapies, routine vision and hearing examinations, home delivered meals, respite care to provide relief for caregivers, and homemaking assistance. This array of benefits helps keep individuals out of institutional facilities while also saving public resources since it is more expensive for Medicaid to pay for an individual’s stay at a skilled nursing facility than it is for Medicaid to provide these home health care services to individuals in the community.

Although some individuals may live out their lives never requiring a higher level of care, other individuals with more serious health issues may not be able to remain in the community, even with the provision of these services. If an individual must move to an assisted living facility or a skilled nursing facility, the individual’s Medicaid coverage can still provide a financial benefit at assisted living facilities and skilled nursing facilities that participate in the Medicaid program. Despite the pervasive myth that any facility participating in the Medicaid program is “low-quality” or undesirable, most skilled nursing facilities and many assisted living facilities participate in the Medicaid program out of necessity given the high cost. If a facility provides low-quality service, it is usually an issue related to management of the facility and has nothing to do with the facility’s participation in the Medicaid program.

To qualify for these benefits, individuals must meet Medicaid’s eligibility requirements, which include an asset cap and a monthly income cap. To learn more about how to comply with Medicaid’s eligibility requirements, it may be necessary to consult with an Elder Law attorney who has knowledge regarding how to structure an individual’s assets for Medicaid eligibility purposes.