All 50 states have at least one Medicaid/Medicare program that provides financial support to individuals living outside of nursing homes. However, a person must meet very specific criteria before qualifying for a state-sponsored home care program. One of the qualifications is the level of care the patient needs. For example, homebound patients typically require skilled care at home, and if they cannot cover the cost of hiring a private duty nurse, they will most likely qualify for their state’s home health care waiver program. Fortunately, even if someone does not qualify for a Medicare home health care program, they may still be eligible for a Medicaid HCBS (Home and Community-Based Services) waiver program.
How to Qualify in Florida
To qualify, one must meet the following criteria:
- Be under the care of an attending physician and have a physician’s order for home health services
- Have a medical condition or disability that substantially limits your ability to perform everyday living activities
- Require services that can be safely, effectively, and efficiently provided in the home or other authorized setting
- Be certified as homebound by your doctor/nurse
Types of Programs Covered by Medicaid
As of October 2021, the services covered by Medicaid/Medicare for individuals living at home or in a facility extend beyond simple home health care services like companionship or light housekeeping. Medicare/Medicaid covers a variety of services, which are personalized for each patient and delivered on an as-needed basis. The list of services is long & updated frequently, so make sure to stay on top of it by checking out Medicare’s official home health services page here.
Home health care
This is the simplest and most common form of home care that Medicaid covers for eligible individuals. Simply put, home health care consists of non-medical services provided by trained caregivers, though other health providers with medical training, such as nurses and doctors, may sometimes be involved.
Personal care
Personal care is also one of the most common forms of care that Medicaid covers. It is offered to individuals who cannot handle their day-to-day living activities and/or need support with them. These activities include personal hygiene, dressing, eating, transferring/assistance with mobility, and maintaining continence. Most states cover personal care via Medicaid.
Homemaker services
Homemaker services include assistance with everyday household chores such as light housekeeping, cooking, cleaning, moving furniture, grocery shopping, and meal prep. Homemaker services may overlap with other types of care; for example, it is very common to see overlap between homemaker & home health care programs. In fact, certain states use the two terms interchangeably, and some states combine both programs into one.
Family and caregiver assistance
This program has recently been recognized as one of the most important for maintaining stability in a home living environment. It includes respite care, short-term relief for primary caregivers. Qualifying for this program shouldn’t be a problem, as it is included in almost every Medicaid-sponsored relief program in almost all states.
Accessibility in home & environment
This program is for those who need special accessibility modifications such as installing car ramps or grab bars at home. It is typically partially funded by Medicaid, though eligibility & coverage vary.
Medical equipment & supplies
This program is for individuals who require specific medical supplies to maintain their independence & health. It is partially funded by Medicaid.
Hospice care
This program is reserved for terminally ill individuals who are expected to live no more than 6 months. Eligibility varies, though in most cases individuals can qualify if they can show that staying at home will be more beneficial than staying in a hospital or an assisted living facility.
Home health care services covered by Medicaid
Part-time skilled nursing care
Physical therapy
Occupational therapy
Speech-language pathology services
Medical social services
Part-time or intermittent home health aide services
Injectable osteoporosis drugs for women
Services that aren’t covered by Medicaid
Around-the-clock care at home
Ready-made meals delivered to your home
Homemaker services if they are the only care that you need
Personal care if it is the only care that you need
