Does Medicaid Pay for In-Home Elder Care

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Medicaid, a cooperative program between states and the federal government, provides health-care benefits to qualifying low-income patients. Because state governments administer the program, differences in eligibility and coverage levels vary around the country. Medicaid provides long-term health care benefits, such as in-home care and nursing-home care to seniors who meet the medical and financial eligibility standards.

In-Home Care

Although all seniors in America are covered by Medicare, the nation’s health insurance program that covers all citizens 65 and older, Medicare only addresses short-term medical costs such as doctors’ fees and hospital stays. Seniors who need financial assistance with in-home nursing care may apply for help through their state’s Medicaid program. Recipients who are over 65 and eligible for care who need nursing home care, though can remain in their own home with support of community assistance programs, may qualify for coverage.

Eligibility Requirements

Unlike Medicare, Medicaid benefits don’t automatically extend to all citizens older than 65. Applicants may apply when they reach 65 for help covering cost of in-home care only if they also meet financial eligibility requirements. Although states determine their own income levels necessary to qualify for their programs, most are based on the U.S. Department of Health and Human Services’ annual poverty guidelines. Recipients of the Social Security Administration’s Supplemental Security Income automatically qualify for Medicaid.

Estate Recovery

If a Medicaid beneficiary meets financial eligibility requirements and owns his own home, the state is required by federal law to seek reimbursement of Medicaid costs through estate recovery programs, which may apply to patients who receive in-home care. In the event that the state’s department of health and human services initiates estate recovery, it places a lien on the beneficiary’s property. The amount provided in Medicaid aid may be repaid to the state to remove the lien. In cases with large amount of medical and home-care bills, the state may take possession of the property.

Nursing Home Care

As with in-home care, Medicare doesn’t provide long-term nursing care coverage, although it provides benefits for a short-term stay as part of a recovery for an illness. If a Medicaid patient who receives in-home care as part of his benefits becomes too ill or otherwise unable to remain in his home, he may transfer to a nursing home and receive continued coverage. Nursing homes aren’t required to take Medicaid, however, so beneficiaries and their families should investigate options in their area.

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