What Does Medicaid Reimburse for Home Care?

Most hospitals and other medical care facilities encourage patients to leave as soon as possible --- not because hospital and care facility workers aren't concerned about health, but because they want to ensure the facility is available to patients who truly need it. For this reason, many people who need care turn to home care. Medicaid may pay for some or all of your home care needs.

State Variances

• Medicaid is run by each state. This means that each has different regulations as to what it will and will not include in Medicaid home care. To be sure of what Medicaid will cover for you, contact your Medicaid caseworker or your local Department of Health and Human Services office. Medical suppliers and physicians also can give you an idea of your state's regulations.

Coverages

• In general, based on federal guidelines, Medicaid home care includes medical supplies and equipment, home care aid (HCA) service and nursing. Other coverage may include physical, speech or occupational therapies, medical social services, and audiology, but these are at the discretion of the state. If you opt for hospice, coverage is typically the same as under Medicare. You can usually get coverage under hospice or home care for things like assistance with grooming, showering, meal preparation, respite care, medically-necessary doctor services, equipment like wheelchairs or hospital beds, and medications.

Short Versus Long-Term

• Medicaid coverage applies to both short- and long-term home care. Short-term care would be applicable to such situations as recuperation after surgery. Long-term care generally is applicable to chronic illnesses like diabetes or cancer. Regardless of whether your home care is short- or long-term, a doctor usually has to sign off on your care, necessary medications or equipment.

Consumer Directed and Guardian Care

• Under Medicaid, you may receive one of two types of coverage. The first type of coverage for which Medicaid reimburses is consumer-directed coverage. With this type, the person receiving the benefits makes the decisions about her medical situation and Medicaid funds. The second type is guardian coverage. This type of coverage extends to those who have someone else making medical decisions for them. This sometimes happens when an elderly individual's condition necessitates medical power of attorney.