You may be interested in receiving home health care services if you’re recovering from a long-term illness, injury or reach a stage in your life when you need assistance with certain daily tasks. Original Medicare benefits may cover the costs of skilled nursing care or home health care under specific circumstances, but Medicare does not pay for custodial care services. Recipients who are dual-eligibles through a Medicare-Medicaid combination of benefits may qualify for several types of home health care services.

Knowing When Home Health Care is Necessary

It can be difficult to know when someone needs additional care to help them with their daily needs, but choosing home health care services sooner rather than later can prevent serious issues from arising. It can also prolong the need to transition into long-term care in an assisted living facility or nursing home.

The following signs should be considered carefully when evaluating whether home health care is a necessary step:

  • Recovery after a health incident. A hospitalization for illness, injury or surgery can create obstacles after returning home when it comes to daily activities, like personal grooming, cooking or household cleaning.
  • Decline in function. This includes repeatedly missing appointments, medications or meals, making significant financial mistakes, neglecting the state of a home or forgoing hygienic practices can all point to a personal struggle to maintain certain standards due to a lack of energy, interest or ability.
  • Diminished mobility. Poor eyesight and chronic physical stiffness or pain can make it very difficult for someone to keep up with their personal needs and the needs of their home and lifestyle. Without help, they are at an increased risk of falls and injuries.

Examples of Home Health Care Services

The rules that determine what services Medicaid will cover are set by each state, so some services may qualify for coverage in one state but not the other. These are a few examples of what could be considered eligible services if the state provides coverage for them:

  • Medical care. This type of care is administered by doctors or nurses and focuses on the medical needs of a patient, such as wound care or infusions.
  • Personal care. Assistance with daily living activities, such as household care and personal grooming needs, may be provided by an agency, or training and funding may be available to help friends and family manage these needs.
  • Hospice care. Terminally ill recipients whose life expectancy is deemed to be 6 months or less may qualify for hospice care in the home when it is considered a safe and comfortable option.
  • Accessibility modifications. Modifications may include changes to a recipient’s vehicle or home to help ease mobility issues and increase independence.
  • Medical equipment and supplies. Recipients may be able to order specific types of equipment and supplies for use in the home and have regularly scheduled deliveries of frequently used supplies.
  • Nutritional assistance. Meal services may be delivered to the home or recipients may be able to attend dining services provided by a local agency. Counseling to help someone maintain or plan their nutritional goals may also be included.
  • Transportation and emergency services. Non-emergency transportation to local appointments is meant to help recipients maintain their health needs or enjoy recreational outings. Response devices for emergency alerts to urgent needs may also be provided.

Medicaid Coverage for Home Health Care

Each state sets income and resource limits for Medicaid eligibility. Recipients must also be eligible according to the medical standards each state requires. Discuss your needs with your physician and contact your state Medicaid services office to find out about your home health care coverage.

Related articles: Frequently Asked Questions (FAQ)

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