Are You Eligible For Respite Care?

What Exactly Is Respite Care—and Why Does It Matter?

Respite care gives unpaid, primary caregivers—often spouses or adult children—a much-needed break from their caregiving duties. These caregivers frequently work long hours without time off, leading to physical, mental, and emotional exhaustion. By providing temporary relief, respite care helps caregivers recharge, handle personal tasks, or even take a vacation without worrying about their loved one’s safety.

How and Where Can Respite Care Be Provided?

It can be arranged for emergencies or short-term relief and may last from a few hours to a couple of weeks. Services can be delivered at home or in a community setting, such as adult day programs, assisted living residences, or nursing facilities. Respite providers may offer supervision, companionship, personal care, housekeeping, transportation, medication management, and sometimes basic medical support. Many are also trained to address Alzheimer’s- and dementia-related behaviors like wandering, agitation, or confusion.

Will Medicaid Actually Pay for Respite Care?

Yes—nearly all states, plus the District of Columbia, offer Medicaid-funded respite care for seniors. Exceptions include Illinois (no respite for the aged), Kansas (may be available only through certain managed care plans), and West Virginia (no respite for the aged or disabled). Even in these states, Medicaid may still cover adult day care, which can serve as a form of respite.

Which Medicaid Programs Cover Respite Services?

Option 1: HCBS Medicaid Waivers (1915(c))

Most respite care coverage comes through Home and Community Based Services Waivers. These waivers provide supports to help people remain at home or in the community instead of moving into nursing homes. They often target specific groups, like seniors, people with disabilities, or those with dementia. Slots are limited, and waitlists are common.

Option 2: Section 1115 Demonstration Waivers

These pilot programs let states experiment with expanding HCBS options, including respite care. Like 1915(c) waivers, enrollment may be capped.

Option 3: Medicaid State Plan

Some states provide respite through their Regular Medicaid or State Plan Options. These are entitlements—if you qualify, you receive services without a waitlist. The 1915(i) HCBS State Plan Option and 1915(k) Community First Choice programs can both include respite services. Note: CFC typically requires a nursing home level of care.

What Are the Eligibility Rules for Medicaid-Funded Respite?

Requirements vary by program and state. Typical 2025 guidelines:

• HCBS Waivers: Income ≤ $2,901/month (300% of SSI), assets ≤ $2,000, and nursing facility level of care required.
• State Plan Medicaid: Income ≤ $967/month (100% SSI) or ≤ $1,304/month (100% FPL), assets ≤ $2,000, and a documented medical need for respite. CFC option also requires nursing facility level of care.

How Much Respite Care Will Medicaid Provide?

It depends on state policy and program type. Examples:

• Arkansas (ARChoices Waiver): Up to 1,200 hours/year (about 50 days).
• California (Medi-Cal Managed Care): Up to 336 hours/year (14 days).
• New York (NH Transition & Diversion Waiver): Up to 30 days/year in 24-hour blocks.
• Tennessee (CHOICES Waiver): 216 hours/year in-home and 9 days/year inpatient respite.

Some states set limits based on an individual care assessment rather than fixed caps.

Respite Care at a Glance: Eligibility & Coverage (2025)

Note: Program names, limits, and eligibility can change annually. Always confirm your state’s current respite care policies.