Does Medicaid pay for home care?

And speaking of "narrow eligibility"...... TX last year 7-15-16 changed claims for payment requirements. Effective 10/1/17 provider has to be enrolled in NPI for Medicaid for orders or referrals written that would involve placement onto / into a Medicaid program to be accepted (Title 42, S 455.440). And they had to have their Medicaid vendor # on orders. Ditto for claims for RXs dispensed from a pharmacy. Both into effect 10/01/17. TXHHS just did an enrollment delay for the requirement due to Harvey in an email yesterday. But it will go back once all things Harvey get more settled & set for Jan 2018.

This is gonna be interesting..... if it means elder has to see a doc who takes "duals" in order to get orders for admission into a Medicaid participating NH / skilled nursing care facility OR other Medicaid paid programs,  folks are going to need to find a new MD. A lot of docs do not take Medicaid at all. A lot of Medicare Advantage plans do not enroll those on Medicaid. If TX can do this and show deceased costs, other states will follow. Not pretty.

Worried - States can "waive" or divert Medicaid $ into programs other than NH. NH - AKA skilled nursing services in a facility - is dedicated funding by federal/ public law. Waivers vary by state as each state administers its Medicaid program uniquely under overall federal guidelines. Waivers - as not dedicated - can change by state legislature each session. From a planning perspective it makes dependence on waiver program bit of a moving target.

Like some states Medicaid waivers will pay for AL, but most states do not at all OR the waiver is very very narrowly defined. Which translates into just a very small # of beds on AL waiver for those facilities that participate. This is why you often hear "the AL requires 2 years of private pay before Medicaid". For the AL, 2 yrs has high probability that Medicaid bed elder will die, move, or need a higher level of care within the 2 yrs, so it's a safe bet that bed will be open in 2 years. The AL contracts will be worded so that terms can change if waiver changes.

What seems to be the trend now for waivers is for community based day programs & moving away from 1-on-1 in the home caregiving by a state paid provider or an AL waiver. It's more cost effective to provide services this way. Like what PACE or some variation on PACE is. Program of All inclusive Care for the Elderly. PACE is paid by combo of Medicare & Medicaid & does a private public partnership through your state - usually with existing experienced community clinics type of providers - to run a center paid by the M&Ms through CMS. Where I am in New Orleans, it's Catholic Charities & there's one by us at The Benson Center. Elders are evaluated for care and if eligible they go to PACE 2 - 4 days a wk & get Basic health care, medication management, activities, meals and transportation provided through the center. Center has MDs, PAs, RNs, all sorts of other nursing staff, PT/OT, too. At no cost to individual, as everybody is a "dual" so on both M&Ms. But all other caregiving time & needs outside of PACE will for the most part need to be provided by family or elder /family pays for. The one by us does not have a copay, so I imagine elder has SS$ to pay for additional caregiver time if need be or family does for free. If something happens like a fall, TIA, then PaCE staffer will get reassement done and then they transition into another Medicaid program - like a NH - if need be.

If you are hoping that Medicaid will pay for 24/7 at home care, well not likely to happen. You'd have to be living in area where cost of care is beyond extraordinarily high, like Alaska or NYC, plus elder would have to document in detail health care need for such 24/7 care.

For my mom, her last yr on NH Medicaid, state reimbursement was $160 day - $4,800mo. Pretty low cost for room & board & 24/7 nursing oversight. I think nationwide R&B reimbursement $ 175 a day. It would be hard to have skilled caregivers accept a $ 7 hr wage before taxes, fica. Not even minimum wage for most places.

My point in this is that depending on a waiver to solve how to keep mom / dad at home will not work for the long run. If your elder does not really have the $ for PP for 2 -3 years, then you need to look at doing what you can now to get them eligible to show "at need" both financially & medically for skilled nursing care in a NH that takes Medicaid.

Medicaid costs are crushing state budgets & states are having to do whatever to narrow eligibility & provide mandated services more cost efficient.

Worried, the biggest caveat is to remember that you will not get Medicaid to pay for 24/7 care at your home in Maryland. As advised elsewhere, find an attorney that is Medicare and Medicaid experienced, not just estate planning. Since you still work and will be a community spouse, it takes a lot of planning to make sure you have all your ducks in a row before making an application. The 5 year lookback is the biggest problem if you have given away to children or friends - lots of states don't have the same problems with asset transfers with spouses. But you need to make sure that any trusts, prepaid assets, or annuities that you get into are Medicaid compliant. Take care.

Thank you, BarbBrooklyn.

A quick check seems to indicate that Maryland is one of the States that funds services in the community with Medicaid funds. I would start out with a call to the Maryland Dept on Aging or even your own local Area Agency on Aging to find out more.

Thank you, BarbBrooklyn. Good point about telling you all where we live to get additional assistance. We live in Maryland.

It depends upon your State. Go to your State's Medicaid website and check.

If you tell us where you live, someone here might be able to do some research for you.