Individuals in need of home health care but possess too many assets to qualify for Medicaid may be forced to spend down their savings or give it away to family members in order to obtain care.
Regular Medicaid and its waiver programs in some states provide home care assistance services, while certain waivers allow recipients to direct personal assistance services themselves and hire attendants (friends or family).
Eligibility Requirements
Medicare and Medicaid are two government-funded health insurance programs that can cover homecare services. Eligibility criteria for medicaid home healthcare typically combine medical and financial considerations; their care options may include regular state Medicaid (sometimes referred to as “original” or “classic”) as well as various home and community based waiver programs.
Medicaid programs vary by state, but generally require individuals with low incomes and resources to be eligible. Many states also set functional needs thresholds before someone receiving home healthcare services from medicaid can receive homecare services.
New York offers five Medicaid home and community based services programs that cover personal care assistance in the form of home health aide services: Aged and Disabled Waiver, Independent Choices Waiver, Consumer Directed Personal Assistance Program (CDPAP), Community First Choice option and Managed Long Term Care (MLTC).
Eligibility for Medicaid Waivers
Rules vary between states, but generally speaking a person must require care similar to that provided in a nursing home in order to qualify for home healthcare services through Medicaid waiver programs known as home and community based service (HCBS) waivers. Waivers allow case-specific planning as well as access to benefits not available through regular Medicaid State Plans (an entitlement program).
Services available under these waivers are diverse and comprehensive, such as nutrition services, personal emergency response systems (“PERS”, also called call and respond systems), transportation assistance and home modifications. In some waivers participants have the freedom to select their provider while others require them to use managed care networks for care delivery.
Oregon stands out as one of the few states offering multiple Home and Community Based Services waivers, such as Aged and Disabled Waivers, Independent Choices Waivers, Client-Employed Provider Waivers and even Spousal Pay Waivers to enable couples to assist each other with home healthcare needs.
Eligibility for Consumer Directed Care
Medicaid programs often permit participants to select their own caregivers for home healthcare services, known as consumer directed care, participant directed care or self-directed care. This enables recipients to hire family members as paid caregivers; giving them more flexibility when selecting and managing home healthcare services.
How this works differs by state and program. Generally, participants must have been certified by their physician to require home healthcare services such as skilled nursing or therapy at home. Some states have specific eligibility requirements like income limits; individuals can also use long term care insurance or Veterans Affairs health benefits to pay for home healthcare and personal care costs – these options have their own steps and rules that must be observed. To find out if you qualify for Medicaid home healthcare or another program contact your local Medicaid agency.
Eligibility for Managed Long Term Care
Medicaid home care services are typically made available to those who meet certain eligibility criteria, which combine medical needs with financial ones. Individuals must require assistance with daily activities like bathing and dressing as well as limited income and resources in order to be eligible.
Most New York State Medicaid recipients who need home care services receive them through a Managed Long Term Care (MLTC) program. In order to become eligible, an evaluator will visit an individual to conduct an intensive evaluation and decide whether MLTC is appropriate.
Current in New York are three MLTC programs. Of particular note is a partially capitated plan which has become mandatory for all dually eligible adults requiring community-based home care services like personal care/home attendant, long-term certified home health agency or Consumer-Directed Personal Assistance program services – providing limited flexibility or choice to participants.