Medicare and Medicaid Home Care Services for Seniors

Long Island Elder Law and Estate Planning Lawyers

Medicare home care services are often underutilized. Explore how Medicare and Medicaid can help provide seniors with the care they need.
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For many seniors who need care as they age, home health care is the preferred option. Home health care presents an alternative to nursing homes and assisted living, providing care for homebound people. Those who receive home health care can remain in their residences, reducing expenses, preserving autonomy, and maintaining community ties. A study explores how Medicare home care services are underutilized by seniors.

Health Affairs estimates that 4 million older adults can only leave their homes with assistance, making accessing care challenging. The Centers for Disease Control and Prevention reports that 1.3 million Americans receive care in nursing homes. According to A Place For Mom, more than 810,000 reside in assisted living.

Although Medicare funds some home health care services, a recent study has found that Medicare beneficiaries are underutilizing the program’s home health care options. Many older adults do not receive the home-based clinical care or home-based long-term services and supports that could benefit them.

Medicare Coverage of Home Health Services

Medicare Parts A and B cover certain home health services. Homebound individuals can receive part-time or intermittent skilled services. Part A covers home health care for people following a hospital stay or a stay in a skilled nursing facility. Part B provides home health care for homebound adults who need skilled nursing care.

A Medicare beneficiary is considered homebound in the following situations:

  • Because of an illness or injury, they have trouble leaving their home without help, such as a cane, wheelchair, walker, or crutches, special transportation, or another person’s assistance.
  • Their physician recommends staying at home.
  • Leaving their residence takes a major effort.

The program covers medically necessary part-time or intermittent skilled nursing care and health assistance, durable medical equipment, and medical supplies for use at home.

Medicaid also covers long-term services and supports (LTSS), which include medical and personal care services that aid with activities of daily living (ADLs). These are the kinds of services an assisted living facility typically provides.

Use of Home-Based Clinical Care and Long-Term Services and Supports Among Homebound Older Adults

A 2023 study published in the Journal of American Medical Directors Association looked into home-based clinical care and home-based LTSS among homebound older Medicare beneficiaries. The researchers examined the Medicare claims of 974 beneficiaries to shed light on their use of in-home services. The study found that while homebound individuals used these services, no group received high levels of all care types.

Homebound individuals more commonly utilized LTSS services than home-based clinical care. They found that approximately 30 percent of participants received some home-based clinical care and bout 80 percent of the sample received home-based LTSS.

The researchers identified three levels of home clinical care and LTSS usage among older adults:

  • Low Care and Services (46.6 percent). The largest group of participants received little home-based care. These individuals tended to be younger with fewer chronic conditions and functional impairments.
  • Home Health Only with LTSS (44.5 percent). While this group used some home health services, such as assistance with ADLs, they received little home-based clinical care.
  • High Clinical with LTSS (8.9 percent). Only a few participants had extensive home-based clinical care. In addition to tending to be older, they were more likely to have dementia and live alone.

In finding that only roughly 9 percent of participants receive high levels of clinical care and LTSS, the study points to a gap between those who could benefit from these services and the care provided. Although in-home care and support could meet the needs of older adults, many homebound older adults do not take full advantage of the services available.

Medicaid Options

Medicaid is a joint federal and state program which can assist those with long-term care expenses, including the cost of a home health care aide. While Medicare provides limited coverage, Medicaid is much more extensive, and can even cover the cost of a live-in aide. However, because of its restrictions, qualifying for Medicaid can be extremely difficult. But paying for substantial home care without it could be all but impossible. New York Medicaid has complex rules for financial eligibility, including a Resource Allowance ($30,182 for a single applicant in 2023). Even if your assets are above that, you may still be eligible with proper asset protection planning, such as an irrevocable trust.

If your need for home care is immediate, time is not something you can afford to lose. Why? If you wait too long or fail to get proper legal advice and your non-exempt assets are above the applicable allowances, you or your loved one may be ineligible for Medicaid benefits at a time such services are desperately needed.

The elder law attorneys at Kurre Schneps LLP have years of experience helping seniors and their families navigate the complexities of Medicaid eligibility and securing home care benefits. Contact us today to schedule your consultation.

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