Home health services can be expensive. According to the U.S. Department of Health and Human Services, even part-time home health care services can cost in excess of $10,000 per year. Of course, these costs will vary widely, based on the specific services that are needed. With the seemingly ever rising cost of health services, it is no surprise that many families struggle to afford care.
This raises an important question: How do you pay for home healthcare services? While it depends on your specific situation, Medicaid offers a potential solution for families. Unfortunately, understanding Medicaid’s eligibility standards and navigating the application process can be confusing. Here, we explain the most important things that you need to know about Medicaid’s home health qualification requirements.
Medicaid and Home Health Care: Understanding the Eligibility Rules
Medicare is the primary federal health insurance program for Americans who are 65 years and older and for some non-retirement age people who have serious disabilities. However, with limited exceptions, Medicare does not offer coverage for long-term care services—including for most home health care services.
Instead, the key federal government program that covers long-term care—such as home health care—is Medicaid. This program is a key part of our country’s social safety net. In fact, researchers have found that an increasing percentage of Americans are relying on Medicaid to cover at least some of their home healthcare costs (Landers, 2016). The key thing that individuals and families need to know about Medicaid is that it is a need-based program. As such, there are very strict eligibility requirements. To obtain home health benefits through Medicaid, a patient must prove:
- Medical Eligibility: To start, Medicaid coverage is only available to applicants who meet the medical eligibility requirements. To get home health care services through Medicaid, you must be able to submit documentation that establishes that the services are “medically necessary”. Home health care services will only be approved to the extent that they are deemed medically necessary for the patient. If you do not have medical documentation establishing the need for home health care, Medicaid will not authorize coverage.
- Financial Eligibility: Additionally, Medicaid also has financial eligibility requirements. There are both income limits and asset limits, which vary from state to state. Essentially, an applicant who has too much monthly income or too much in total liquid assets may be denied coverage through the program. If you are worried about meeting Medicaid’s financial eligibility requirements, it is highly recommended that you consult with an experienced professional. You may even need to speak to an attorney.
How much will Medicaid actually pay for home health care? The answer is that it depends on your specific medical and financial circumstances. However, in some cases, Medicaid benefits are sufficient to cover the entire cost of home health care benefits. In other cases, Medicaid will only provide partial coverage.
Home Health Care Coverage Must Be Assessed on a Case-By-Case Basis
Getting home health care coverage is complicated. It is an issue that should always be assessed by an experienced professional who can carefully review your individual circumstances and eligibility for public programs. Some states have put additional social programs into place to help cover some of the gaps left by the federal programs.
Beyond that, some patients are eligible to have their medical costs covered under other federal programs. As an example, the Energy Employees Occupational Illness Compensation Program (EEOICPA) and the Radiation Exposure Compensation Act (RECA) are federal programs that provide full medical coverage to people who were affected by the nuclear weapons industry—whether as employees or as residents of testing areas. If you or your loved one developed a serious medical condition and you meet certain criteria, you may be eligible to receive no-cost home health care services through an EEOICPA claim or a RECA claim.
EEOICPA & RECA Beneficiaries May Be Eligible for Free Home Healthcare Services
At United Energy Workers Healthcare and Four Corners Health Care, our experienced, compassionate staff works tirelessly to help EEOICPA / RECA beneficiaries get access to the best available service. Free home health benefits may be available. To get more information, please contact us today. We have office locations throughout the United States.
Sources: LongTermCare.gov, (2017, October 17). Costs of Care. Retrieved from: https://longtermcare.acl.gov/costs-how-to-pay/costs-of-care.html
Landers, S. & Madigan, E. (2016) The Future of Home Health Care: A Strategic Framework for Optimizing Value. Home Health Care Management & Practice Retrieved from: https://journals.sagepub.com/doi/10.1177/1084822316666368