Making decisions about a loved one’s future is already a heavy topic, but often, there is not a lot of time to plan for upcoming changes. Emergencies, worsening conditions, or lack of finances can all change the type of care your loved ones need. Keeping your family member at home and comfortable for as long as possible is oftentimes the primary goal, but will Medicaid pay for 24-hour home care?
In this article, we will explore how to obtain 24-hour care coverage through Medicaid, what Medicaid programs cover home care, and some alternative methods for paying for home health care. With this information, you can be confident in making the best decision for you and your family members regarding home care.
Table of Contents
How Many Hours of Home Care Does Medicaid Cover?
Due to the high expenses of home care, Medicaid is unable to cover the cost of 24-hour home care. Each state has its maximum number of hours for a patient to utilize at-home care under Medicaid, which all vary based on medical necessity, assessments, and waiver eligibility.
Using a Certified Medicaid Planner™, like Legacy Navigation, can help you understand the rules and eligibility depending on the state you are in. With our expertise in the programs, rules, and regulations, we can assist you in completing applications and waivers tailored to your specific needs. We are here to help in every step of the medicaid planning process.
How To Get 24-Hour Care Coverage With Medicaid
Suppose you or your loved one needs care coverage. In that case, the first step is to have an assessment done to determine the medical necessity of in-home care and review the financial eligibility requirements. This will help determine if Medicaid is the right program for you.
Additionally, you will need to review the maximum hours of home care. This number varies by state, but no state will cover 24-hour in-home care. If care is needed beyond the maximum (or 24-hour care is required), the patient will need to move to an assisted living facility to receive round-the-clock care.
Some facilities that Medicaid will cover for 24-hour care include:
- Assisted living facilities
- Memory care facilities
- Skilled nursing facilities
Medicaid planning can be stressful, but if you are working with a Certified Medicaid Planner™, your questions can be easily answered, and you can get your plans squared away faster. Legacy Navigation is here to help every step of the way, setting you and your family members up for a safe and reliable future.
4 Alternative Options to 24-Hour Home Health Care Covered by Medicaid
Although Medicaid does not cover 24-hour at-home care, there are other opportunities for care that Medicaid will cover. These facilities vary based on the type of care required and the amount that Medicaid will cover, depending on the patient’s needs. Let’s discuss each type and explain why a patient might choose one over the other.
#1: Assisted Living Facility
An assisted living facility is a long-term care option for older adults or individuals with disabilities who require assistance with daily activities but do not require skilled nursing. Assisted living facilities offer round-the-clock care. However, it differs from skilled nursing in that assisted living does not offer the higher levels of care, such as 2-person assists, trach care, wound management, severe debilitation, and other advanced medical care. In an assisted living facility, you will receive:
- Housing
- Personal Care:
- Bathing
- Dressing
- Taking medications
- Support Services:
- Housekeeping
- Meals
To receive approval for 24-hour care under Medicaid in an assisted living facility, a nurse, through a Medicaid waiver program, will conduct a Level of Care Assessment to determine eligibility. It is important to note that Medicaid generally does not cover room and board. This is a national rate determined by the federal government, currently $835 (sometimes less)
#2: Memory Care Facility
A memory care facility is a specialized facility that provides care for patients with specific memory impairments. These include:
- Alzheimer’s
- Dementia
- Cognitive impairments
- And more
In these facilities, patients will receive:
- 24-hour supervision
- Activities for cognitive support
- Assistance with daily tasks:
- Dressing
- Bathing
- Eating
To receive approval for 24-hour care under Medicaid in a memory care facility, Home and Community-Based Services Waivers will assess the needs and cover the amount deemed appropriate. It is important to note that Medicaid generally does not cover room and board.
#3: Skilled Nursing Facility
A skilled nursing facility, often referred to as a nursing home, is typically the most comprehensive level of long-term care for Medicaid patients. These facilities offer both daily living assistance and medical care.
At a skilled nursing facility, patients will receive:
- 24-hour medical care and monitoring
- Rehabilitation services
- Skilled services:
- Wound care
- Physical therapy
- IV therapy
- Medications
- Assistance with daily tasks:
- Dressing
- Bathing
- Eating
Suppose Medicaid determines that a skilled nursing facility is necessary for a patient after a medical assessment and financial evaluation. In that case, Medicaid can approve coverage of the care, including room and board, as well as other related expenses. This is one of the only programs that Medicaid will cover in full if deemed medically necessary.
#4: Supplemented Care
Supplemented care is when a patient maximizes their care at home and utilizes family, friends, or another private, paid option to cover the remaining hours of care to make up the 24-hour requirement. This tends to be a preferred option for those who:
- Want to stay in their residence
- Need more care, but would not receive the necessary financial assistance
This can be covered using Medicaid waivers — either a Home and Community-Based Services Waiver or Managed Long Term Services and Supports Waiver.
What Medicaid Programs Pay for Home Care?
Regular State Medicaid
With Regular State Medicaid, the plan requires the state to make home health benefits available to those who meet the eligibility criteria. With this program, there is no waiting list, and those who are eligible for the benefits are entitled to receive them.
HCBS Medicaid Waivers
Home and Community-Based Services waivers provide more in-home benefits than Regular State Medicaid plans, such as:
- Adult daycare
- Companion care
- Assistance with daily activities
- Personal emergency response systems
- Durable medical equipment
- Assisted living services
- Structured family caregiving
- And more
Although there are more covered services through HCBS, this is not an entitlement program, which means patients may have to wait for services.
Alternative Methods for Paying for Home Health Care
Paying for home health care can be stressful and expensive if Medicaid does not cover it. Fortunately, there are other ways to pay for home health care. Some include:
- Long-term care insurance
- Personal savings
- Assisted Living
- Nursing home care
- Etc.
If you are unsure about how to pay for your 24-hour or long-term care, let the experienced team at Legacy Navigation guide you. Our team of personnel knows exactly what hurdles you may face and can help you through them.
Let Legacy Navigation’s Team of Certified Medicaid Planners™ Help You Get Coverage for the Care You Need
Navigating Medicaid for at-home care can be overwhelming and complicated, but Certified Medicaid Planners™ at Legacy Navigation can help. We offer a range of services, including application assistance, financial planning, asset protection, clinical case management, non-emergent transportation, durable power of attorney, and more.
If you or your loved ones are eligible for Medicaid, contact Legacy Navigation to help you take the next step in the journey for long-term care support you can rely on.
