In-Home Care Through Medicaid

Most people who need long-term care would rather receive it at home. Long-Term Care Medicaid makes that possible in every state, through a mix of regular Medicaid benefits, waiver programs and managed care plans. This guide explains what in-home care Medicaid can pay for, who qualifies, how services are approved and delivered, and the limits families should plan around.

Figures change periodically. Double-check current amounts before relying on them.

The short version

Home health (skilled nursing and therapy visits, and home health aides) is a mandatory Medicaid benefit for people who qualify.
Personal care (help with bathing, dressing, eating and similar tasks) is offered in every state through the state plan, waivers or both.
Home and community-based services waivers add services such as homemaker help, respite, adult day care, home-delivered meals, home modifications and medical alert systems, but can have waiting lists.
Many programs let the person direct their own care, including hiring family members in many states.
Services are based on an assessment of need, and hours are often capped. Medicaid does not pay rent, food or utilities.

Types of in-home care Medicaid can cover

Home health services

Medicaid must cover home health services for people entitled to nursing facility services, and states cover them for other groups too. Home health includes part-time skilled nursing, home health aide services, and medical supplies and equipment, ordered by a doctor or other practitioner. Physical, occupational and speech therapy may also be covered.

Personal care services

Personal care, sometimes called attendant care, covers hands-on help with activities of daily living: bathing, dressing, grooming, eating, toileting, transferring and mobility. It may also include related tasks, such as meal preparation, light housekeeping and laundry. States offer personal care through:

the state plan personal care option, available to everyone who qualifies without a waiting list;
Community First Choice (section 1915(k)), a state plan option for attendant services;
HCBS waivers (section 1915(c)), which often include personal care along with other services.

Waiver services

Waivers can include a wide range of services designed to keep people at home, such as:

homemaker and chore services;
respite care for family caregivers;
adult day care;
home-delivered meals;
personal emergency response systems;
home modifications (ramps, grab bars, widened doors);
specialized medical equipment and supplies;
transportation;
case management;
caregiver training;
assistive technology.

See HCBS waivers.

Who qualifies

Financial rules

In-home care through waivers and many state plan programs uses rules similar to nursing home Medicaid:

an asset limit (often $2,000 for one person; where the single limit is $2,000, a couple who both apply can usually keep $3,000);
an income rule, often the special income limit of $2,982 a month in 2026 for waiver programs, with a Miller trust in some states if income is higher, or a medically needy approach;
spousal protections for married applicants;
the look-back for gifts, in most states, for waiver services.

Some state plan personal care programs are available to people who qualify for regular Medicaid, with different financial rules.

Functional need

Most waivers require that the person meet the state’s nursing-home level of care. State plan personal care often uses a lower threshold, such as needing help with a certain number of daily activities. A nurse or social worker assesses the person’s needs. See Who qualifies for in-home care?.

How services are approved

Apply for Medicaid (or the specific program) and request an assessment.
Assessment. An assessor visits, asks about daily activities, health and supports, and may observe the person.
Service plan. A case manager or care coordinator develops a person-centered plan listing services and hours.
Provider selection. The person chooses an agency, or hires their own caregiver if self-direction is offered.
Services begin. Reassessments happen periodically or when needs change.

If the approved hours seem too low, the person can ask for a reassessment or appeal through a fair hearing.

Agency care vs. self-directed care

Most programs offer two ways to receive care:

Agency-directed. A licensed home care agency hires, trains, schedules and supervises the aides.
Self-directed (consumer-directed). The person, or a representative, hires, trains and supervises their own caregivers, often with help from a fiscal agent who handles payroll. Many states let family members be hired. See Consumer-directed care and Getting paid as a family caregiver.

Limits to plan for

Hours caps. Programs usually approve a set number of hours per week based on assessed needs and program limits. Round-the-clock care is rarely covered.
Cost limits. Some waivers cap the total cost of services, sometimes relative to nursing home costs.
Waiting lists. Waivers can cap enrollment.
Workforce shortages. Even with approval, finding aides can be hard in some areas.
No room and board. Medicaid does not pay rent, mortgage, food or utilities at home.

Medicare home health vs. Medicaid home care

Medicare covers home health only for people who are homebound and need intermittent skilled care, and it does not cover ongoing personal care alone. Medicaid can cover ongoing personal care. Many people have both, with Medicare covering skilled visits and Medicaid covering personal care. See Medicaid vs. Medicare for long-term care.

A simple example

Walter, 79, lives with his wife, Betty. He has Parkinson’s disease and needs help with bathing, dressing and getting in and out of bed. Betty is 76 and cannot lift him. Walter applies for his state’s waiver. Because he is married, the spousal rules protect a share of the couple’s assets and income for Betty. After the assessment, the waiver approves 28 hours a week of personal care, adult day care twice a week, a stair lift and a medical alert system. Walter chooses self-direction and hires a neighbor as his aide. Betty handles evenings and weekends.

Getting help

The local Area Agency on Aging and the state Medicaid agency can explain home care programs. A Certified Medicaid Planner can help with the financial rules, especially for married couples, and with timing the application.

Frequently asked questions

Does Medicaid pay for 24-hour home care? Rarely. Some programs approve high hours for people with very high needs. Families often fill gaps.

Can my daughter be paid to care for me? In many states, yes, through self-directed programs. Spouses can be paid in some states and programs.

Is there a waiting list? State plan personal care generally has none. Waivers may.

Do I have to be homebound? Not for Medicaid personal care or waiver services. Medicare home health requires being homebound.

Key terms

Personal care: hands-on help with activities of daily living.
Home health: skilled nursing, therapy and aide services ordered by a practitioner.
Service plan: the written list of approved services and hours.
Self-direction: a way of receiving services in which the person hires and manages their own caregivers.
Electronic visit verification (EVV): a federally required system that records home care visits.

Preparing for the assessment

The assessment decides how many hours are approved, so preparation matters:

keep a week-long diary of the help the person needs, including nights;
list falls, hospital visits and near-misses;
describe the worst days, not just the best;
have the family caregiver present to explain what they do;
bring a list of medications and diagnoses;
ask what services are available and how the hours were calculated.

Common mistakes

Downplaying needs during the assessment.
Not asking about state plan personal care while waiting for a waiver slot.
Not having a backup plan when an aide does not show up.
Not appealing a reduction in hours.

A second example: living alone

Doris, 86, lives alone in an apartment. She has macular degeneration and arthritis and needs help with bathing, cooking and housework, but she is mentally sharp and wants to stay independent. She qualifies for her state’s personal care program under the state plan, which has no waiting list, while she waits for a waiver slot. The state plan program approves 15 hours a week of personal care through an agency. When her waiver slot opens six months later, she adds home-delivered meals, a medical alert pendant and a weekly homemaker visit. A neighbor checks on her each evening. Doris stays in her apartment with a mix of paid and informal help.

When home care is not enough

Sometimes needs grow beyond what home care can safely provide, for example when a person needs help several times every night or wanders. Signs that it may be time to consider another setting include repeated falls, missed medications despite reminders, caregiver exhaustion and frequent hospital visits. Moving to assisted living or a nursing home in these situations is a reasonable choice. The case manager can help compare options.

A person can also move between settings more than once; returning home after a facility stay is possible with the right supports.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.