In-Home Senior Care: Navigating Medicaid Coverage and Qualification Process

Is in-home senior care covered by Medicaid?

Yes. In-home senior care is covered by Medicaid. You would have to meet the requirements financially and clinically.

From a clinical perspective, qualifying is based on your physician referral and then an assessment made by your Managed Care Organization (MCO).

To qualify for nursing or home care services, a person must have a monthly income below 300% of the FBR or $2,313 in 2019 and a total resource value below $2,000 after excluding $6,000. Countable resources include cash and investments. If the income is higher than 300% of the FBR, the person can still qualify for nursing services if the income is less than $2,550 after medical expenses or if the resources are less than $2,400. The care services can only start after the provider gets a PA 162 notice from the CAO. The CAO cannot retroactively approve any services in the CHC Waiver.

What is included in home health aide services?

Home care services include assistance with meal prepping, daily activities such as assistance with laundry, light housekeeping, and companionship. The caregivers may assist with bathing and dressing. Also, incontinence care. They can assist with mobility as well as transfers, whether it be transferred from bed to wheelchair from wheelchair to a seat. The caregivers are trained to do those types of things with the clients.

What is the process to receive in-home care for my loved one?

To receive in-home care for a loved one it is a process that can vary from person to person. The process can take up to 90 days, depending on what is needed and required by the state agencies. Essentially, we’ll make a phone call and start the application. The Area Agency on Aging will come and do an assessment, and they will need a form from the physician that has to correlate with the assessment from the Area Agency on Aging to determine that they are clinically eligible. Once deemed clinically eligible, the case will move forward to the County Assistance Office for financial eligibility. Once the consumer is deemed clinically and financially eligible, a service coordinator will be assigned and come out to do the last assessment to determine how many hours are approved. Once the hours are approved, the agency will then provide an agency caregiver, or if there is a family member who would like to be the caregiver, we would essentially onboard them and hire them through our agency to start the services.

How does someone qualify for in-home care?

To qualify for in-home care, through the process, we would work with the clients and with the state agencies to ensure that the process is moving along and make sure that they are clinically and financially eligible. Clinically eligible is when the assessor from the Area Agency on Aging has agreed that you are in need of home care services, and that will also correlate with what the physician has filled out on the form. Once deemed clinically eligible, then the financial eligibility will also come from the state. From my experience, clients who are under $2,700 a month, as well as $8,000 in assets, have been deemed clinically eligible for services. However, there are other programs and options that our intake department will facilitate and assist with the process to ensure that we are able to provide some type of services.