Are You Eligible For In-Home Care?
Will Medicaid Really Pay for In-Home Care?
Yes—every state offers Medicaid-funded in-home care in some form. While Medicaid has long covered nursing home care for those meeting functional and financial needs, in-home care provides an alternative for people who wish to stay in their own homes or community settings. It helps seniors maintain independence and is often more cost-effective for states than institutional care.
Can You Choose Your Own Caregiver?
In many states, yes. Under models called consumer-directed care, self-directed care, participant-directed care, or cash and counseling, beneficiaries can select and hire their caregivers—including relatives, and in some states, even a spouse. This allows Medicaid to directly pay family members to provide personal care.
Where Can Medicaid In-Home Services Be Provided?
“Home care” under Medicaid may include one’s own home, a relative’s or friend’s home, an adult foster care home, or even an assisted living residence—depending on state rules and the specific Medicaid program.
Which Medicaid Programs Can Pay for In-Home Care?
Option 1: Regular State Medicaid (State Plan)
Known as Original Medicaid or Classic Medicaid, this program must cover medically necessary home health care. Many states also add optional personal care services, such as help with bathing, dressing, and eating. State Plan programs are an entitlement—if you meet the criteria, you receive benefits without a waitlist.
State Plan Options That May Cover In-Home Care
- 1915(k) Community First Choice (CFC): Offers attendant services for Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), such as mobility help, grooming, toileting, meal prep, and light housekeeping. Currently in 9 states: AK, CA, CT, MD, MT, NY, OR, TX, WA.
- 1915(i) HCBS State Plan Option: Covers supports like skilled nursing, adult day health, respite care, and home modifications without requiring nursing home level of care. Can be targeted to specific groups at risk of institutionalization.
Option 2: HCBS Medicaid Waivers (1915(c))
These waivers fund services to help people remain at home or in the community instead of entering nursing homes. They generally require a nursing home level of care. Services can include adult day programs, companionship care, assistive technology, personal emergency response systems, and more. Slots are limited and waitlists are common.
Option 3: Section 1115 Demonstration Waivers
States use these pilot programs to test and expand Medicaid service delivery. They can offer in-home supports and may sometimes reduce waitlists, though not always.
What Are the Financial Eligibility Rules for Medicaid Home Care?
Limits depend on the program type and state. Typical 2025 rules:
- Regular State Medicaid: Income limit is usually ≤ 100% of Federal Poverty Level ($1,304.17/month) or ≤ 100% of SSI/Federal Benefit Rate ($967/month). Asset limit is typically $2,000.
- HCBS & 1115 Waivers: Often use the same limits as Institutional Medicaid—≤ 300% of SSI ($2,901/month) and ≤ $2,000 in assets.
Some assets, like a primary home, vehicle, household goods, and certain personal items, are exempt. Planning tools such as Miller Trusts, Medicaid Asset Protection Trusts, Irrevocable Funeral Trusts, and Medicaid-Compliant Annuities may help applicants qualify—but asset transfers within Medicaid’s 60-month look-back can cause penalties.
What Functional or Medical Needs Must Be Proven?
Eligibility requires demonstrating a need for help with ADLs/IADLs, such as bathing, dressing, toileting, mobility, laundry, cooking, or shopping. Requirements vary by state:
- Regular Medicaid: Often requires need for help with one or more ADLs/IADLs.
- HCBS Waivers & CFC Option: Usually require nursing home level of care.
Most programs require a functional assessment and, in many cases, physician verification.
Which Home Care Providers Accept Medicaid?
Not all do. Each state maintains a list of approved providers. Many programs also allow consumer direction, so beneficiaries can choose qualified friends or relatives as paid caregivers.
What Services Can Medicaid Cover in the Home?
Available services vary by state and program, but may include:
- Help with ADLs: bathing, mobility, dressing, eating, toileting
- Help with IADLs: shopping, laundry, housekeeping, meal preparation
- Assistive technology and durable medical equipment
- Home modifications for safety and accessibility
- Vehicle modifications
- Skilled nursing care
- Adult day care or health services
- Respite care
- Transportation (medical and non-medical)
- Therapies: physical, speech, occupational
- Meal delivery and congregate meals
- Personal emergency response systems
- Structured family caregiving
- Transitional services from nursing home to community
Note: Medicaid will not pay for room and board in assisted living or adult foster care.
How Much Will Medicaid Actually Pay for In-Home Care?
Coverage amount depends on state rules, program type, and assessed care needs. Medicaid may cover a few hours per week of personal care, multiple days of adult day care, or respite care several times a month. Consumer-directed caregivers are paid at state-approved rates, which are usually slightly below market rates.
Medicaid In-Home Care at a Glance (2025)
| Eligibility Snapshot | Common Services Covered |
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Note: Income and asset limits vary by state and program; verify your state’s current Medicaid rules.
