Medicaid & Home Care: State by State Benefits & Eligibility

Medicaid Home Care Benefits for the Aging

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 that 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.

• Medicaid State Plans (Regular Medicaid) in most states, but not all, will pay for home care in the form of Personal Care Services (PCS) or Personal Attendant Services (PAS).
• Institutional Medicaid is provided in long-term-care institutions (nursing homes and intermediate care facilities). Therefore, it does not pay for home care.
• Medicaid Waivers, which are offered as an alternative to nursing homes, pay for home care. They also often pay for other related in-home support services to help the elderly remain living at home.

Types of Home Care Covered By Medicaid

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. What follows is a generalized list with explanations of what is typically offered by Medicaid in most states.

• Home Health Care – This 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. Home care, or personal care, is provided by family members or paid caregivers, but not medically trained professionals.
• Home Care / Personal Care – This is non-medical or custodial care typically provided to assist individuals in performing their activities of daily living or instrumental activities of daily living. This can include bathing, grooming, dressing, eating, and mobility. In many states, personal care is covered through regular Medicaid or a Medicaid Waiver, and frequently through both.
• Homemaker Services – This includes assistance with general household chores. It can include housekeeping, laundry, shopping for groceries and other essential items, as well as the preparation of meals. The lines between homemaker services, 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 – This is another area now 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 in all, states.
• Home and Environmental Accessibility Modifications – Home and sometimes vehicle modifications are made to increase or maintain independence. They are often paid for, at least in part, by Medicaid. Modifications can include alterations such as wheelchair ramps, walk-in bathtubs, stairlifts, and environmental aids for lighting.
• Medical Equipment and Supplies – Medically necessary equipment and supplies are covered by Medicaid. The processes to get the equipment should be closely followed to receive the greatest benefit amounts.
• Nutrition Services – This includes a variety of services such as home-delivered or congregate meals, nutritional counseling, and/or nutritional supplements.
• Personal Emergency Response Services – PERS are electronic monitoring or call-and-respond services. They enable persons to live alone or to spend part of the day without direct supervision. Click here for a list of Medicaid programs that cover PERS.
• Transportation Assistance – It provides transportation escorts or rides for non-emergency medical appointments. In some areas, it includes transportation for recreational purposes as well.
• 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.
• Adult Day Care (Adult Day Health) – While technically not a home-care service, adult day care provides daytime supervision in a community-based setting. Besides snacks and meals, personal care assistance and social activities are provided. Based on one’s situation, this type of care can provide enough support to enable seniors to continue living at home or the home of a relative.

Medicaid Payments to Family Members to Provide Home Care

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 23 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.

Qualifying for Medicaid and Home Care Waivers

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 $2,829 and countable assets of $2,000 (in 2024). Regular/State Plan Medicaid may have lower income limits. They are oftentimes equal to the SSI limit ($943/month in 2024), or equal to the federal poverty level ($1,255/month in 2024). 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.

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, 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 each 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.

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 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.