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What is Medicaid home care and how does it work?

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Medicaid is a federal-state joint program which offers health insurance coverage to low-income seniors, children, and those who have disabilities. It also covers care inside a nursing home for the ones who are eligible. Typically, Medicaid home care services offered through community- and home-based services “waiver” programs to people who require a high care level, yet who’d like to stay at home.

Medicaid’s programs are run by the state, and every state offers different rules about how to be eligible. Medicaid is only available to individuals with low income, so each state establishes its own income and asset limits.

Is your loved one qualified for Medicaid home care?

To qualify for Medicaid, and therefore, in-home care, there are requirements which should be met. Is your loved one qualified for Medicaid Home Care? Besides being a resident within the state where one applies, there also are functional and financial needs that have to be met.

Financial criteria for Medicaid home care

While both assets and income are taken into consideration for Medicaid eligibility reasons, the limits differ based on the state where one lives and the program for which a person is applying. To qualify for the state Medicaid program, you have to meet the criteria established for their specific eligibility class. For the purposes of this post, the eligibility class is “disabled, blind, and aged”. In general, the majority of states limit a person’s month-to-month income to either 100 percent of the FPL (Federal Poverty Level) or 100 percent of SSI (Supplemental Security Income)/ FBR (Federal Benefit Rate). A state that uses 100 percent of the Federal Benefit Rate as the income limit permits one applicant up to $1,073 per month, as of 2021. And as of 2021, states using 100 percent of Supplemental Security Income, limits a person’s income to $794 per month. Assets also are considered and are usually limited to $2,000 for a person.

Level of care/functional need

A functional need threshold, (medical need), also must be met for one to qualify for in-home care. For the regular Medicaid (state Medicaid plan), individuals frequently must show a need for assistance with IADL and/or ADL. That includes requiring assistance with transferring from a bed to a chair, mobility, eating, toiletry, doing laundry, bathing, and meal preparation. Precise functional need differs by the program and the state. But as one example, eligibility requirements might require that the applicant need help with one IADL or ADL, help with a minimum of two activities of daily living, or help with three instrumental activities of daily living. To check functional needs, an evaluation is performed. For in-home benefits through regular state Medicaid, individuals don’t necessarily require a level of care to that which is offered in nursing homes.

Within the majority of states family members can be paid for offering care to a recipient of Medicaid. The applicant has to apply for Medicaid and choose a program which allows a recipient to choose her or his own caregiver, oftentimes referred to “consumer directed care.” The majority of states allowing paid family caregivers don’t enable legal spouses and legal guardians to be paid by Medicaid; however, some states will. Some states only pay caregivers if they don’t reside in the same home as a Medicaid recipient.

Story by Brad Bernanke


augusta free press news
augusta free press news


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