How much does medicaid pay for home health care per hour

All 50 states have at least one Medicaid/Medicare program that provides financial support to individuals living outside of nursing homes. Further, one must meet a very specific criteria before qualifying for a state sponsored home care program. One of the qualifications is the level of care that is needed for the patient, for example, homebound patients typically require skilled care at home, and if they are incapable of covering the associated costs with hiring a private duty nurse, then they will most likely qualify for a home health care waiver program by their state. Fortunately, even if one does not qualify for a Medicare home health care program, they may still be eligible for a Medicaid HCBS waiver program (Home and Community Based Service)

How to Qualify in Florida

To qualify, one must meet the following criteria:

• If you are under the care of an attending physician and have a physician’s order for home health services
• If a medical condition or disability that substantially limits your ability to perform everyday living activities
• Require services that can be safely, effectively, and efficiently provided in the home or other authorized setting
• If you are certified homebound by your doctor/nurse

Types of Programs Covered by Medicaid

As of October 2021, the services that are covered by Medicaid/Medicare for individuals living at home or in a facility extends beyond simple home health care services like companionship or light house-keeping. Medicare/Medicaid covers a variety of services, and the services offered are personalized for the patient and are delivered on an as-needed basis – the list of services is long & updates frequently, make sure to stay on top of it by checking out Medicare’s official home health services page here.

Home health care

The simplest and most common form of home care that Medicaid covers for eligible individuals. Simply put, home health care is a non-medical services provided by trained caregivers, though sometimes other health-providers with medical training may be involved, such as nurses and doctors.

Personal care

Personal care is also one of the most common forms of care that Medicaid covers. Personal care is offered to individuals who are incapable of handling their day-to-day living activities and/or require support with their daily living activities – activities include personal hygiene, dressing, eating, transferring/assistance with mobility, and maintaining continence. Most states cover personal care via Medicaid.

Homemaker services

Homemaker services include assistance with everyday household chores such as light house-keeping, cooking, cleaning, furniture relocating, groceries, and meal prep. Homemaker services may overlap with services from other types of care, for example, it is very common to see overlap in services between homemaker & home health care programs. As a matter of fact, certain states use these two terms synonymously; and some states consolidate both programs into one.

Family and caregiver assistance

Recently recognized as one of the most important care programs for maintaining stability in a home living environment. This program includes respite care, short term relief for primary caregivers. Qualifying for this program shouldn’t be a problem as it is included in almost every Medicaid sponsored relief program, in almost all states.

Accessibility in home & environment

This program is for those who need special accessibility modifications such as installing car ramps, or grab bars at home. This program is typically partially funded by Medicaid, though eligibility & coverage varies.

Medical equipment & supplies

This program is for individuals who require specific medical supplies to ensure independence & health. This program is partially funded by Medicaid.

Hospice care

This program is reserved for terminally-ill individuals who are expected to live no more than 6 months. Eligibility varies, though in most cases individuals can qualify if they can substantiate that staying at home will provide more benefits than staying at a hospital or in an assisted living facility.

Home health care services covered by Medicaid

Part-Time skilled nursing care
Physical therapy
Occupational therapy
Speech-language pathology services
Medical social services
Part-time or intermittent home health aide services
Injectable osteoporosis drugs for women

Services that AREN’T covered by Medicaid

Around the clock care at home
Ready-meals delivered to your home
Homemaker services IF it is the only care that you need
Personal care IF it is the only care that you need

Financial cost isn’t everything when it comes to caring for a loved one, but knowing the average cost of 24-hour home health care can help you make a more informed decision.

As adults age, they can need increasing levels of care and assistance. For some, they may need someone to help with household chores a few hours each week. Others might require a 24-hour caregiver for help during the day and night.

Are you an adult child with aging parents who need hands-on care?

If you are, then you may also be wondering, “How much does 24/7 in-home care cost?”

In this article, we’re providing you with an elderly care cost comparison. We’ll give you an in-home care cost estimate and answer the question, “Is home health care cheaper than assisted living?”

Keep reading to learn about the cost of 24/7 care at home.

Elderly Care Cost Comparison

It’s difficult to make in-home care cost estimates because prices vary depending on: 

• The agency
• Geographical location
• Type of care

The distinction between “kinds of care” is important because medical insurance will often cover costs of in-home health care, but usually doesn’t cover anything that’s considered companion care (or “custodial care”). 

In-home companion care is any form of non-medical assistance, such as grooming, transportation, assistance moving around, housekeeping, companionship, etc.

Home health care is medically necessary assistance prescribed by a doctor. This includes such things as in-home physical therapy, assistance with feeding tubes, COPD care, assistance administering medication, etc.

In-Home Care Cost Estimate

The average cost of elder care varies from state to state, ranging from $16/hr in Louisiana to $28/hr in Washington. (For the remainder of this article, we’ll look specifically at Virginia.) 

In Virginia, the average in-home care cost estimate is $22/hr for companion care and $23/hr for home health care. 

This means that in Virginia, the average cost of in-home elder care adds up to $180 for an 8-hour day, $880 for a 40 hour week, and $3,520 for a month of care.

But if an aging loved one needs care during the day and night, there are also 24-hour caregiver options available.

In-home elder care solutions in Charlottesville, Richmond, Williamsburg, VA and Charleston, SC.

Average Cost of 24-hour Home Health Care vs. 24-hour Companion Care

One major benefit of in-home elder care is that it’s adaptable to the needs of each senior. Since in-home care is scheduled hourly, you only pay for exactly the amount of care you need. 

But sometimes, an elderly adult needs hands-on assistance all day and night. 

So, how much does 24/7 in-home care cost?

The average cost of 24/7 care at home stacks up to around $15,000 a month, whether that’s 24-hour companion care or home health care. 

Most people don’t need 24 hours of care until much later in life, but it’s good to know about it so you can start planning early. 

Alternatives to Having a 24 Hour Caregiver

Apart from an in-home 24-hour caregiver, there are other ways to ensure your loved one receives the care they need. The primary alternative to in-home care is residence in an elder care facility. 

Here are the three major options when it comes to alternative living facilities:

1. Assisted Living Facilities: These eldercare residences primarily provide assistance with activities of daily life and personal “custodial” care but don’t provide as much skilled nursing care. 
2. Nursing Homes: In addition to providing assistance with activities of daily life, nursing homes provide comprehensive medical support, with nurses on hand 24/7.
3. Memory Care: People with any form of dementia need special kinds of care, whether it’s provided by an in-home caregiver or through a facility. Most nursing homes (and some assisted living facilities) are equipped for this kind of care, for an extra fee.

And, here’s a quick cost breakdown for each of these eldercare residences:

In assisted living facilities, “memory care” for those with dementia incurs an additional monthly fee of $1,000-$4,000. However, memory care for those with dementia does not affect the hourly rate of in-home care or nursing home care. 

After all these elderly care cost comparisons, you may still be wondering, “Which is cheaper, home care or an assisted living facility?”

Is Home Health Care Cheaper than Assisted Living?

When it comes to end-of-life care, finances are only one of many factors to consider. 

But from a purely financial perspective, here is an elderly care cost comparison:

• Up to 55 hours a week, in-home care costs less than assisted living 
• Up to 100 hours a week, in-home care costs less than living in a nursing home 
• If 24/7 nursing care is needed (168 hours a week) then living in a residential facility will probably be less expensive 

Though in-home care isn’t necessarily always the cheapest option, it’s often the best. With in-home care, your loved one will receive focused one-on-one attention from a trained caregiver—something most facilities can’t provide.  

The bottom line is that 24-hour nursing care has a cost no matter which route you take, so let’s consider how to pay for senior care costs.

Ways to Pay 24 Hour Nursing Care Costs

There are some ways that individuals can get assistance paying for home care costs. Five of the most useful resources are:

• Medicare
• Medicaid
• The Aid and Attendance (A&A) Benefit for Veterans
• Long-term Care (LTC) Insurance
• Life Insurance Settlement

Here’s a look at these resources in more detail.

1. Medicare

Medicare is the health insurance provided by the government to all seniors age 65+. Medicare covers most home health care services, including:

• Nursing care
• Physical and occupational therapy
• Medication administration. 

However, to be covered, the home health care must be considered, “intermittent care”, which is defined as “less than 7 days each week or less than 8 hours each day.”

Medicaid doesn’t necessarily cover in-home custodial care and has limits to its assisted living facility coverage. So, you’ll want to look into your specific plan to see what it covers.

2. Medicaid

Medicaid is a form of government assistance that’s only available to those who qualify via low income or disability. 

Like Medicare, Medicaid covers all short-term medically prescribed care. In some states, there are waivers extending Medicaid benefits to cover non-medical care expenses. 

Unlike Medicare, Medicaid can help cover residence in a care facility for those who qualify. If you think you might qualify, you should talk to an agent or look up details on the website.

3. The Aid and Attendance (A&A) Benefit for Veterans 

A&A provides Veterans with a monthly stipend that can be used to pay for long-term care, including in-home care. However, the veteran is required to show that they need in-home care in order to qualify.

4. Long-Term Care (LTC) insurance  

LTC insurance is a form of insurance that specifically covers long-term care services, such as in-home care. Policies must be originated before long-term care commences, so it pays to look into it sooner rather than later. 

5. Life Insurance Settlements

Some life insurance policies allow you to claim your settlement before death. If you take your settlement early, it’s often less than the full policy amount but can be a reasonable means of paying for end-of-life care.

Some other helpful resources regarding paying for elder care you can look into are: 

• U.S. Department of Health and Human Services Long-Term Care Hub
• AARP Home Care Payment Resource Guide
• National Council on Aging Benefits CheckUp
• National Institute on Aging- Aging in Place Guide
• State Health Insurance Assistance Programs (SHIP)

Any financial help you can receive will make getting quality care for your loved one that much easier.

Best 24 Hour Caregivers in Virginia

In this article we’ve explored the costs of end-of-life care, seeking to answer the question “is home health care cheaper than assisted living?” 

Though there’s a lot of variation in cost, up to 100 hours a week of in-home care is often less expensive than living in a nursing home. However, the average cost of 24 hour home health care may be higher than the cost of living in a residential facility. 

Regardless of which option you choose, 24-hour nursing care can be costly. Some common ways people pay for end of life care include:

• Medicare
• Medicaid
• The VA Bill
• Long Term Care Insurance
• Life Insurance Settlements

Though this article focuses on the financial element of elder care, money isn’t the only factor to consider. Sometimes, the extra cost of 24/7 care at home is worth the benefits of aging in place and receiving intentional care from a trained caregiver.

Are you looking for compassionate, in-home care services in Virginia or South Carolina? 

Commonwise Home Care is a premier home care agency providing high-quality care and memory care to aging adults. We offer a comprehensive list of home care services, including:

• 24-hour caregivers
• Memory (dementia) care
• In-home physical therapy  

Speak to a Care Advisor today to hear about how in-home assistance could be a perfect fit for you and your family.

In-home elder care solutions in Charlottesville, Richmond, Williamsburg, VA and Charleston, SC.

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