Who Qualifies For Home Health Care Services?

Medicare will pay for home health care if it can verify that you need short-term skilled nursing or therapy and that you are homebound, meaning you cannot leave without significant effort and have need of assistance in doing so (i.e. using assistive devices, special transportation needs or help getting out of bed or walking). Your doctor must sign a plan of care which details which services will be provided – office visit, hospital visit or video conferencing may all qualify –

Home health care can help people recover from illness or surgery in the comfort of their own home while remaining as independent as possible. Medicare, Medicaid and some private insurers offer home health services, yet many people remain unclear whether they qualify. Qualifying for home health services will depend upon an individual’s specific medical needs as well as state regulations.

Non-medical home care services are not subject to as stringent regulation as medical home health care services, yet still offer assistance with everyday tasks like bathing, grooming, meal preparation, running errands and cleaning. Non-medical care may be provided through agencies or family or friends and often does not require a doctor referral; non-medical services may even be covered under long-term care insurance policies and veterans can qualify for Aid and Attendance benefits through the Department of Veteran Affairs.

Medicaid eligibility varies by state and is determined based on an individual’s financial circumstances. As of 2023, regular state Medicaid (also referred to as original or classic Medicaid) sets an income limit at 300% of Supplemental Security Income (SSI), though waivers and LTSS Demonstration Waivers may provide higher limits; for more information regarding eligibility please reach out directly to your state Medicaid program.

Home healthcare provided by doctors (such as nurses or physical therapists ) typically involves wound care, injections and teaching patients how to take care of themselves at home. Yount emphasizes this type of home health care helps patients return to normal routines following hospital stays or recoveries from injury, says Yount. Home health aides may assist with daily tasks like bathing, grooming and dressing until you’re capable of doing them on your own or are supported by caregivers.