Each state has its own set of eligibility requirements; however, states are only mandated to provide home health services to individuals who receive federally assisted income maintenance payments, such as Social Security Income and Aid to Families with Dependent Children (AFDC), and individuals who are “categorically needy.” Categorically needy recipients include certain aged, blind, and/or disabled individuals who have incomes that are too high to qualify for mandatory coverage but below federal poverty levels.Individuals younger than 21 who meet income and resources requirements for AFDC, yet otherwise are ineligible for AFDC, also qualify as categorically needy.
While home health care agencies are more cost-effective than hospitals, nursing homes and assisted living facilities, you will want to use all of your available resources before paying out of pocket.
Two of the most common sources for home health care funding are Medicare and Medicaid.
What’s important to keep in mind is that just because you may be eligible for Medicare or Medicaid, does not mean they will pay for all the services you want.
Medicaid is administered by individual states, Medicaid is a joint federal-state medical assistance program for low-income individuals.
Hospice is a Medicaid-covered benefit in 38 states.
The Medicaid hospice benefit covers the same range of services that Medicare does.
Medicare - If you are on Medicare, and wish to receive services from a home health care agency, you must meet four specific criteria.
Medicaid covers most health care costs for low income families.
People that have disabilities and qualify for social security disability are automatically covered by Medicaid some states.
Others require a set income and application; (see application for N. Medicaid on Links to Resource) Medicare is different and may not cover certain costs associated with home health care.
Medicare may pay all, most, some, or none of the fees.