Comment From Patricia: Does Medicare or Medicaid pay for any home health care?

Judy Peres: Both Medicare and Medicaid pay for certain home health care services. Home health services include skilled nursing; physical, speech and occupational therapy; social work services; and aide services for assistance with functional needs. These services enable the provision of good care at home, but Medicare limits coverage to beneficiaries who meet the definition of "homebound" (unable to leave their homes without considerable effort) and who have a part-time (fewer than 8 hours per day) or intermittent skilled need. No deductible or coinsurance is required.

Home health care coverage and services are not the same as general home and community-based services (HCBS). Medicare does not cover many needed services under the home health benefit, including 24-hour daily home care; home meal delivery; housekeeping services such as cleaning, laundry and shopping; and personal care from home, i.e. a home health aide when aide care is the only type of care you require. Medicare does not pay for full-time home care, meal delivery, maid-type services or ADL assistance care (personal care assistance) if this is the only care required.

Administered by individual states, Medicaid is a joint federal-state medical assistance program for low-income individuals. Each state has its own set of eligibility requirements; however, states are only mandated to provide home health services to individuals who receive federally assisted income maintenance payments, such as Social Security and individuals who are "categorically needy." Categorically needy recipients include certain aged, blind and disabled individuals who have incomes that are too high to qualify for mandatory coverage but are still below federal poverty levels.

Under federal Medicaid rules, coverage of home health services must include part-time nursing, and medical supplies and equipment. At the state's option, Medicaid also may cover audiology; physical, occupational and speech therapies; and medical social services. Home and community-based services (HCBS) provide opportunities for Medicaid recipients to receive services in their own home or community. These programs serve a variety of targeted population groups.

The Clearinghouse for Home and Community Based Services will help you understand what is available in your state.

Comment From Bob Blair: I need a weekly caregiver to assist with bathing and showering. Is there a provision for this?