Medicaid's Home Care Benefits: Eligibility, Waivers & Application Information

Page Reviewed / Updated - Dec. 2013

 

Medicaid Home Care Benefits for the Aging

 Today all 50 states and D.C. have at least one program that provides assistance to individuals living outside of nursing homes, be that at home, in adult day care or assisted living.

Does Medicaid Pay for Home Care for Aging Individuals?  The short answer to this question is Yes.  However to better understand how and when Medicaid's home care benefits apply, it is necessary to provide some background information on what Medicaid is and how it works.  

Funds for Medicaid come from both the federal government and the individual states and as such, the rules governing Medicaid also come from two sources.  The federal government sets certain standards but  gives the states considerable flexibility with regards to the services they provide.  This is especially true in the area of home care.  

A second complication to understanding Medicaid's home care benefits is that within each state there are multiple Medicaid programs that offer different home care benefits.  States have a "Medicaid State Plan", sometimes referred to as Regular Medicaid and they also have "Institutional / Long Term Care Medicaid" and there are Medicaid Waivers which are offered as an alternative to Institutional Medicaid.

Medicaid State Plans, in most but not all states, will pay for home care in the form of personal care services or PCS.  Institutional Medicaid, by its very nature, is provided in long term care institutions and therefore does not pay for home care.  However, Medicaid Waivers which are offered as an alternative to nursing homes, does pay for home care and very often other related in-home support services to help the elderly remain living at home.

The important point for the reader to understand are:
1) Medicaid's home care services are different in every state.  
2) Within each state, the home care benefits depend on the type of Medicaid in which the individual is enrolled.

As the focus of this article is on home care for aging individuals, our state-by-state guide focuses largely on Medicaid waivers as they are most applicable to the elderly.  

Types of Home Care Covered By Medicaid

 "Medicaid now offers so many options for providing home and community services that they can be confusing for policymakers, state officials, advocates, and consumers alike." - from a US Health &  Human Services Report

Today, the variety of services covered by Medicaid for individuals living at home goes well beyond simple home health care.  However, to provide a comprehensive list can be misleading as the benefits depend both on the state in which the beneficiary lives and the type of Medicaid coverage they are receiving.  Follows is a generalized list with explanations of what is typically offered by Medicaid in most states.  

Home Health Care - is medical care provided to individuals in their homes.  Trained medical professionals such as doctors and nurses provide these services.  It is important to distinguish home health care from home care or personal care which is provided by family members or other caregivers, but not medically trained professionals.

Home Care / Personal Care - is non-medical or custodial care typically provided to assist individuals in performing their activities of daily living or instrumental activities of daily living, such as bathing, eating and assistance with mobility.  Personal care, in many states, is covered through either regular Medicaid or through a Medicaid Waiver and frequently through both.  

Homemaker Services - include assistance with general household chores such as housekeeping, laundry, shopping for groceries and other essential items as well as in the preparation of meals.  The lines between homemaker services and support with the instrumental activities of daily living and "chore services" are not well defined.  In some states these phrases may be used interchangeably.  Though initially not a Medicaid benefit, homemaker services are now recognized as being essential to helping individuals remain living at home and with relative independence.

Family and Caregiver Support - is another area recognized as important to maintaining a stable home living environment.  Support to caregivers in the form of training and respite care (temporary relief from their caregiving efforts) is now included in nearly every, if not all states. 

Home and Environmental Accessibility Modifications - home and sometimes vehicle modifications made with the objective of increasing or maintaining the beneficiary's independence are often paid for, at least in part, by Medicaid.  Typically modifications include alterations such as wheelchair ramps, walk-in bathtubs, stair-lifts and environmental aids for lighting.  

Medical Equipment and Supplies - Medically necessary equipment and supplies are covered by Medicaid.  Beneficiaries should be careful to closely follow the designated procurement processes to receive the maximum benefit amounts.

Personal Emergency Response Services - abbreviated PERS, these are electronic monitoring or call and respond services that enable persons to live alone or to spend portions of their day without direct supervision.  

Transportation Assistance - can be provided in the form of transportation escorts or rides for non-emergency medical appointments and in some areas, transportation for recreational purposes.

Hospice Care - Medicaid hospice care is usually reserved for terminally ill individuals who have a life expectancy of six months or less.  If it is determined the individual may be more comfortable in their home, Medicaid may pay for hospice at home.

 

Medicaid Payments to Family Members for Home Care

It is possible that some family members in certain states can be paid by Medicaid for the personal care they provide to their loved ones.  In general terms, the process is as follows.  An individual applies for Medicaid, once approved they then sign-up for a Medicaid waiver that pays for home care and allows for "Consumer Direction" of home care services.  Consumer Direction means the beneficiary is given the flexibility to select some of their care providers rather than have Medicaid choose them on their behalf.  The beneficiary then hires their family members as personal caregivers.  Medicaid regulates the amount they can be paid and usually prohibits legal guardians and spouses from being paid but notably does not prohibit the adult children.  Click here to learn more about this option.

Qualifying for Medicaid and Home Care Waivers

Medicaid eligibility is determine by each state separately and within the state there are usually different requirements for institutional vs. regular Medicaid.  Institutional or long term care Medicaid typically has less restrictive eligibility guidelines than does regular Medicaid.  A rule of thumb for institutional Medicaid (and Medicaid waivers) is that the applicant is permitted monthly income of $2,130 / month and countable assets of $2,000 (in 2013).  However, there is a great range within the states and many exceptions to what are considered countable assets and income.  Visit our Medicaid page for complete eligibility requirements or to find assistance qualifying for Medicaid.

State by State Guide to Medicaid's Home Care Benefits

Today all 50 states and D.C. have at least one program that provides assistance to individuals living outside of nursing homes, be that at home, in adult day care or assisted living.  Many states offer several programs, usually those that do will offer personal care assistance through their Medicaid State Plan (an entitlement program) and also through a Medicaid Waiver (which limits enrollment).  Follow the links in the table below to learn more about the eligibility requirements and benefits of any program. 

Please note that this is not a list of all Medicaid waivers which offer home care, but rather those that are relevant to the elderly.  Other waivers exist for the developmentally disabled and those with traumatic brain injury.

For a guide to Medicaid's assisted living benefits, click here.



2013 State Medicaid Home Care Benefits

State

State Medicaid Policy on Home Care

Other Options Can Help Residents

Alabama In Alabama, there are two Medicaid Waivers that help with home care, the  Elderly and Disabled and the SAIL Waiver.   Both waivers offer a Personal Choices option which allows self-direction of home care.

Other Financial Assistance
Affordable Care Options in AL

 

Alaska Alaska Medicaid helps residents with home care through Personal Care Assistance.  Participants have the option of choosing their own care providers or having the state manage that process on their behalf.  Another option is the Older Alaskans Program which provides many supports for the participants and relief for caregivers but does not pay for personal care directly.

Alaska Senior Benefits
Alaska Senior Access Program
Other Financial Assistance
Senior In-Home (SIH) Services
Affordable Care Options in AK

Arizona Medicaid in Arizona is delivered on a managed care model.  Participants approved for Long Term Care Services can receive assistance at home.  A second option is the SDAC Program which allows participant to self-direct their personal care.

Arizona NMHCBS
Other Financial Assistance
Affordable Care Options in AZ



Arkansas DAAS ElderChoices is a program that provide supports to help individuals remain living in their homes but not personal care.  Arkansas' sister program, which does provide personal care, is called Independent Choices. Other Financial Assistance
Affordable Care Options in AR
California

In California there are two Medicaid (Medi-Cal) programs that provide assistance at home.  The  NF/AH Waiver, for individuals with more severe needs and the MSSP Waiver for persons with lower levels of impairment.  While not at-home care, the new CBAS Program provides for adult day care.

Alzheimer's Day Care
In-Home Supportive Services
Other Financial Assistance
Affordable Care Options in CA




Colorado Colorado's Elderly, Blind and Disabled Medicaid Waiver pays for both personal care assistance at home as well as other supports to help individuals remain living at home.  These include modifications to improve the access and safety of the residence.  The CDASS Program is an option for waiver participants which allows them to self-direct these services.

Home Care Allowance
Other Financial Assistance
Affordable Care Options in CO



Connecticut In Connecticut, Medicaid has a program called the Home Care Program for Elders (CHCPE).  This program is somewhat unique in that it is also open to non-Medicaid eligible residents.  The state also offer the Personal Care Assistance program which is available to residents under 65 years of age. ConnPACE RX Assistance
Other Financial Assistance
Affordable Care Options in CT
Delaware

Delaware has a relatively new Medicaid program called the Amended Elderly and Disabled Waiver.  Beneficiaries of this program can receive assistance both in their homes and in adult day care.   Medicaid managed care does as well with Diamond State Health Plan Plus.

DE RX Assistance Program
Other Financial Assistance
Adult Day Care & Alzheimer's Day Treatment
CARE Delaware
Affordable Care Options in DE
D.C. Washington DC offers an Elderly and Disabled Waiver that helps local residents with home care. 

Other Financial Assistance
Affordable Care Options in DC

Florida Florida's Medicaid program has several waivers which will provide assistance to individuals in their homes.  The Nursing Home Diversion, Aged and Disabled and the Alzheimer's Disease Waivers will all do so.  In addition, Florida allows Medicaid participants to self-direct their care through its Consumer Directed Care Plus Waiver Project R.E.L.I.E.F.
Alzheimer’s Disease Initiative
Home Care for the Elderly
Other Financial Assistance
Affordable Care Options in FL
Georgia Georgia Medicaid offers two waiver options that help with home care; CCSP and SOURCE.  Both waivers offer very similar benefits and have similar eligibility requirements but they are available in different geographic areas of the state. Other Financial Assistance
Affordable Care Options in GA
Hawaii In the years during the economic downturn, Hawaii converted it's Medicaid waiver programs, Nursing Homes without Walls and Residential Alternative Community Care into managed care.  Home care may still be covered for Hawaii Medicaid beneficiaries but it will be at the discretion of the managed care provider.  Learn more about Hawaii managed Medicaid Kupuna Care
Chore Services Program
Other Financial Assistance
Affordable Care Options in HI
Idaho

Through the Medicaid Aged and Disabled Waiver, Idaho residents can receive a variety of home care services including personal care, adult day care and respite.  Idaho also has a Personal Care Services Program which allows participants to self-direct their care.

Idaho Senior Respite
Other Financial Assistance
Idaho Homemaker Services
Affordable Care Options in ID
Illinois In Illinois, the state Medicaid program offers a HCBS Waiver.  Under that waiver, participants can receive services at home.  However, the range of approved services is more limited than in many states.  Homemaker services and adult day care are among the more important of those included. Illinois Community Care
Illinois Cares Rx Assistance
Other Financial Assistance
Affordable Care Options in IL
Indiana Indiana Medicaid's Aged and Disabled Waiver offers a very wide range of support services to help individuals remain living at home such as home modifications, respite care, meals, supplies and non-emergency transportation.  Unfortunately, personal care is not included. Indiana Choice
Hoosier Rx Assistance
Other Financial Assistance
Affordable Care Options in IN
Iowa

Medicaid in Iowa, through the HCBS Elderly Waiver covers many services to help the elderly remain living in the homes.  These includes personal or attendant care, which can be self-directed. 

Other Financial Assistance
Affordable Care Options in IA
Kansas Kansas offers the Frail and Elderly Medicaid Waiver intended to prevent or at least delay the placement of frail elderly individuals in nursing homes. By providing home care and home support services, the waiver accomplishes this goal. Kansas Senior Care Act
Other Financial Assistance
Affordable Care Options in KS
Kentucky Personal care at home as well as other supports to help individuals remain living in their homes are covered by Medicaid in Kentucky.  The program is called the Waiver for the Aged and it is also known as the HCB Services Waiver.  A second waiver called Supports for Community Living Waiver offers support for a more limited range of persons. Hart-Supported Living
Kentucky Personal Care Attendant
Other Financial Assistance
Affordable Care Options in KY
Louisiana Louisiana has several Medicaid programs that will provide assistance to residents living outside of nursing homes. These are the Adult Day Care Waiver, EDA Waiver, PCS Waiver and finally the new Community Choices Waiver. Other Financial Assistance
Affordable Care Options in LA
Maine Maine has two Medicaid programs that provide assistance to elderly and disabled individuals in their homes.  The first is the Older Adults and Adults with Disabilities Waiver which covers a broader set of services and the second is called Consumer Directed Attendant Services.  Although a more limited range of services are available under the second option, it allows the participants to self-direct or choose their own service providers.

Maine Home-Based Care
Maine DEL and RX Plus
Other Financial Assistance
Affordable Care Options in ME

 

 

Maryland Maryland's Medicaid Waiver for Older Adults pays for personal care at home as well as covers the cost of some home modifications to increase the safety and accessibility of the home and allow the participant greater independence. Senior Care Program
In Home-Aide Services
Other Financial Assistance
Affordable Care Options in MD
Massachusetts Massachusetts Medicaid (Mass-Health) has three programs that provide assistance to individuals outside of nursing homes.  The Frail Elder HCBS Waiver provides for a wide range of home care and health services.  The Personal Care Attendant program is more limited in scope but covers most or all of the participant's personal care needs.  Finally, the unique Caregiver Homes program allows an elderly individual to move into the home of a caregiver.  In this situation, care is not provided in the beneficiary's  home but it is still offered in a home in place of institutional care. HCP and ECOP Programs
Prescription Advantage
Other Financial Assistance
Affordable Care Options in MA
Michigan Medicaid in Michigan has two programs that provide assistance at home.  The Choice Waiver provides for a broad range of services at home, although it is open to only those aged 65 and older.  The Home Help Program is open to younger individuals but covers a more limited range of services.  Adult Medical Program
Other Financial Assistance
Affordable Care Options in MI
Minnesota Minnesota has three Medicaid programs that help individuals living at home to receive care or support services.  The Elderly Waiver offer broad-based support, Personal Care Assistance offers personal care and the Consumer Support Grant provides cash assistance to individuals to select and retain their own care providers.  This grant can also be allocated towards home modifications which decrease the participant's reliance on other persons. Alternative Care Program
Other Financial Assistance
Affordable Care Options in MN
Mississippi Mississippi Medicaid's Elderly and Disabled Waiver provides a variety of supports and care services to individuals in their homes.  Notably absent from the care services is personal care.  However, the Waiver does pay for adult day care.  Other Financial Assistance
MS In Home Care Services / Homemaker
Affordable Care Options in MS
Missouri In Missouri, Medicaid offers the Aged and Disabled Waiver which helps participants to receive care support in their homes.  While 24/7 personal care at home is not included, adult day care and homemaker services are.  Also of note are Home and Community Based Services. Missouri Rx Plan
Other Financial Assistance
Affordable Care Options in MO
Montana Montana, through Medicaid, pays for home care using two programs or waivers.  First, the HCBS Waiver includes assistance with personal care, homemaker services and in several other areas.  The second option, Personal Assistance Services, can be self-directed allowing the participant to select their own care providers.

Big Sky Rx Program
Other Financial Assistance
Affordable Care Options in MT

Nebraska Nebraska has a single Medicaid waiver targeting the elderly called the Aged and Disabled Waiver.  This waiver provides some support for assisted living, adult day care and home care services though notably absent from its benefits list is personal care provided at home.  Lifespan Respite
Other Financial Assistance
SSAD Program
DPFS Program
Affordable Care Options in NE
Nevada Medicaid in Nevada has two waivers that provide assistance for non-nursing home, residential care but just one for home care.  The HCB Elderly Waiver provides for adult day care, homemaker/chore services as well as several other supports to help the elderly age in place. Nevada COPE
NV Homemaker Program
Other Financial Assistance
Affordable Care Options in NV
New Hampshire New Hampshire’s Choices For Independence Program is a Medicaid waiver that offers a very broad range of support services including personal care and assistance with the activities of daily living in one's home.  Transitions in Caregiving
Other Financial Assistance
Affordable Care Options in NH
New Jersey

In  New Jersey, there are two different Medicaid programs that assist families in caring for aging loved ones at home.  The first is the comprehensive Global Options Waiver which offers personal care and many other supports.  The second option is the Personal Preference Program which covers a more limited range of services but allows the participant to self-direct their own care. 

NJ Alzheimer's Adult Day Care
NJ Statewide Respite Care
NJ Assistance for Community Caregiving
Other Financial Assistance
Affordable Care Options in NJ
New Mexico In New Mexico there are two Medicaid programs which help the elderly receive care at home instead of in nursing homes.  The CoLTS C Waiver and the Mi Via Program.  CoLTS C is the more traditional Home and Community Based Services waiver and Mi Via is the more progressive allowing the individual to hire their own care providers including certain members of their family.  Other Financial Assistance
Affordable Care Options in NM
New York In the State of New York there are two very different Medicaid programs that cover home care.  The Managed Long Term Care Program covers a very wide suite of care services and supports but gives the participant very little flexibility or control.   Consumer-Directed Personal Assistance is the opposite.  While it will only pay for a limited range of services to help aging in place, it does offer the participant great choice in who provides them with care. Expanded EISEP Program
EPIC Rx Assistance
Other Financial Assistance
Affordable Care Options in NY
North Carolina North Carolina Medicaid offers the Community Alternatives Program which covers many services that help families to manage the process of caring for a loved one at home.  CAP, as the program is referred to, has a Consumer Choice option that permits the self-direction of certain care services.  However, the Choice option may not be available statewide.  Also of note is the Special Assistance In-Home Program for Adults. Other Financial Assistance
Affordable Care Options in NC
North Dakota In North Dakota there is an Aged and Disabled Medicaid waiver that offers homemaker services, respite care, help for home accessibility modifications and adult day care. Other Financial Assistance
Affordable Care Options in ND
Older Americans Act Services
SPED and Ex-SPED
Ohio Ohio offers two Medicaid Waivers that address the challenges of caring for a loved one at home.  Under the PASSPORT Waiver, a more broad set of services are available, while the Home Care Waiver specifically addresses issues surrounding home care.  However, the Home Care Waiver is not yet available statewide.  Other Financial Assistance
Affordable Care Options in OH
Oklahoma In Oklahoma, home care from Medicaid is available both as a waiver and through the Medicaid state plan.  The waiver program is called Oklahoma ADvantage and it offers many support and care services delivered to the individual in their home.  The Personal Care Program is limited service-wise to only personal care but offers the participant the option of self-directing their care. Respite Resource
Other Financial Assistance
OK In Home Assistance for the Elderly
Affordable Care Options in OK
Oregon  Of all the states, Oregon Medicaid offers the most options with regards to home care.  Four different waivers cover nearly all services that an elderly individual living at home may require.  The Aged and Disabled Waiver is the most traditional of the four, Independent Choices offers great flexibility in allowing the beneficiary to determine their own care needs and Client-Employed Provider allows participants to hire their own service providers with the state managing the administrative tasks.  Finally, a unique program called Spousal Pay will pay spouses to help care for each other.  Project Independence
Other Financial Assistance
Affordable Care Options in OR
Pennsylvania    Pennsylvania offers two Medicaid waivers to help with home care.  The Pennsylvania Department of Aging (PDA) Waiver is the more traditional of the two covering a wide range of home care and support services.  Services My Way, the other option, allows great flexibility for the participant to determine their care needs and from whom they receive services.  However, Services My Way is not yet available statewide. PACE Rx Assistance
Other Financial Assistance
Affordable Care Options in PA
Rhode Island

Rhode Island has a Medicaid program called Personal Choice that covers personal care at home as well as various other supports as does the Home and Community Care Waiver.  RI also has a unique program called RIte@Home.  Although RIte@Home does not provide care in one's home, it allows the participant to move into the home of another individual who provides care, thereby avoiding nursing home placement. 

RIPAE Rx Assistance
Other Financial Assistance
Affordable Care Options in RI
South Carolina The Community Choice Waiver from South Carolina Medicaid covers home care and other support services for eligible individuals in the state.  The Waiver will also pay for home accessibility modifications to allow an individual greater independence and reduce their need for care services.  Other Financial Assistance
Affordable Care Options in SC
South Dakota In South Dakota there are 2 Medicaid programs relevant to the elderly that cover home care services.  The HCBS Waiver for the Elderly will pay for adult day care, home chore services and home modifications to decrease the participant's reliance on others.  It should be noted that 24/7 personal care at home is not an included benefit.  There is also SD Medicaid Personal Care Services. Other Financial Assistance
Homemaker, Chore Services & Respite
Affordable Care Options in SD
Tennessee In Tennessee, there are two programs from Tenn-Care (Medicaid) that offer help at home: the Elderly and Disabled HCBS Waiver and CHOICES in Long Term Care.  The Elderly and Disabled Waiver is the more traditional of the two options covering personal care, adult day care and certain home modifications.  CHOICES is a progressive program in which the participants are given the option to select their own care providers.  Other Financial Assistance
OPTIONS for Community Living
Affordable Care Options in TN
Texas Texas has multiple Medicaid programs that help elderly individuals remain living outside of nursing homes or help their families in their caregiving activities.  There are two Medicaid waivers which provide similar coverage, the CBA Waiver and the STAR Plus Waiver.  Between the two, every county in Texas is covered.  In addition, there is the Primary Home Care program, which unlike the Waivers, is an entitlement program.  Finally, the state offers the Day Activity and Health Services program which covers adult day care.  CCAD Program
Community Attendant Services
DADS Services to Assist Independent Living
In-Home and Family Support Program
Other Financial Assistance
Affordable Care Options in TX
Utah The Aging Waiver for Individuals 65 and Older is a Utah Medicaid waiver that covers a very wide range of services that support the elderly participant directly or support their primary caregivers to help them remain living in their home.  Services include personal care, home delivered meals, respite care, home accessibility modifications and other supports.  The Alternatives Program
Other Financial Assistance
Affordable Care Options in UT
Vermont In Vermont, Medicaid (or Green Mountain Care) has 3 programs that help with home care.  The Choices for Care program is a Medicaid waiver that covers personal care, adult day care and several other services.  This can be self-directed.  Also available is Attendant Services.  This option is more focused on providing direct support to the individual and less to their caregivers. Finally, for technology dependent persons, there is the High Technology Home Care Program. Rx Assistance
Other Financial Assistance
Affordable Care Options in VT
Virginia In Virginia there is a Medicaid waiver called the Elderly or Disabled Waiver with Consumer Direction.  Under this program participants can receive a variety of home care services such as personal care, adult day care, respite care as well as other forms of assistance.  Most of these services can be self-directed should the participant choose to do so.  Also worth mentioning is the Technology Assisted Waiver as it helps to pay for technology that enables an individual to continue living independently at home.  Virginia Adult Services
Other Financial Assistance
Affordable Care Options in VA
Washington Washington State offers several Medicaid options that help assist individuals in their homes.  COPES and the Medically Needy In-Home Waiver provide similar services such as personal care and adult day care as well as other supports.  The Medicaid Personal Care option offers a more narrow range of care options but allows for a degree of consumer choice in care providers.  The New Freedom Program combines the best of both options but is only available in King County. 

Volunteer Chore Services
Other Financial Assistance
Nurse Delegation Program
Affordable Care Options in WA

 

West Virginia West Virginia has two Medicaid programs that provide assistance at home.  The Aged and Disabled Waiver provides personal care and home maintenance services as well as transportation assistance and other minor supports.  Medicaid Personal Care is limited to assistance with the activities of daily living.

Ron Yost Program
Family Alzheimer’s In-Home
Lighthouse Program
WV In Home Services (for the elderly)
Other Financial Assistance
Affordable Care Options in WV

 

Wisconsin Wisconsin has several programs intended to provide help to the elderly in their homes. These are designed to reduce nursing home placements.  The first two are called CIP-II and COP-W.  Another option is the IRIS Program which encourages participants to self-direct their care.  At present the IRIS Program is not available statewide.  Community Options Program
Alzheimer's Family & Caregiver Support
Family Care and Partnership
Alzheimer’s Family and Caregiver Support
Other Financial Assistance
Affordable Care Options in WI
Wyoming The Wyoming Home and Community Based Services Waiver, whose objective is to lower the number of nursing home placements, offers home care services for eligible participants.  These include personal care, adult day care, transportation, meals and other supports.  Wyoming CBIHS
Other Financial Assistance
Affordable Care Options in WY

 

 

Other Financial Assistance Options

For many families, Medicaid is not the best source of funds to pay for home care.  For families with an immediate need, the Medicaid application and approval process can be time-consuming.  Medicaid waivers, which are usually the best Medicaid option for home care, are not entitlements.  There are a limited number of slots available for each waiver and waiting lists in some states can extend for many months.  Families in this situation should consider how to reduce home care costs and find other sources of financial assistance besides Medicaid by using our Resource Locator Tool.

 

Finding Affordable Home Care
Seeking affordable, quality care is a great way to lower home care costs.  A few dollars per hour less can equal savings of $1,000s over the course of a year.  Use our free service to find affordable care in your area.  Get started now.