Being cared for in the familiar walls of one’s own home is an invaluable option that lets people live with dignity, independence, and comfort. However, the financial strain of long-term care can be a major hurdle. Many families face the difficult task of finding quality care for their loved ones, often worrying about how they’ll manage to cover the costs.
Fortunately, Medicaid can help ease the burden for many. By taking the time to understand and maximize Medicaid programs, families can access the support needed to ensure their loved ones receive the best possible care. Here’s what to know about Medicaid-funded home care.
What is Medicaid, and how can it support long-term care?
Medicaid is a joint federal and state program that helps cover healthcare costs for low-income individuals, including those who need long-term care due to disabilities or chronic conditions.
Unlike Medicare, which is primarily for older adults and focuses on short-term, medically necessary care, Medicaid is a needs-based program that can provide vital support for those who wouldn’t otherwise be able to afford long-term care services.
Let’s take a closer look at some of the key Medicaid programs that can provide the financial support needed for in-home, long-term care.
Key Medicaid programs for long-term care at home
Medicaid offers several programs that can help individuals afford to stay in their own homes while receiving the care they need. These programs are designed to provide support and flexibility, allowing seniors and individuals with disabilities to live independently and with dignity.
While program names and availability vary from state to state, there are a few key ones to know and consider, including:
Regular State Medicaid
Regular state Medicaid is available in every state and provides essential health benefits for low-income individuals, including those who need long-term care.
States are required to offer home health services to those in need, which can include skilled nursing care and other medical services in the home. While not federally mandated, many states also offer personal care assistance—help with daily activities like bathing, dressing, and eating—through their regular Medicaid plans.
Community First Choice (CFC)
The Community First Choice (CFC) option, made available by the Affordable Care Act under Section 1915(k), allows states to offer home and community-based attendant services and support, including for activities of daily living (ADLs), such as grooming, mobility, meal preparation, and light housekeeping. This program is designed to help individuals who would otherwise need to move to an institution for care to stay in their own homes.
Currently, nine states have implemented the CFC option: Alaska, California, Connecticut, Maryland, Montana, New York, Oregon, Texas, and Washington.
HCBS State Plan
The Home and Community-Based Services (HCBS) State Plan option under Section 1915(i) allows individuals to receive a combination of medical services, such as skilled nursing services, and long-term services, like respite, supported employment, and even home modifications to improve safety and accessibility.
What’s unique about this option is that, unlike some other Medicaid programs, it doesn’t require individuals to need a nursing home level of care to qualify. However, states can target these services to specific groups, such as those with Alzheimer’s or frail seniors, to ensure they get the support they need to avoid institutional care.
HCBS Medicaid Waivers
Home and Community-Based Services (HCBS) Medicaid Waivers, also known as Section 1915(c) Waivers, provide another way to access in-home care through Medicaid.
These waivers are designed for those who prefer to receive long-term care services and support in their home or community, rather than in an institutional setting. States can offer a range of unlimited medical and non-medical services under this program, including homemaker, personal care, adult day health services, and respite care. However, it’s important to note that these waivers are not guaranteed, and there may be waiting lists due to limited availability.
Program of All-Inclusive Care for the Elderly (PACE)
While PACE is technically a Medicare program, it’s an option for long-term care that some states integrate with Medicaid. The program offers a comprehensive range of services for seniors who meet certain criteria, including medical care, social services, and in-home support.
Consumer Directed Care
Many states also have Medicaid programs that provide support for recipients who want to have more control over their in-home care. Consumer-directed care, or self-directed care, allows individuals to hire, train, and manage their caregivers, which can include friends, family members, or other trusted individuals.
Consumer-directed home care is available under different names depending on the state. For instance, in New York, it’s known as the Consumer Directed Personal Assistance Program (CDPAP). To receive funding for this care, individuals typically need to qualify for Medicaid and demonstrate that they, or a designated individual, can manage the responsibilities of being an employer, which includes training and supervising their caregivers.
How to maximize Medicaid benefits for home-based care
Medicaid-funded home care can be life-changing but navigating its benefits can be complex. Here’s how to approach it:
1. Assess your needs.
The first step is to thoroughly assess the specific care needs of yourself or your loved one. Consider not only physical needs—such as medical services or assistance with ADLs—but also emotional and social needs. For instance, is there a need for companionship or community involvement? Understanding the full spectrum of requirements will help you determine the level and type of care necessary and ensure that the Medicaid services you choose are the right fit.
2. Understand your state’s Medicaid offerings.
Medicaid programs and benefits can vary significantly by state. It’s crucial to understand what’s available in your local area, as each state has different eligibility rules, benefits, and application processes. Research your state’s Medicaid website or local resources to get a clear picture of the options available to you.
3. Apply for the right programs.
Once you have a clear understanding of your needs and the available Medicaid programs, the next step is to apply for the right ones.
This process typically involves gathering necessary documentation, such as proof of income, medical records, and identification. Make sure to fill out the application forms accurately and completely to avoid delays. Be prepared to provide detailed information about the type of care needed and how it aligns with Medicaid’s eligibility requirements.
If you need extra help with this process, CDChoices can refer you to a Medicaid Managed Long Term Care Plan that we work with, who will assist you with the application, eligibility requirements, and more.
4. Consider working with a Medicaid planner or specialist.
Seeking assistance from a Medicaid planner or specialist can also be valuable. These professionals have a deep understanding of Medicaid eligibility and work to help you structure your finances, prepare necessary documents, and maximize your benefits. They can also offer guidance on how to plan for future needs and make adjustments to your care plan as necessary.
If that sounds like the support you need, we here at CDChoices can get you in touch with financial planners who specialize in ensuring you can still receive your income and assets while getting on Medicaid.
5. Regularly review and update care plans.
Medicaid benefits and personal needs can change over time, so it’s important to regularly review your care plan and coverage. Periodically review the care being provided to ensure it still meets your needs and check if there are any changes in Medicaid benefits or program offerings. Remember, staying proactive will help you make sure that you’re always receiving the best possible support for home care.
Taking control of your long-term care needs
Navigating getting Medicaid funding for home care can feel overwhelming, but understanding your options is the first step toward a comfortable and supportive care experience. While the process might seem complex, you’re not alone. There are numerous resources and support systems available to guide you.
As an enrolled provider within the New York State Medicaid-funded CDPA, we here at Consumer Directed Choices are dedicated to empowering consumers to enjoy greater autonomy and independence by deciding their own course of care. Whether you have questions about eligibility, benefits, or navigating the system, we’re just a call or click away.
