For many individuals, particularly seniors and those with disabilities, the ability to remain in the familiar comfort of their own home while receiving necessary care is paramount. The Medicaid Care At Home Program offers a vital lifeline, providing financial assistance for in-home support services. While traditionally Medicaid has been associated with nursing home care, it is increasingly recognized as a crucial resource for those seeking to age in place or manage disabilities at home. This program not only supports individual independence and well-being but also presents a more cost-effective alternative to institutional care for states.
Medicaid’s commitment to home-based care extends across all 50 states, albeit with variations in program specifics and service delivery. A significant aspect of many Medicaid care at home programs is the option for consumer-directed care, also known as participant-directed care or self-directed care. This model empowers care recipients to have greater control over their services, sometimes even allowing them to hire family members, including adult children or even spouses, as paid caregivers. This offers families the opportunity to provide care for their loved ones while receiving financial compensation.
It’s important to note that “home care” within Medicaid programs can encompass a range of living environments beyond just an individual’s private residence. Depending on the state and specific program rules, eligible individuals may receive care in the home of a friend or relative, in adult foster care settings, or even within assisted living facilities. The precise scope of eligible locations is defined by each state’s Medicaid program guidelines.
Did You Know? Navigating the complexities of Medicaid eligibility can be challenging. Fortunately, resources are available to assist seniors and individuals with disabilities in understanding and qualifying for Medicaid programs. Learn more about different types of Medicaid assistance programs.
Navigating Medicaid Programs for In-Home Care
Medicaid offers several pathways to access in-home care services, each with its own set of rules and benefits. These primarily fall under three categories: Regular State Medicaid, Home and Community Based Services (HCBS) Medicaid Waivers, and Section 1115 Demonstration Waivers. Understanding the distinctions between these programs is crucial to accessing the right support.
Regular State Medicaid: Your Foundation for Home Care Benefits
Regular State Medicaid, also known as Original Medicaid or Classic Medicaid, serves as the foundational Medicaid program in every state. Under federal mandates, states are required to provide home health benefits to Medicaid recipients who have a demonstrated medical need for such services. Furthermore, many states extend their Regular Medicaid plans to include personal care assistance within the home. This personal care assistance encompasses non-medical support with Activities of Daily Living (ADLs) such as bathing, dressing, and eating.
Beyond the basic framework of Original State Plans, the Affordable Care Act introduced State Plan Options, offering states additional flexibility in providing home care services. One notable option is the Community First Choice (CFC) option, which allows states to offer in-home personal attendant services to individuals who require assistance with both Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). IADLs include tasks like meal preparation, light housekeeping, and managing medications. The CFC option is designed to support individuals who, without these services, would likely require nursing home placement. Currently, a number of states have adopted the CFC option, including Alaska, California, Connecticut, Maryland, Montana, New York, Oregon, Texas, and Washington.
Another significant State Plan Option is the section 1915(i) HCBS State Plan Option. This option broadens the scope of in-home care assistance available through Medicaid, potentially including skilled nursing services, adult day health care, respite care for caregivers, and even home modifications to enhance accessibility. Importantly, the 1915(i) option does not always require individuals to demonstrate a need for nursing home level care, making it accessible to a wider range of individuals who need support at home. States may also target these services to specific populations at risk of institutionalization, such as those with Alzheimer’s disease or frail elderly adults.
A key advantage of Regular State Medicaid and its State Plan Options is their entitlement nature. This means that individuals who meet the eligibility requirements are guaranteed to receive benefits without facing waiting lists.
HCBS Medicaid Waivers: Expanding Home Care Services
Home and Community Based Services (HCBS) Medicaid Waivers represent another significant avenue for accessing Medicaid-funded long-term services and supports (LTSS) at home. These waivers, also referred to as Section 1915(c) Waivers, are specifically designed to promote independent living for elderly individuals and those with disabilities by providing services in community settings rather than institutions. Typically, eligibility for HCBS waivers requires demonstrating a Nursing Home Level of Care need, indicating that without waiver services, the individual would be at risk of institutionalization.
HCBS Waivers generally offer a more extensive array of in-home benefits compared to Regular State Medicaid Plans. These benefits can include adult day care programs, companionship care, assistance with a wide range of daily living activities, personal emergency response systems (PERS), durable medical equipment (DME), assisted living services in certain states, and structured family caregiving programs which allow family members to be compensated for providing care.
It is crucial to understand that HCBS Medicaid Waivers are not entitlement programs. Meeting the eligibility criteria does not automatically guarantee immediate receipt of services. Due to funding limitations and high demand, waiting lists for HCBS waiver programs are common in many states.
Section 1115 Demonstration Waivers: Innovative Approaches to Home Care
Section 1115 Demonstration Waivers offer states even greater flexibility in designing and implementing their Medicaid programs, including home and community-based services. These waivers serve as pilot programs, allowing states to test innovative approaches to improve their Medicaid service delivery and expand access to care. While some Section 1115 waivers may help reduce or eliminate waiting lists for home care services, this is not always the case, and the specifics vary significantly from state to state. These waivers are often used to target specific populations or address unique service delivery challenges within a state.
Medicaid Home Care Program Eligibility: Is It Right for You?
Eligibility for Medicaid, and consequently for Medicaid care at home programs, hinges on meeting specific criteria. Beyond state residency, the key eligibility factors are financial need and functional need.
Financial Eligibility for Medicaid Home Care
Medicaid financial eligibility considers both income and assets, but the specific limits vary based on the state and the particular program. For Regular State Medicaid, eligibility criteria are often aligned with the “aged, blind, and disabled” eligibility group. Generally, most states cap monthly income at either 100% of the Federal Poverty Level (FPL) or 100% of the Supplemental Security Income (SSI) / Federal Benefit Rate (FBR). In 2025, for example, a state using 100% of the FPL might set an income limit of approximately $1,304 per month for a single applicant, while a state using 100% of SSI might have a lower limit, around $967 per month. Asset limits for Regular State Medicaid are typically quite strict, often around $2,000 for an individual.
Explore state-specific Medicaid eligibility requirements for home care.
HCBS Medicaid Waivers and LTSS Demonstration Waivers often have more lenient income limits compared to Regular State Medicaid Plans. Many of these waiver programs utilize the same income eligibility standards as Institutional (nursing home) Medicaid. A common benchmark for income limits in these waiver programs is 300% of SSI. In 2025, this translates to a monthly income limit of approximately $2,901. However, the asset limit for these waiver programs often remains at $2,000 in most states.
Important: Exceeding Medicaid’s financial limits does not automatically disqualify an individual from receiving Medicaid home care. Strategic financial planning can help individuals who are over the income or asset limits become eligible.
Certain assets are considered exempt or “non-countable” by Medicaid, meaning they are not factored into the asset limit. Common examples of exempt assets include an individual’s primary home (within certain equity limits), household furnishings, a vehicle, and personal items like engagement and wedding rings. Furthermore, various Medicaid planning strategies exist to help individuals become financially eligible. These strategies may involve the use of legal and financial tools such as Miller Trusts (also known as Qualified Income Trusts), Medicaid Asset Protection Trusts, Irrevocable Funeral Trusts, and Medicaid Compliant Annuities. Consulting with professional Medicaid Planners can be invaluable in navigating these complex financial rules and developing a compliant plan. Find a qualified Medicaid planner near you.
It is critical to avoid gifting assets or selling them below fair market value in an attempt to meet Medicaid’s asset limits. Medicaid has a Look-Back Period, typically five years, during which past asset transfers are scrutinized. Improper asset transfers during this period can result in a Medicaid ineligibility period, delaying access to needed care. Learn more about the Medicaid Look-Back Period and penalty divisors.
Functional Needs: Demonstrating Need for In-Home Support
In addition to financial criteria, Medicaid home care programs require applicants to demonstrate a functional need for assistance. This is often referred to as a medical need or Level of Care need. For Regular State Medicaid Plans, this typically involves showing a need for assistance with Activities of Daily Living (ADLs) and/or Instrumental Activities of Daily Living (IADLs). ADLs encompass fundamental self-care tasks such as mobility, transferring (e.g., from bed to chair), toileting, eating, and bathing. IADLs include more complex tasks like managing finances, preparing meals, doing laundry, and light housekeeping. The specific functional need requirements vary by state and program. For instance, a state might require assistance with one ADL or IADL, or perhaps a minimum of two ADLs, or three IADLs. To assess functional need, Medicaid typically conducts an in-person assessment.
For HCBS Medicaid Waivers and the Community First Choice State Plan Option, the functional need requirement is generally aligned with the Level of Care provided in a nursing home. This often translates to a significant inability to perform ADLs and/or IADLs independently. Physician verification of the need for this level of assistance is commonly required. Understand more about Nursing Home Level of Care requirements.
Choosing Your Medicaid Home Care Provider
It is important to be aware that not all home care providers accept Medicaid. Each state’s Medicaid agency maintains a list of participating providers. This list can be accessed through the state Medicaid agency’s website or by contacting them directly. Find contact information for your state’s Medicaid agency.
Many Medicaid programs offer consumer direction or self-directed care options for personal care and attendant services. This empowers Medicaid recipients to choose their own caregivers, which can include friends, neighbors, and family members. To determine if consumer-directed care is an option in your state, it’s best to contact your state’s Medicaid agency directly. You can also explore state-specific Medicaid programs that offer home and community-based services.
Services Covered by Medicaid Care at Home Programs
Medicaid care at home programs offer a wide spectrum of services and supports designed to facilitate aging in place and independent living. In addition to case management to coordinate care, covered services may be available in an individual’s home, the home of a relative or friend, adult foster care homes, or assisted living facilities, depending on the state and program. It is important to note that Medicaid typically does not cover room and board costs in assisted living or adult foster care settings; it focuses on covering the care services themselves. While the list below provides a comprehensive overview of potential services, the exact benefits available vary by state and specific Medicaid program.
- Assistance with Activities of Daily Living (ADLs): Bathing, dressing/undressing, eating, mobility, toileting
- Assistance with Instrumental Activities of Daily Living (IADLs): Shopping for essentials, laundry, light housecleaning, meal preparation
- Assistive Technology to enhance independence and safety
- Home Health Care services, including skilled nursing and therapy in the home
- Home Modifications to improve accessibility and safety: Grab bars, wheelchair ramps, widened doorways, non-slip flooring
- Vehicle Modifications to accommodate wheelchairs or other mobility equipment
- Durable Medical Equipment (DME): Wheelchairs, walkers, hospital beds, and other necessary equipment
- Adult Day Care / Adult Day Health Care programs for social engagement and daytime support
- Skilled Nursing Care delivered in the home setting
- Respite Care services to provide temporary relief for family caregivers
- Transportation assistance for medical and non-medical appointments and errands
- Therapy Services: Physical therapy, speech therapy, occupational therapy
- Meal Delivery services and Congregate Meals programs
- Personal Emergency Response Systems (PERS) / Medical Alert devices for immediate help in emergencies
- Structured Family Caregiving programs: Allowing Medicaid to pay a family member to provide care
- Transitional Services to support individuals moving back home from a nursing home setting
In some instances, depending on the service and the program, there may be a modest cost-sharing component, such as a co-payment or contribution towards the cost of care.
Watch a brief animation illustrating how Medicaid supports seniors aging in place.
Understanding Medicaid Home Care Program Costs
The extent to which Medicaid covers in-home care costs varies depending on the state and the specific Medicaid program an individual is enrolled in. Some programs may provide coverage for a personal care assistant for several hours daily or on certain days of the week, adult day care services a few days per week, or respite care services periodically throughout the month.
For consumer-directed care programs, caregivers who are hired by Medicaid recipients are paid an hourly rate that is pre-approved by Medicaid. This hourly rate is established by each state and program and generally tends to be somewhat lower than the prevailing market rate for private home care services.
Medicaid care at home programs represent a vital resource for individuals seeking to maintain their independence and receive necessary care within the comfort of their own homes. By understanding the different program types, eligibility requirements, and covered services, individuals and families can effectively navigate the Medicaid system to access the support they need to age in place with dignity and well-being. It is recommended to contact your local Medicaid office or consult with a Medicaid planning professional for personalized guidance and to explore the specific options available in your state.
