Who Qualifies For Home Health Care?

Home health care refers to an umbrella of medical support services provided in the home for people recovering from illness or injury. Its aim is to enable these people to get back up and remaining living safely within their own environments as much as possible, such as nurses and physical therapists providing treatment; along with personal care aides that help with basic tasks like bathing, eating, grooming and using the bathroom if required. Home health aides typically follow a “plan of care” created by doctors which they adhere to based on each patient’s individual needs; coverage can include Medicare/ Medicaid as well as some private health policies.

In order to qualify for home health care, seniors and their family must first meet with a doctor and discuss whether the proposed treatment plan is necessary and suitable. A physician should reevaluate their patient regularly to make sure it works as planned. Once an appropriate plan has been created, financing options such as Medicaid, long-term care insurance policies or private payments or reverse mortgage can be discussed as financing solutions for home health care services.

Medicare Part A and B each cover home health care coverage, providing individuals who qualify with skilled nursing and/or rehabilitative therapy services (such as physical therapists). Medicare home health care eligibility depends upon meeting certain criteria – for instance needing skilled nursing and/or rehabilitation therapies after injury or surgery for example). To qualify, certain criteria must be fulfilled to qualify – this could include needing skilled nursing assistance as well as rehabilitation therapy services from physical therapists or even an occupational therapist to learn to walk again after being injured.

Medicare’s home health benefit provides more than rehabilitation, covering medical social services, durable equipment and supplies, home health aide services as well as some state programs providing additional in-home health care for seniors who do not meet Medicare criteria.

Medicaid programs vary, but most provide home health services to eligible seniors. In New York State, for instance, the Personal Care Services Program (PCSP) assists seniors with personal care needs both at home or in adult foster care homes, residential care facilities, memory care units, assisted living communities or other community settings. It’s available to New York State Medicaid beneficiaries enrolled in either PACE or Managed Long-Term Care who meet eligibility requirements; to participate, your doctor must submit a request form and a nurse assessor will visit to evaluate your need and visit you personally in person to assess what services may be necessary to meet those needs.

Many seniors who receive home health services pay privately for caregivers either with their own money, private insurance policies or reverse mortgages, or through reverse mortgages. Many private insurers offer plans allowing beneficiaries to select and direct the services they receive, while Medicaid programs that permit “Consumer Direction” of personal care/attendant care may permit recipients to hire friends or family as in-home assistants; provided timesheets and compliance rules are adhered to; for more information about this option please reach out directly to your local Medicaid agency.