As of June 2019, all 50 states and D.C. have at least one program that provides assistance to elderly individuals living outside of nursing homes. Be that at home, in adult day care, in adult foster care, or assisted living. Most states offer multiple programs.
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 state government. And as such, the rules governing Medicaid also come from two sources. The federal government sets certain standards, but gives the states flexibility on 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 many Medicaid programs. And each program offers different home care benefits. States have a “Medicaid State Plan,” sometimes referred to as Regular Medicaid. They also have “Institutional Medicaid” (which by definition does not cover home care). In addition, there are Medicaid Waivers which are offered as an alternative to Institutional Medicaid. These are sometimes called Home and Community Based Services, HCBS Waivers, 1915(c) Waivers, or 1115 Demonstration Projects.
The important points 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 program in which the individual is enrolled.
“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. This is because the benefits depend on both 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.
In most states, it is possible for family members to be paid by Medicaid for providing personal care for their loved ones. In brief, this process works as follows.
1) An individual applies for Medicaid
2) Once approved, they then sign-up for a specific Medicaid program that pays for home care and allows for “Consumer Direction”. Consumer Direction, also called self-directed care, means the beneficiary can select their care providers rather than have Medicaid choose providers on their behalf.
3) The beneficiary then hires their family member as a personal caregiver.
4) The family member/caregiver submits timesheets to Medicaid. They are paid by Medicaid or indirectly by a legally responsible third party service.
Interested parties should be aware that in all but fifteen states, Medicaid prohibits legal guardians and spouses from being paid. Notably, Medicaid does not prohibit the adult children from being hired and compensated. Ironically ex-spouses can also be hired, which sometimes results in “Medicaid divorces.” Learn more about family members getting paid as caregivers.
Medicaid eligibility is determined by each state separately. Within the state there are usually different requirements for institutional vs. regular Medicaid. A rule of thumb for institutional Medicaid (and Medicaid waivers) is that the applicant is permitted a monthly income of $2,313 and countable assets of $2,000 (in 2019). Regular/State Plan Medicaid may have lower income limits. They are oftentimes equal to the SSI limit ($771/month in 2019), or equal to the federal poverty level ($1,041/month in 2019). However, there is a great range in income and asset limits within the states. There are also 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.
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, in adult foster care, or assisted living. Many states offer several programs. And usually those that do will offer personal care assistance through their Medicaid State Plan (an entitlement program) and 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 that offer home care, but rather those waivers that are relevant to the elderly. Other waivers exist for developmentally disabled individuals and for persons with traumatic brain injuries that are not included here. For a guide to Medicaid’s assisted living benefits, click here.
|State||State Medicaid Policy on Home Care||Other Options Can Help Residents|
|Alabama||In Alabama, there are four Medicaid programs that help with home care. These are the Elderly and Disabled Waiver, the SAIL Waiver, and the Personal Choices Program. All programs offer self-direction of home care. This allows participants to have some choice about their caregiver. The newer Alabama Community Transition (ACT) Medicaid Waiver will provide home care to nursing home residents who return home.||Other Financial Assistance Affordable Care Options in AL|
|Alaska||Alaska Medicaid helps residents with home care through Personal Care Services (PCS). Participants have the option of choosing their own care providers or having the state manage that process on their behalf. Another option is the Alaskans Living Independently Waiver (ALI), which provides many supports for the participants in their homes. But it does not pay for personal care directly. Finally, the Adults with Physical & Developmental Disabilities Waiver is another option.||Senior Benefits Program(SAP) Adult Day Services 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 Arizona Long Term Care Services (ALTCS) can receive assistance at home. A second option is the SDAC Program which allows participants to self-direct their personal care. Lastly, a program called Agency With Choice (AWC) offers considerable flexibility for participants.||Arizona NMHCBS Other Financial Assistance Affordable Care Options in AZ|
|Arkansas||Arkansas offers home care through Independent Choices and their regular Medicaid Personal Care benefit. The DAAS ElderChoices waiver is no longer valid but has been replaced with ARChoices, which also offers this option.||Other Financial Assistance Affordable Care Options in AR|
|California||In California, there are multiple Medicaid (Medi-Cal) programs that provide assistance at home. The HCBA Waiver, formerly called the NF/AN Waiver, is for individuals with more severe needs, the MSSP Waiver if for persons with lower levels of impairment. There is also the popular In Home Supportive Services program, and finally, the CBAS Program provides for adult day care (which is not home care but can help seniors remain living at home).||Alzheimer’s Day Care Paid Family Leave 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 offers the Personal Care Assistance program, which is available to disabled residents under 65 years of age, as well as seniors over the age of 65. Lastly, an option called Community First Choice has eliminated wait lists for home care. The Adult Family Living Medicaid benefit is similar to adult foster care, which helps seniors in a home-like environment.||Statewide Respite Care ProgramOther Financial Assistance Affordable Care Options in CT|
|Delaware||Delaware uses a Medicaid managed care model. Home health care, personal care assistance, and chore services are just a few of the home based services provided under the Diamond State Health Plan Plus.||Other Financial Assistance Adult Day & Alzheimer’s Day Care CARE Delaware Affordable Care Options in DE|
|D.C.||Washington DC offers an Elderly and Disabled Waiver that helps local residents with home care. Personal Care is also available under the District’s regular Medicaid program.||The Caregivers’ InstituteUniversal Paid Leave Act Other Financial Assistance Affordable Care Options in DC|
|Florida||Florida delivers its long term care benefits via Managed Long Term Care. Under SMMC LTC, home care, including meal delivery, companion care, and homemaker services, is a covered benefit.||Project R.E.L.I.E.F. Alzheimer’s Disease Initiative Local Services Program 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 only persons receiving SSI can receive services via SOURCE.||Non-Medicaid, HCB Services Other Financial Assistance Affordable Care Options in GA|
|Hawaii||In the years during the economic downturn, Hawaii converted its 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, now called Med QUEST.||Kupuna Care Chore Services Program Community Living 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 in addition to personal care assistance, provides homemaker services. Finally, there is a newer program, with limited geographic availability, for dual eligibles called the Idaho Medicare Medicaid Coordinated Plan.||Idaho Senior Respite Idaho Homemaker Services Other Financial Assistance 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. There are also two managed Medicaid programs depending in which area of the state one resides: HealthChoice Illinois and Illinois Medicaid-Medicare Alignment Initiative.||Illinois Community Care Home Accessibility Program 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, medical supplies, attendant care, and non-emergency transportation. The Indiana Caregiver Homes / Structured Family Caregiving benefit under that waiver enables personal care through a home sharing arrangement.||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 their homes. These include personal or attendant care, which can be self-directed. Another option is the Health and Disability Waiver. Note that this second option is only available to persons under 65 years of age.||Other Financial Assistance Affordable Care Options in IA|
|Kansas||Kansas Medicaid (KanCare) 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, which is also known as the HCB Services Waiver. A second waiver called Supports for Community Living Waiver offers support, but is intended for the developmentally disabled.||Hart-Supported Living Homecare Program Personal Care Attendant Adult Day & Alzheimers Respite 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 LT-PCS Waiver, the Adult Day Health Care Waiver, and the Community Choices Waiver, which replaced the EDA 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 Elderly and Adults and Adults with Disabilities Waiver, which covers a broader set of services, and the second is called Consumer Directed Attendant Services. Both programs allow the participants to self-direct or choose their own service providers.||Home-Based Care Program Caregiver Respite Program DEL and RX Plus Other Financial Assistance Affordable Care Options in ME|
|Maryland||The Community First Choice Program, a state plan option, provides services and supports to enable seniors to live at home. The Increased Community Services (ICS) Program assists persons in transitioning from nursing homes to their homes and provides supports to keep them at home. The Community Options Waiver 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. Two other programs also provide help at home. These are Community Pathways and Community Personal Assistance. There is also the Medical Day Care Services Waiver, which provides daytime supervision and care in a community setting.||Senior Care Program In Home-Aide Services Senior Prescription Drug Assistance Accessible Homes for Seniors Attendant Care Program Other Financial Assistance Affordable Care Options in MD|
|Massachusetts||Massachusetts Medicaid (Mass-Health) has four programs that provide assistance to individuals outside of nursing homes. The Frail Elder HCBS Waiver provides 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. The unique Caregiver Homes program allows an elderly individual to move into the home of a caregiver, or for the caregiver to move into the home of the care recipient. While care may not be provided in the beneficiary’s home, it is still offered in a home in place of institutional care. Finally, there is the Adult Day Health Program, which does not provide in-home care, but does provide care in the community during the day.||HCP and ECOP Programs Prescription Advantage Other Financial Assistance Affordable Care Options in MA|
|Michigan||Medicaid in Michigan has several programs that provide in-home assistance. The Choice Waiver provides a broad range of services, such as help with personal care, chore and homemaker services, and respite care at home. The Home Help Program covers a more limited range of services. Finally, there is the Health Link Program, which is only available in approximately 25 counties. It is a managed care program for persons eligible for both Medicaid and Medicare.||Other Financial Assistance Affordable Care Options in MI|
|Minnesota||Minnesota has five Medicaid programs that help individuals living at home to receive care or support services. The Elderly Waiver and Personal Care Assistance offer personal care. Another option is the CADI Waiver. Finally, the state now offers two managed Medicaid programs that offer home care: Senior Health Options & Senior Care Plus.||Alternative Care Program Essential Community Supports Community Support Grant 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, including personal care and adult day care. Serving a different audience in their homes is the Independent Living Waiver.||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 seniors to receive care support in their homes, while the Independent Living Waiver provides in-home services for physically disabled persons between 18 and 64 years old. Also of note is the Home and Community Based Services program. Finally, Personal Care is available under the Medicaid State Plan.||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, also called the Big Sky Waiver, includes assistance with personal care, homemaker services, and in several other areas. The second option is Personal Assistance Services. Both programs can be self-directed, allowing participants 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. Another option through the regular Medicaid program is called simply Personal Assistance Services.||Lifespan Respite Other Financial Assistance SSAD Program DPFS Program Affordable Care Options in NE|
|Nevada||Medicaid in Nevada offers the Waiver for the Frail Elderly for non-nursing home care. It also provides adult day care, homemaker/chore services as well as several other supports to help the elderly age in place. Under the Medicaid State Plan, personal care is also provided at home. Finally, the WIN Waiver, more formally known as the HCBW for Persons with Physical Disabilities provides home care for severely disabled persons.||Nevada COPE Senior RX Program NV Homemaker Program Personal Assistance Services AT/IL 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. Personal Care Attendant Services is also available under their regular Medicaid program.||Other Financial Assistance Affordable Care Options in NH|
|New Jersey||New Jersey no longer offers HCBS Waivers and instead has a statewide Medicaid managed care program called Managed Long Term Services and Supports (MLTSS). Under this program home care is provided. It can also be consumer directed under the Personal Preferences sub-program.||Alzheimer’s Adult Day Care Statewide Respite Care Senior Gold Prescription and PAAD Family Leave Insurance Program Assistance for Community Caregiving Other Financial Assistance Affordable Care Options in NJ|
|New Mexico||New Mexico recently switched from HCBS Waivers to a Medicaid managed care program called Centennial Care Community Benefit, which offers home care. In addition to personal care assistance, private duty nursing, home health aides, and homemaker services are available.||Older Americans Act MEDBANK Other Financial Assistance Affordable Care Options in NM|
|New York||In the State of New York there are three 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. The newest option is called the Community First Choice Option (CFCO).||Expanded EISEP Program Community Services for the Elderly EPIC Rx Assistance RESTORE Program Paid Family Leave 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 disabled 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. Personal Care Services are available statewide and are a Medicaid entitlement, so no waiting lists exist.||In-Home Aide ServicesSpecial 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. Under the Medicaid State Plan, personal care is also provided at home.||Other Financial Assistance Affordable Care Options in ND Older Americans Act Services SPED and Ex-SPED|
|Ohio||Ohio offers a Medicaid Waiver that addresses the challenges of caring for a loved one at home. Under the PASSPORT Waiver, a broad set of in-home services are available. Newly available in 29 counties is the managed care Medicaid program called MyCare Ohio.||Older American Act ServicesElderly Services Program 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.||Adult Day Services 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. Five different programs 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. The newer K Plan under the Community First Choice option also helps. 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 three Medicaid programs to help with home care. The Pennsylvania Department of Aging (PDA) Waiver is the more traditional, offering a wide range of home care and support services. Services My Way allows great flexibility for the participant to determine their care needs and from whom they receive services. New in 2018, is the HealthChoices Program.||PACE Rx Assistance Options Program Other Financial Assistance Affordable Care Options in PA|
|Rhode Island||Rhode Island has a Medicaid program that covers personal care at home, as well as various other supports, called the Global Consumer Choice Compact Waiver. RI also has a unique program called [email protected]. Although [email protected] 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 AssistanceCareBreaks Respite Services Program Home and Community Care Co-Pay Program Caregiver Insurance Program Other Financial Assistance Affordable Care Options in RI|
|South Carolina||The Community Choices 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. Another option is Community Supports, which is for persons with intellectual disabilities or a related disability.||Older Americans Act Other Financial Assistance Affordable Care Options in SC|
|South Dakota||In South Dakota, there are two Medicaid programs relevant to the elderly that cover home care services. The HCBS Waiver for the Elderly, formally called the HOPE waiver, 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 Caregiver Support Program In-Home Services Program Homemaker, Chore Services & Respite Affordable Care Options in SD|
|Tennessee||Tennessee covers home care with the CHOICES in Long Term Care program in lieu of nursing home placement. In addition to personal care and homemaker services, assistive technology, personal emergency response systems, and home modifications are benefits.||Other Financial AssistanceAdult Day Care OPTIONS for Community Living Affordable Care Options in TN|
|Texas||Texas now offers a statewide, comprehensive Medicaid managed care program called the STAR Plus Waiver. It helps elderly individuals remain living outside of nursing homes and helps families with caregiving activities. There is also the Community First Choice Program. Finally, there exists another Medicaid option called Primary Home Care.||CCAD Program Community Attendant Services 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 New Choices Waiver helps the elderly move from nursing homes into private homes. Finally, under the Medicaid State Plan personal care services are provided.||The Alternatives Program Other Financial Assistance Affordable Care Options in UT|
|Vermont||In Vermont, Medicaid (or Green Mountain Care) has 4 programs that help with home care. The Choices for Care program is a Medicaid waiver that covers personal care and adult day care. This program operates under the more comprehensive Global Commitment to Health Medicaid Waiver. Choices for Care has a special eligibility group called Moderate Needs Group Services Program. Also available is Attendant Services. This option is more focused on providing direct support to the individual and less to their caregivers. For technology dependent persons, there is the High Technology Home Care Program. While not technically a home care program, there is also Adult Day Services.||Rx Assistance Dementia Care Respite Grants VCIL / HAP Home Sharing Program Other Financial Assistance Affordable Care Options in VT|
|Virginia||In Virginia, there is a managed care Medicaid waiver called Commonwealth Coordinated Care Plus Waiver. 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.||Virginia Adult Services Other Financial Assistance Affordable Care Options in VA|
|Washington||The State of Washington has several Medicaid programs that help seniors in their homes. While COPES and Medicaid Alternative Care (MAC) Program provide a variety of similar services, personal care is not one of them. Instead, personal care is available through the Medicaid Personal Care option or the Community First Choice Option. The New Freedom Program combines the best of both options but is only available in King and Pierce Counties. Lastly, there is the State Nurse Delegation Program.||Volunteer Services Tailored Support for Older Adults Other Financial Assistance 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 offers several programs intended to provide help to the elderly in their homes. These are designed to reduce nursing home placements. The first option is the IRIS Program, which encourages participants to self-direct their care. The Medicaid State Plan offers Personal Care. Lastly, there is Family Care and Partnership.||Alzheimer’s Family & Caregiver SupportSeniorCare RX Other Financial Assistance Affordable Care Options in WI|
|Wyoming||The Community Choices Waiver offers a variety of home care services. These include personal care, adult day care, transportation, meals, and other supports.||Wyoming CBIHS Other Financial Assistance Affordable Care Options in WY|
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 or even years. 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.