How to Qualify for Home Health Care

How to Qualify for Home Health Care

What is Home Health Care?

Before we get into the nitty-gritty of home health care, it is important to first define exactly what home health care is. As a general term, home health care refers to a wide variety of medical procedures and tasks that can be done inside your own home. This is opposed to going out to a hospital, specialist, or a doctor. While this is often thought of to be for the elderly or those with very limited mobility, but in reality, there are many injuries and illnesses that can benefit from proper home health care services:

  1. People are unable to leave the home for long periods of time or are suffering from mobility issues

  2. Recommended by your doctor or specialist to stay home or limit movement

  3. Those who may be suffering from mental health issues such as memory loss

  4. Help during adjustment periods with new medications or after certain treatments or surgeries

  5. Anybody who is having more difficulty in their normal day-to-day activities

This freedom to stay at home during these times is made possible thanks to the wide variety of medical procedures and tasks that can be performed by in-home care providers. Thanks to the increase in technological advancements, many medical procedures can be performed by specialists, registered nurses, and other professionals right inside your home. The specific treatments and procedures that are right for you can be discussed with your doctor or specialist. Some of the in-home health care services a patient may receive include:

  1. Elderly Care Services

  2. Private Duty Nursing Services

  3. Pediatric Home Nurse Services

  4. Medical Social Worker Services

  5. Home Health Aide Services

Benefits of Home Health Care Services

It is estimated that more than 4.5 million patients are using home health care providers in the United States alone. With numbers this high, one has to wonder what the benefits of receiving medical care at home instead of hospitals or nursing homes truly are. While the exact benefits will vary depending on the patient and their respective situation, here are some of the more common and popular reasons people choose in-home health care.

  1. Receiving in-home health care services allow someone to be more independent and continue their daily routines.

  2. The costs associated with home health care providers can be less expensive than receiving the care elsewhere.

  3. There is someone around when you or another caregiver is not able to be there to help out or handle accidents.

  4. Patients can receive medication management and help with diet and other nutritional aspects.

How to Qualify for Home Health Care

You’ve seen what home health care is and how it can help those dealing with various illness, conditions, and issues. Now, it is time to see if you can qualify for in-home health care. There is no one specific standard to qualify for actual in-home health care, though the businesses that provide those services may have requirements patients must meet. The decision to need skilled medical professional lies solely on the patient and their doctor.

Generally speaking, when people ask, “Do I qualify for home health care services,” they are asking more if they are eligible for any sort of assistance. There are many services out there that may be able to help you or someone you know, but the top inquired about assistance programs are Medicare and Medicaid. Here, we will discuss what these programs are and what they require to be considered eligible for in-home health care assistance.


Medicare vs Medicaid

Medicare and Medicaid are two separate health assistance programs that are run by the federal government. While the names sound similar, these two programs are aimed at helping different groups of the American population. There may be cases where a person is eligible for both Medicare and Medicaid, but most people will either qualify for one or the other. To know which one you may qualify for, we have to look at what each one is.


What is Medicare?

Medicare is a government insurance program. This program is intended for those who are age 65 or older. It may cover those under the age limit if they have a disability or are a dialysis patient. Patients who are eligible for Medicare do not have to meet any certain financial requirements and may be required to pay deductibles, monthly premiums, and copays for services. Medicare is a federally-run program under the Centers for Medicare & Medicaid Services.


What is Medicaid?

Medicaid is a medical assistance program that is geared at helping low-income individuals with the medical help they need. There are no age requirements to qualify for Medicaid as it is based solely on a person’s income. There is no deductible to meet or monthly fees with Medicaid, but there may be a co-pay in some cases. The federal government gives states guidelines to follow, but each state runs its own Medicaid program, making the details vary from state to state.


Requirements to Qualify for In-Home Health Care Services

If you are looking into receiving home health care services, it may be possible for Medicare and Medicaid to help cover some of the cost. As these programs are different types of programs aimed at helping different groups of people, the type of help and requirements they need are different. Medicaid is run by each individual state, making it much more difficult to clearly define exactly what is required to be considered eligible for any type of assistance.


Medicare is a federally run program, so it works pretty much the same across the country. This makes it much easier to define exactly what is required to qualify for home health care assistance:

  1. You must be considered homebound using the criteria set forth by the Centers for Medicare & Medicaid.

  2. You must require skilled care on a part-time or intermittent basis.

  3. You must be under the care of a doctor who completes the correct paperwork and meets the proper deadlines.

  4. You must receive your care from a Medicare-approved home health care agency.

How Much Does Home Health Care Cost?

The cost of in-home health care is a serious question on the minds of many people. Either they are worried about themselves or concerned for the well-being of a loved one in the near future. The actual cost of your in-home health care will depend heavily on several factors:

  1. The type of medical care received

  2. The region or state care will be received

  3. Amount of time someone is needed to help

  4. The type of supplies needed daily

While the cost of in-home health care varies greatly from state to state and area to area, the national average is sitting around $4,000 per month, with an hourly rate of approximately $22.


How Costs Can Be Determined

Before any in-home health care services are provided, an assessment will be done. This will determine the amount of care needed and other factors. The cost of the care needed will likely be broken down into one of three types of payment arrangements.


The most common type of payment arrangement for in-home health care is to pay by the hour. For many clients of home health care agencies, the need for isn’t a constant thing. Instead, many seniors and others that seek home health care can do many of the daily activities and functions needed to live a happy and independent life. A skilled worker may be needed for as little as few hours a day to help with minor issues, help manage medications, or perform any of several other medical tasks.


It is possible to find home health care that can charge daily rates. This type of payment arrangement is designed for those people that need care more steadily throughout the day. This can be the case for those that have serious mobility issues or may be suffering from diseases such as Alzheimer’s. In these cases, an hourly fee would add up quickly, so a daily rate is usually agreed upon that includes breaks for the caregiver. This daily cost will vary based on the cost of living in your area and the amount of care needed. Other factors may play a role in determining a daily rate for a client. Daily rates can run an average of $200 to $350 per day depending on various factors.


Often times, someone will be able to handle daily chores or activities with someone that is homebound, such as a family member or close friend, but even they will need to sleep and take a rest. During these times, it is common for the family to hire someone to simply keep an eye out during the overnight hours. The pay here can be cheaper than a daily rate as there is generally less to do and worry about but offer the peace of mind and rest to keep things going smoothly.


How Much Does Medicaid Pay for Home Health Care?

This is a little bit of a difficult question to answer, but there is assistance for Medicaid users seeking home health care services. The difficulty lies in a couple of different things. The first issue is that Medicaid is a state-run program that must follow federal guidelines. This means that in each state, the Medicaid program is run differently and can cover different things at different amounts. A second issue lies in the fact that each state also has multiple Medicaid programs aimed at helping home health care clients.


In most states, a Medicaid State Plan (sometimes called Regular Medicaid) will cover some of the costs of in-home health care services. Another way to possibly help pay for home care is Medicaid waivers, which are meant to help keep the elderly from living in their homes. Some clients have Institutional Medicaid, which only covers immediate care facilities and nursing homes with no in-home care benefits.


To provide a complete list of benefits and services covered under Medicaid would be nearly impossible due to the state-by-state nature of the program. Some things are common amongst most states, but this is not to say these services are covered in every case or scenario:

  1. Home health care provided by trained medical personnel

  2. Support for family and caregivers in the form of training and respite care

  3. Medical equipment and supplies necessary for medical reasons

Compensation to Family Caregivers

Family members can be compensated or paid as caregivers through most state Medicaid program. This does not apply to legal guardians and spouses from being hired and paid through Medicaid as caregivers. There are no restrictions on adult children or ex-spouses being hired and paid as caregivers.


The process is straightforward and easy to maneuver. The first step is to apply for your state’s Medicaid program. Once accepted, you can then sign up for a specific program that gives patients that ability to choose their own care as opposed to Medicaid choosing for them. This is commonly called Self-Directed Care or Consumer Direction in most states. The patient is then free to hire on whomever they wish as a caregiver, such as a family member or ex-spouse, who will then submit timesheets to Medicaid for payment.


It is important that you look at your plan and details to see what is specifically covered and how to properly fill out all paperwork. Not all Medicaid plans operate the same in each state, so those who move are especially cautioned to pay close attention and speak with a representative about their plan’s coverage.


How Much Does Medicare Pay for Home Health Care?

As we discussed earlier, Medicare is a federally run program which makes it pretty similar around the country. To qualify for home health services, you must meet the requirements previously mentioned. The important thing to note is that Medicare does not cover more than part-time or intermittent in-home health care. This means the care must be less than eight hours a day or less than seven days a week.

If you meet all of the requirements, Medicare can pay up to 100% of your in-home care services costs. In some cases, a client may have to pay 20% of the Medicare-approved amount for durable medical equipment (DME). Before receiving services, your Medicare-approved agency will give you a price list and explain how much Medicare will pay and how much you or your loved one is responsible for.


What Is a Home Health Aide?

All of these programs typically cover home health aides and caregiving, but they have more restrictive benefit coverage on personal care type services. While it is common for people to confuse these two professions, these are two different professions. Namely, home health aides can provide medical care that personal care workers are unable to provide or perform. This is why they are covered under Medicaid and Medicare, while personal care workers are not.

A home health aide is someone who is a person who works with the elderly or disabled to provide care. This care can be provided in a person’s home or inside an institution such as a nursing home. These individuals are trained to administer medical procedures such as giving medication and working with some medical devices, but they can also provide some more basic personal care needs. While home health aides generally work alone, they are under the supervision of a trained professional such as a registered nurse.


The daily tasks of a home health aide can vary widely based on factors such as training, certifications, and needs of the client. Some of the more common tasks performed by home health aides can include:

  1. The maintaining of records such as medication changes or doctor orders

  2. Provide transportation to and from doctor appointments or other necessary meetings

  3. Assist in the feeding, bathing, and other grooming habits of the client at hand

  4. Offer assistance with physical therapy and other medically needed exercises

  5. Administer medications based on the specific orders of the client’s doctors

Home health aides can provide a wealth of independence to those who are experiencing health issues. No matter if these are temporary changes or more permanent issues, having someone around to provide the care and medical attention needed when a family member or close friend cannot be can do wonders for more than just the physical healing of a person. Being able to maintain a certain quality of life through the use of a professional home health aide helps keep the client in a better mental and emotional state while providing self-confidence and a sense of normalcy.


Contact Centric Healthcare today for more information on home health services!

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