Does Medicaid Pay For Long-term Care in the Home?

Medicaid provides important benefits for seniors and other individuals who are unable to care for themselves and who need long-term care. While many seniors benefit from Medicaid coverage to help pay the cost of a nursing home, there are also situations where a senior or his/her family members want to ensure that their loved one remains at home for as long as possible. In these situations, the key question becomes whether or not Medicaid will pay for in-home care.

As with many government benefit programs, the answer is – it depends.    There is no guarantee of eligibility for home care through Medicaid.   Several Medicaid Waiver programs exist that provide a variety of supportive services for qualified individuals who would otherwise require nursing home placement without those services.  Medicaid Waiver programs are not the same in every locality.

To qualify for a Medicaid Waiver program that will assist with in-home care, the person must generally meet the same medical and financial criteria for eligibility as required for assistance with nursing home costs (the Institutional Care Program, or “ICP”).    To determine if the applicant meets the medical criteria, Medicaid will evaluate such things as what medicines the person takes, what diagnoses they have, and their need for assistance with activities of daily living, such as bathing, dressing, feeding, toileting and transferring.  Typically, you will need to show that if you did not receive Medicaid to pay for home care, you would no longer be able to live at home and would need to move into a nursing home.

The applicant must have limited income and assets.  The same income and assets rules apply for Medicaid Waiver programs as for the nursing home program.

If the person in need of care, or their spouse, has transferred/given away, assets within sixty months of applying for benefits, the transfer can make them ineligible for benefits for a period of time.  The rules regarding transferring assets are very complex.  They are not based on common sense so do not rely on good old logic to try to figure it out.  Before giving anything away, or if you have already given assets away within the last sixty months, you should definitely not apply for Medicaid or any government benefit program without first seeking legal advice from an elder law attorney.  Filing an application for benefits at the wrong time can actually extend the period of ineligibility beyond five (5) years!

Funding for Medicaid Waiver programs for in home services is limited.  Even if a person meets the medical and financial requirements for eligibility, at any given time the program may be out of money.  In those situations, the person is put on a waiting list.  Funding can be at irregular intervals and in varying amounts.  There is no way to know how long a person will remain on the waiting list.  When funding is available those on the waiting list in the greatest need receive priority.

Another important consideration for families is that even when a person is approved and receiving Medicaid Waiver benefits, it does not pay for round the clock care.  The recipient must have a primary caregiver.  Medicaid waiver programs provide “supportive services” not complete care.  Services provided can vary from one person to the next.  A case manager will evaluate the applicant and determine their needs and determine the services to be provided.

An elder law attorney can help with the process of Medicaid planning to ensure eligibility for benefits.