Does Medicaid Pay for In-Home Care? Coverage and How to Apply

What Medicaid in-home care can include

Medicaid pays for care at home through several programs. Some exist in every state, and others are options each state chooses.

Home health services (every state)

Home health is a mandatory Medicaid benefit, so every state must cover it. Under the federal rule for this benefit, it includes:

• Nursing care on a part-time or intermittent basis
• Home health aide services from a home health agency
• Medical supplies, equipment and appliances you use at home

States may also cover physical therapy, occupational therapy and speech therapy as part of home health.

A doctor, nurse practitioner, clinical nurse specialist or physician assistant has to order the care as part of a written plan, and that plan is reviewed every 60 days. Before services start, a practitioner must document a face-to-face visit with you that happened within 90 days before or 30 days after your home health care begins. That visit can happen by telehealth if your state allows it.

You do not have to be homebound to get Medicaid home health, and you do not have to have been in a hospital or nursing home first. Medicare, by contrast, only covers home health if you are homebound.

Personal care services (many states)

Personal care is an optional benefit, so not every state offers it under its regular Medicaid plan. It covers hands-on help with daily activities, such as bathing, dressing and using the bathroom. A doctor's plan of treatment or a service plan approved by the state authorizes the care.

Under this regular benefit, the paid worker cannot be a family member, which the federal rule defines as a legally responsible relative. Some self-directed programs work differently (see the family caregiver section below).

Home and community-based services (HCBS) waivers

HCBS waivers, also called 1915(c) waivers after the section of the Social Security Act that created them, help people who would otherwise need a nursing home or similar facility get care at home instead. According to Medicaid.gov, 47 states and DC run at least one, and about 257 waiver programs are active nationwide.

Waiver services can include:

• Case management (someone who helps coordinate your services)
• Homemaker services
• Home health aide and personal care services
• Adult day health services
• Habilitation services
• Respite care, which gives a family caregiver a break

States can also add other services that help people move out of, or stay out of, a facility.

Each waiver is aimed at a specific group, such as older adults, people with physical disabilities, people with intellectual or developmental disabilities, or children who depend on medical technology. To qualify, you must need the same level of care that would qualify you for a nursing home or other institution under your state's rules.

States also choose the maximum number of people each waiver will serve. When a waiver is full, people may be placed on a waiting list.

Other state options

States can offer home-based services in a few other ways. You don't need to know these program names to apply, but you may see them in letters or on your state's website.

• 1915(i) state plan HCBS: home and community services for people who meet needs-based criteria set by the state.
• Community First Choice (1915(k)): attendant services and supports at home, offered under the state's Medicaid plan.
• Self-directed personal assistance services (1915(j)): lets you manage your own personal care services and budget.

PACE

The Program of All-Inclusive Care for the Elderly (PACE) gives medical and social services through a team of health professionals, so most participants can stay in the community. You can join if you:

• Are 55 or older
• Live in the service area of a PACE organization
• Are eligible for nursing home care
• Can live safely in the community when you enroll

Once you join, PACE becomes your only source of Medicare and Medicaid services. You can leave the program at any time, for any reason.

Who qualifies for Medicaid in-home care

You generally need to clear two hurdles.

The first is Medicaid eligibility itself. Each state sets its own income and asset rules within federal guidelines, and only your state Medicaid agency can tell you for sure if you qualify. Our guide on how to enroll in Medicaid walks through the basic application.

Waivers can use different financial rules. A state can use a waiver to cover people at home who would otherwise only qualify for Medicaid in a nursing home or other institution, often because of a spouse's or parent's income and savings. States can also use spousal protection rules, which set aside part of a couple's income and savings for the spouse who still lives at home.

The second hurdle is need. For home health, that means a practitioner's order. For waivers and most personal care programs, the state or its contractor assesses how much help you need with daily activities and whether you meet the program's level of care.

If you're not sure which programs to look at, the KPCB Edge benefit finder can point you to other help you may qualify for.

Can a family member get paid to provide care?

Often, yes, through what Medicaid calls self-directed services. In a self-directed program, you (or a representative you choose) decide who provides your care. You can recruit, hire, train and supervise your own workers, and in some programs you also control how your care budget is spent.

States can offer self-direction through 1915(c) waivers, 1915(i) and 1915(k) services, and 1915(j) personal assistance services. Choosing your own worker can mean hiring someone you already know, including a relative, if the program's rules allow it.

There are limits on which relatives can be paid. Under 1915(j), a state may choose to let you hire legally liable relatives, such as parents or spouses. Rules for spouses and parents vary by program and state, so ask your state Medicaid agency what its programs allow.

You won't have to run payroll alone. If you control a care budget, the program must offer financial management services, which can handle tax withholding and filing, timesheets and paychecks for your workers. Anyone who chooses self-direction must also have access to a support broker or counselor who helps manage the arrangement. Your plan must include a backup plan for days when your worker is sick or unavailable.

Pay depends on the program. Under 1915(j), for example, participants decide how much they pay for a service within their budget. Ask the agency or your case manager how pay works in your program.

Medicare vs. Medicaid for home care

Many people have both Medicare and Medicaid. When a service is covered by both, Medicare pays first and Medicaid can fill in the difference up to the state's payment limit.

	Medicare	Medicaid
Must you be homebound?	Yes	No, states can't limit home health to people who are homebound
Skilled nursing and aide visits	Part-time or intermittent, when you need skilled care	Part-time or intermittent nursing, plus home health aide services, in every state
Help with bathing, dressing and similar tasks when that's the only care you need	Not covered	Covered in many states through personal care or HCBS waivers
Homemaker services like shopping and cleaning	Not covered unless related to your care plan	Can be covered through HCBS waivers
24-hour care at home	Not covered	Depends on your state's programs and your assessed need
Cost	$0 for covered home health services; 20% of the approved amount for medical equipment after the Part B deductible	Usually low or no cost; states may charge small copays on some services

Medicare's home health benefit usually means up to 8 hours a day of skilled nursing and aide care combined, with a maximum of 28 hours a week, according to Medicare.gov. If you still need to sign up for Medicare, see our guide on how to apply for Medicare online.

How to apply for Medicaid in-home care

1. Contact your state Medicaid agency

Use the Medicaid.gov state contact page to find your state's agency and phone number. If you aren't on Medicaid yet, you can apply through that agency or through HealthCare.gov, which sends your information to your state. You can apply any time of year.

When you call, ask:

• Which in-home care programs your state offers for someone in your situation
• Whether any of them have a waiting list
• Whether you can self-direct care or hire a family member
• What paperwork they need from you

2. Talk to your doctor

For home health services, your doctor or another qualified practitioner has to order the care and write the plan. Tell them exactly what you struggle with at home, such as getting in and out of the shower or managing medicines, so it's in your record.

3. Complete the needs assessment

For waivers and personal care, the state or its contractor will assess what help you need. Have your medication list, recent medical records and the names of your doctors ready.

4. Apply for every program that fits

You may qualify for more than one program. Ask to be placed on any waiver waiting list you're eligible for, and ask what services you can get in the meantime.

5. Build your service plan

If you're approved, you'll work with a case manager or care team on a written plan that lists your services, hours and providers. In self-directed programs, the planning process is led by you, and you can bring family or friends.

How long it takes and what happens next

Federal rules say a state's decision on a Medicaid application can't take longer than 90 days if you apply based on disability, or 45 days for most other applicants, except in unusual circumstances. The state has to tell you its own time limits when you apply. Waiver waiting lists are separate and can take longer, depending on your state.

Once services begin, your caregiver will likely check in and out of each visit using electronic visit verification (EVV). Federal law requires states to use EVV for Medicaid personal care and home health visits.

If you're denied or your services are cut

Your state must tell you in writing about your right to a fair hearing when you apply and whenever it denies or changes your benefits or services. You can ask for a hearing if you think the agency got your eligibility wrong, reduced your hours or services, or took too long to decide.

Read the notice carefully. States must give you a reasonable amount of time to ask for a hearing, up to 90 days from the date the notice was mailed. Your state's deadline may be shorter, so check the date on your notice. You can represent yourself or bring a lawyer, relative or friend. You can look for free legal aid near you at LawHelp.org.

Costs and estate recovery

Out-of-pocket costs are usually small. States can charge copays on many Medicaid services, but most are limited to nominal amounts, and some groups, such as people receiving hospice care, are exempt.

Some people in HCBS waivers may have to put part of their monthly income toward the cost of their care after they're found eligible. Your state will tell you if this applies and how much.

Estate recovery is the other cost to understand. For people 55 and older, states must try to recover what Medicaid paid for nursing facility care, home and community-based services, and related hospital and prescription drug costs from the person's estate after they die. States cannot recover from the estate while the person is survived by a spouse, a child under 21, or a child of any age who is blind or disabled. States must also have a hardship waiver process. For advice about your own situation, contact your state Medicaid agency or a legal aid office.

Frequently asked questions

Does Medicaid pay for 24-hour home care?

Medicaid home health is part-time or intermittent. Some HCBS waivers and personal care programs can cover more hours, based on your assessment and your state's limits. Ask your state Medicaid agency what its programs allow.

Can my spouse get paid to take care of me?

It depends on the program. Regular Medicaid personal care can't be provided by a legally responsible relative like a spouse. Under the 1915(j) self-directed option, a state may allow you to hire a spouse or parent. Your state Medicaid agency can tell you whether its programs allow it.

Why is there a waiting list for the waiver?

States choose the maximum number of people each 1915(c) waiver serves. When all the slots are full, new applicants may wait. If you already have Medicaid, ask about home health or personal care services you can get in the meantime.

Will Medicaid take my house after I die?

Your state may try to recover the cost of home and community-based services from your estate if you got them at 55 or older, but not while you are survived by a spouse, a child under 21, or a blind or disabled child. States can also recover for other services, so ask your state agency or legal aid how its rules work.

Sources

• Mandatory & Optional Medicaid Benefits, Centers for Medicare & Medicaid Services, accessed October 2026
• Home & Community Based Services, Centers for Medicare & Medicaid Services, accessed October 2026
• Home & Community Based Services Authorities, Centers for Medicare & Medicaid Services, accessed October 2026
• Home & Community-Based Services 1915(c), Centers for Medicare & Medicaid Services, accessed October 2026
• Home & Community Based Services 1915(i), Centers for Medicare & Medicaid Services, accessed October 2026
• Self-Directed Personal Assistant Services 1915(j), Centers for Medicare & Medicaid Services, accessed October 2026
• Community First Choice (CFC) 1915(k), Centers for Medicare & Medicaid Services, accessed October 2026
• Self-Directed Services, Centers for Medicare & Medicaid Services, accessed October 2026
• Program of All-Inclusive Care for the Elderly, Centers for Medicare & Medicaid Services, accessed October 2026
• Seniors & Medicare and Medicaid Enrollees, Centers for Medicare & Medicaid Services, accessed October 2026
• Spousal Impoverishment, Centers for Medicare & Medicaid Services, accessed October 2026
• Estate Recovery, Centers for Medicare & Medicaid Services, accessed October 2026
• Cost Sharing Out of Pocket Costs, Centers for Medicare & Medicaid Services, accessed October 2026
• Electronic Visit Verification, Centers for Medicare & Medicaid Services, accessed October 2026
• Where Can People Get Help With Medicaid & CHIP?, Centers for Medicare & Medicaid Services, accessed October 2026
• Home health services coverage, Centers for Medicare & Medicaid Services, accessed October 2026
• Medicaid & CHIP coverage, HealthCare.gov, accessed October 2026
• 42 CFR 440.70, Home health services, Electronic Code of Federal Regulations, accessed October 2026
• 42 CFR 440.167, Personal care services, Electronic Code of Federal Regulations, accessed October 2026
• 42 CFR 441.15, Home health services, Electronic Code of Federal Regulations, accessed October 2026
• 42 CFR 435.912, Timely determinations of eligibility, Electronic Code of Federal Regulations, accessed October 2026
• 42 CFR 431.206, Informing applicants and beneficiaries, Electronic Code of Federal Regulations, accessed October 2026
• 42 CFR 431.220, When a hearing is required, Electronic Code of Federal Regulations, accessed October 2026
• 42 CFR 431.221, Request for hearing, Electronic Code of Federal Regulations, accessed October 2026