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Housing – Who Pays For Home Care Services? – Public Third Party Payors

Generally speaking, there are three methods of payment for home care services: self-pay, public third-party payors, and private third-party payors. Self-pay is the default payment option for home care. Whenever home care services are not paid by other methods, the patient must pay for the services. However, several public third-party payors also provide home care services or fund such services, including Medicare, Medicaid, the Older Americans Act, the Veterans Administration, Social Services Block Grant Programs, and Community Organizations.

Medicare

If a senior is eligible for Medicare, he or she may be eligible for home care services provided by a home health agency certified by Medicare. To qualify, a Medicare recipient must be homebound and under the care of a physician, and he or she must require medically necessary skills nursing or therapy services. Medicare will pay for the following services if they are medically necessary and provided through a home care agency that is Medicare-certified: home care agency services; intermittent skilled nursing services; physical, occupational, and speech therapy; social work; and medical supplies and equipment.

Medicare will pay for home-based hospice services if patients are terminally ill and if they are expected to live six months or less. A physician must certify that a patient is eligible for the Medicare hospice benefit, and the patient must surrender his or her right to Medicare benefits outside of hospice care.

Medicaid

The federal government only mandates that Medicaid, which is a state-administered program, cover home care for individuals who either receive income maintenance payments or to those who are categorically needy. The categorically needy includes some members of the elderly population, as well as blind or disabled individuals who meet certain income guidelines. To the extent that home care is covered, the federal government requires that certain services be provided, including nursing care, home health care, and durable medical equipment and supplies. States may choose whether to cover certain types of therapy and medical social services, as well. A solid majority of states cover hospice in their Medicaid programs, providing identical benefits to those available under Medicare.

Older Americans Act

Through the Older Americans Act, state and local social service programs receive federal funding for home care, personal care, chore and escort services, meal delivery, and shopping. This funding is limited to frail and disabled individuals at least 60 years of age in the most social and financial need.

Veterans Administration

The Veterans Administration provides home care using its network of home care units. Only veterans who are at least 50 percent disabled due to a service-related condition are eligible for this benefit, and a physician must authorize the provision of services.

Block Grant Programs

The federal government provides money every year to states, based on population, to provide social services to their citizens. Home care, homemaker services, and chore services often receive part of this funding, to help the elderly remain independent and in their homes.

Community Organizations

Although resources vary by community, some state and local governments, as well as community organizations, will pay for all or part of home-based care. These resources are usually allocated on the basis of need and eligibility, and the funding agency or organization determines the terms of both.

Copyright 2012 LexisNexis, a division of Reed Elsevier Inc.