Who Qualifies For Home Health Care Services?

who qualifies for home health care services

Home health care refers to medical services offered in your own home to treat chronic health problems or recover from illness or injury. Its aim is to keep you close to familiar people and things while giving the support needed for managing your condition effectively. Home health services may be provided following hospital stays, rehabilitation centers visits or skilled nursing facility stays; or prescribed by your physician as part of ongoing treatment plans.

Medicare covers most of the costs of home health care services. To qualify, you must meet certain requirements: You must be an eligible Medicare beneficiary; homebound; under care from a physician or allowed practitioner who orders home health services and regularly reviews your care plan; and choose an agency approved by Medicare to deliver care services – Medicare typically pays for these episodes of care on an hourly basis for 60 days at a time.

To be considered homebound, one must present a doctor’s certification confirming their inability to leave their home without considerable effort and/or needing special transportation or help from someone else due to illness or injury. Your physician also needs to certify that intermittent occupational, physical or speech therapy services will be needed, along with having created and reviewed regularly by them a plan of care designed by both themselves and a practitioner they approve.

Home health care recipients who also participate in Medicaid benefit from its joint Federal-State program. Medicaid helps low-income individuals meet eligibility requirements by means of assets and income; each state sets its own eligibility rules; beneficiaries typically choose the personal care aide of their choice among friends or family; some states also offer Consumer Directed Services to enable seniors use Medicaid money towards private home health care aides.

To be eligible for Medicaid programs, individuals must first secure a doctor’s prescription and undergo an assessment from a nurse assessor. Your doctor must then send this paperwork directly to your local Medicaid agency while the nurse assessor visits your home to verify if you meet eligibility criteria; which generally means owning no more than $15,450 as an individual and $22,800 collectively (some states may impose additional asset-related eligibility criteria); otherwise you must spend down or transfer assets into trust to become eligible.