What are Home Health Services under Medicaid?

As individuals seek ways to access healthcare services in the comfort of their own homes, Medicaid stands as a crucial resource for many. Understanding what home health services are covered under Medicaid can provide clarity and support for those in need. Let’s delve into a comprehensive guide to home health services under Medicaid:

What are Home Health Services?

Home health services encompass a range of medical and non-medical care provided to individuals in their homes. These services are designed to help individuals recover from illness or injury, manage chronic conditions, and maintain their independence. Home health services can include skilled nursing care, physical therapy, occupational therapy, speech therapy, personal care assistance, and more.

Coverage Under Medicaid

Medicaid, a joint federal and state program, provides health coverage to millions of low-income individuals and families in the United States. While Medicaid is administered by the states, it must adhere to federal guidelines regarding covered services. Home health services are typically covered under Medicaid, but coverage specifics may vary by state.

Eligibility Criteria

Eligibility for home health services under Medicaid is based on several factors, including income, assets, and medical necessity. Generally, individuals must meet their state’s income and eligibility requirements to qualify for Medicaid-covered home health services. Additionally, individuals must require skilled care or assistance with activities of daily living to qualify for these services.

Covered Services

Home health services covered under Medicaid may include, but are not limited to:

  • Skilled nursing care
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Medical social services
  • Personal care assistance (such as help with bathing, dressing, and grooming)
  • Home health aide services
  • Medical equipment and supplies

Care Plan and Coordination

Before receiving home health services under Medicaid, individuals typically undergo an assessment to determine their care needs. A care plan is then developed in collaboration with the individual, their healthcare providers, and the Medicaid-approved home health agency. The care plan outlines the specific services and supports that will be provided to meet the individual’s healthcare needs.

How to Access Services

To access home health services under Medicaid, individuals can contact their state’s Medicaid agency or local Medicaid office for information on eligibility and enrollment. Once approved, individuals can work with their healthcare providers to coordinate the necessary services and supports.

Conclusion

Home health services under Medicaid play a vital role in supporting individuals’ health and well-being in their own homes. By understanding the coverage available and the eligibility criteria, individuals can access the care they need to recover from illness, manage chronic conditions, and maintain their independence. If you or a loved one may benefit from home health services under Medicaid, explore your options and reach out to your state’s Medicaid agency for assistance.

What are the quality ratings for hospice?

Medicare is intentional to provide open and transparent information about agencies that serve hospice as part of the Medicare benefit.

Agencies must convey the typical conditions they treat and therefore can claim expertise in providing services for end-of-life. Diagnoses that are typically identified for hospice services under Medicare include:

  1. Cancer
  2. Renal Failure
  3. Dementia
  4. Cardiac Disease
  5. HIV/AIDS
  6. Liver Disease
  7. Pulmonary Disease
  8. Neurologic Disease
  9. Stroke or Coma

Medicare requires agencies display where they provide services. This information is different from where they are eligible to provide services. Typical location include: home, assisted living facility, skilled nursing facility, inpatient hospital facility, inpatient hospice facility, or other locations.

Hospice includes 4 levels of care. Those are:

a) Routine home care which is the most common and is provided with the patient is generally stable and symptoms are adequately controlled.

b) General inpatient care is a crisis-like level of care that is implemented for the short-term to support controlling pain and other symptoms. It is usually provided in the hospital or skilled nursing facility.

c) Continuous home care is a crisis-like level of care that is implemented for the short-term to support out of control pain and symptoms in the home setting.

d) Respite care is a temporary care level in a nursing home, hospice facility, or hospital to allow a family member or caregiver some time off. This level of care is not tied to the patient’s symptoms.

Hospice agencies must report what levels of care they engage in to support their patients.

Another rating is the family and caregiver experience. This rating involves the family review of communication, timeliness of services, respect for the patient, providing emotional and spiritual support, help with pain and symptoms, the training provided for the care of the patient, an overall rating, and the willingness to recommend the agency.

Medicare reviews all agency documentation and identifies the completeness of the initial nursing assessment and the visit frequencies from a nurse or social worker in the last 3 days of life. Medicare will also identify if the agency is accepting Medicare, Medicaid, and/or Medicare Advantage patients, as well as report on average how long people access hospice services through the particular agency.

For example, Elite serves both Medicare and Medicaid patients, as well as Medicare Advantage Plan recipients. Patient with Elite’s hospice services are typically receiving hospice for 56 days. The information is updated with Medicare review and state surveys. If you would like to review agencies that you are considering for hospice services, please go to medicare.gov/care-compare/