Page Reviewed / Updated - Apr. 2018
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 governments 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 Medicaid" (which by definition does not cover home care) and 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 Waivers or Demonstration Projects.
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.
In most states, it is possible for family members to be paid by Medicaid for providing personal care to 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 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 and is paid by Medicaid or indirectly by a legally responsible 3rd party service.
Interested parties should be aware that in all but twelve states Medicaid prohibits legal guardians and spouses from being paid. Notably, Medicaid does not prohibit the adult children or ironically, ex-spouses for being hired and compensated, thereby resulting in some “Medicaid divorces”. Learn more about family members getting paid as caregivers.
Medicaid eligibility is determined by each state separately and 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 monthly income of $2,250 / month and countable assets of $2,000 (in 2018). Regular / State Plan Medicaid may have lower income limits, often times equal to the SSI limit ($750 / month in 2018). 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.
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 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 Medicaid Policy on Home Care
Other Options Can Help Residents
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, meaning participants 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.
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. A new option is the Alaskans Living Independently Waiver which provides many supports for the participants in their homes but does not pay for personal care directly. Finally, the Adults with Physical & Developmental Disabilities Waiver is another option.
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. Lastly, a new program called Agency With Choice offers considerable flexibility for participants.
Arkansas offer 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.
In California there are multiple Medicaid (Medi-Cal) programs that provide assistance at home. The NF/AH Waiver, for individuals with more severe needs, the MSSP Waiver for persons with lower levels of impairment. 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).
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.
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 residents under 65 years of age. Lastly, a new option called Community First Choicehas eliminated wait lists for home care. The Adult Family Living Medicaid benefit is similar to adult foster care, which helps senior in a home-like environment.
Delaware recently switched from a waiver model to a Medicaid managed care model. As such, the Amended Elderly and Disabled Waiver is no longer an option. However, home care is still provided under the Diamond State Health Plan Plus.
Florida's recently converted from HCBS Waivers to Managed Long Term Care. Under SMMC LTC, home care is a covered benefit. The following waivers are no longer active: Nursing Home Diversion, Aged and Disabled, Alzheimer's Disease, Consumer Directed Care Plus Waiver.
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Alzheimer’s Disease Initiative
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.
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.
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. Finally a newer program for dual eligibles called Idaho Medicare Medicaid Coordinated Plan.
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.
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. However, the Indiana Caregiver Homes / Structured Family Caregiving benefit under that waiver does enable personal care through a home sharing arrangement.
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. Another option is the Health and Disability Waiver. Note that this second option is only available to persons under 65 years of age.
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.
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 but is intended for the developmentally disabled.
Louisiana has several Medicaid programs that will provide assistance to residents living outside of nursing homes. These are the PCS Waiver and the new Community Choices Waiver. The EDA Waiver has been phased out and is no longer an option.
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.
The Community First Choice Program is now the primary option along with the related Increased Community Services (ICS) Program. Playing a reduced role is Medicaid Waiver for Older Adults which 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.
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.
Medicaid in Michigan has several 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. Finally the Health Link Program, which is only available in approximately 25 counties.
Minnesota has four 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.
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 in the Independent Living Waiver.
In Missouri, Medicaid offers the Aged and Disabled Waiver that helps seniors to receive care support in their homes as does the Independent Living Waiver. 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. Finally, Personal Care is available under the Medicaid State Plan.
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.
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.
Medicaid in Nevada offers the HCB Elderly Waiver 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.
|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.
|New Jersey|| |
New Jersey recently changed from HCBS Waivers to 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. The Global Options Waiver is no longer an option.
|New Mexico|| |
New Mexico recently switched from HCBS Waivers to a Medicaid managed care program called Centennial Care Community Benefit which offers home care. The CoLTS C Waiver and the Mi Via Program are no longer valid options.
|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).
|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. Personal Care Services are available statewide and are a Medicaid entitlement, so no waiting lists exist. Also of note is the Special Assistance In-Home Program for Adults.
|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.
Ohio offers a Medicaid Waiver that address 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 Medicaid program called MyCare Ohio.
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.
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.
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.
|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 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.
|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. Another option is Community Supports.
|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 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.
Tennessee recently replaced its Elderly and Disabled HCBS Waiver which covered home care with the CHOICES in Long Term Care program. The new program also covered home care in lieu of nursing home placement.
Texas now offers a statewide, comprehensive Medicaid program called the STAR Plus Waiver that helps elderly individuals remain living outside of nursing homes and helps families with caregiving activities. Also new is the Community First Choice Program. Finally, there exists an older Medicaid option called Primary Home Care.
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.
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, adult day care but has largely been replaced by 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. Finally, for technology dependent persons, there is the High Technology Home Care Program.
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In Virginia, there is a new 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. Also worth mentioning, the Technology Assisted Waiver and the Elderly or Disabled Waiver are no longer viable options as these waivers have been terminated.
The State of Washington has several Medicaid programs that help seniors in their homes. COPES, Medicaid Alternative Care (MAC) Program, 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. Lastly is a newer program called Community First Choice Option.
|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.
Wisconsin offers a variety of 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. However, the IRIS Program may not be available statewide. The Medicaid State Plan offers Personal Care. Lastly, there is Family Care and Partnership. CIP-II and COP-W have expired, and therefore are no longer valid options.
The Wyoming Home and Community Based Services Waiver, offered home care, but the waiver has been absorbed into the Community Choices Waiver, which now offers the same benefits. These include personal care, adult day care, transportation, meals and other supports.
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.