What if I Don’t Qualify for Medicaid Home Care?

Medicaid home care eligibility requires that you meet a particular functional or medical criteria. Factors like your income, assets and residency can determine Medicaid eligibility. 

But what if you don’t qualify for Medicaid? And what if you don’t qualify for Medicaid home care?

You and your loved ones know your needs better than anyone. If you discover that you might not qualify for Medicaid, consult with an expert and pursue local programs that could improve your quality of life.

Explore Community Programs

Waiver-funded or home and community-based services (HCBS) offer support to help you stay in your home instead of moving to a long-term care institution. The federal government waives medical assistance rules so states can individually use funds for these programs. HCBSs typically cost less than half of what residential care facilities can cost. 

Each HCBS has particular eligibility requirements and might include different medical and daily living services, such as personal care, financial services, occupational, physical and speech therapies, referral services and case management.

Speak to a Certified Elder Law Attorney 

Consider speaking with a lawyer. Certified elder law attorneys (CELAs) specialize in law related to aging adults, such as estate management, long-term care and Medicaid policies. CELAs must pass a certification exam that evidences their expertise in elderly law. 

Speaking with a CELA can help you learn more about Medicaid policies and whether you can become eligible for Medicaid home care. A CELA can also walk you through other options available should you not qualify for home care through Medicaid. 

Consider In-Home Care Using Private Pay  

If you can financially support in-home care yourself, you can control the selection of your caregiver and services. 

The average hourly rate for professional caregivers such as registered nurses (RN) home health aids (HHA) is around $25 to $30, although this depends on your needs, location, the professional’s level of experience and other relevant factors. 

Selecting a home health provider you trust to serve as your caregiver is crucial for open communication about your needs and expectations. If you don’t qualify for Medicaid home care and do pursue private pay care, options can vary from provider to provider and state to state.

Look Into Other Insurance Plans 

Consider alternative insurance plans if you do not qualify for Medicaid home care. Private insurance plans may not cover long-term care, but they may cover short-term home care when prescribed by a doctor. You will need to carefully review your policy details to confirm available benefits. 

If longer care is needed, you can consider a long-term care insurance plan. These plans may cover some in-home care expenses and services. The cost of your long-term care insurance policy usually depends on factors, such as age, amount and types of services you require, and additional benefits you choose. 

Some long-term care insurance plans provide you with a certain amount of money to hire a caregiver — including friends or family  — while others require you to receive care from a licensed home care agency. 

Convert Your Life Insurance Policy 

Life insurance policies may allow you to convert your policy to cover home care services. Policies that include this feature provide you with a tax-exempt advance on your life insurance and sometimes require you to pay an additional premium. 

The amount you receive is based on your policy, monthly premiums, health, age and other factors. You can also sell your life insurance policy to a third party to fund long-term care at home or in an assisted living facility. 

Receiving In-Home Care

There is more than one way to receive care in the comfort of your own home. Speaking with qualified professionals — such as CELAs or community program leaders — can help you determine available options. Understanding your existing policies and finances will also make it easier to explore your possibilities.

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