Who Qualifies For Home Health Care Services?

Home health care services provide invaluable help for patients recovering from illness, injury or surgery and managing chronic health conditions. Medicare, Medicaid and private insurance plans often cover these costs; however it’s essential for both the patient and his/her family to understand what eligibility requirements exist before initiating home health services.

Home health care services typically assist individuals recovering from recent hospital stays or living with a chronic condition such as cancer, diabetes, heart disease or arthritis. People in need may require assistance walking around their home due to their condition and may require assistance with daily tasks like bathing, dressing and eating as well as medical attention to ensure their safety and well-being in the comfort of their own home.

For home health care to be eligible, a physician must first order services and determine that you are homebound. This process typically includes an evaluation of how frequently and easily you leave the house as well as assistance such as wheelchair or walker use to get in and out. Furthermore, your physician will consider any needs outside your home that require leaving it altogether such as attending church services, shopping trips or attending family functions.

If you qualify, home health agencies will assign you with a nurse or therapist who will visit your home regularly to work on developing a care plan, providing services such as physical therapy, occupational therapy and speech-language pathology services as well as any medical equipment and supplies (e.g. wheelchair, walker) needed for therapy sessions and keeping your doctor updated about your progress and health status.

Many states provide Medicaid programs that enable individuals to hire personal care aides directly, known as Personal and Community-Assisted Long-Term Care (PACE or MLTC), at home to assist with daily activities at home. Due to eligibility restrictions set by these programs – often strict income and asset thresholds apply for PACE/MLTC participation – it’s wise to speak to either your social worker or doctor prior to enrolling in any PACE or MLTC plans.

Medicaid programs also permit individuals to “self-direct” their own personal care aides – often family or friends of the recipient – making this option suitable for helping with food preparation, bathing and using the bathroom, getting out of bed in time to use the toilet, or other needs such as getting to and from appointments. For more information regarding this program in your state please reach out directly.