Does Medicaid cover in-home care? Yes, Medicaid covers care so seniors can age in place. In fact, according to Medicaid.gov, more than 86% of long-term support beneficiaries received care in their own homes, rather than in a senior care setting, through Medicaid waiver programs in 2021.
However, how Medicaid covers in-home care depends on your state and your medical needs.
Read on to learn more about Medicaid home health care vs. personal care, how to get Medicaid to pay for a caregiver and Medicaid income limits for home care.
[READ: How Much Does In-Home Care Cost & How to Pay for It]
Understanding the Two Types of Medicaid Home Care
Medicaid is a joint federal-state program that provides health care coverage to those with limited income and assets. Medicaid differs from Medicare, which is health insurance primarily for older adults and younger individuals with certain disabilities. Medicare typically covers short-term skilled services, such as nursing care or therapy, while Medicaid covers longer-term support for those who meet the financial and functional requirements.
Medicaid in-home care coverage comes through a mix of your state’s baseline Medicaid benefits, home and community programs and state programs and waivers. The biggest factor in Medicaid coverage of in-home care is whether care is medical home health care vs. nonmedical personal care; the two are treated differently under Medicaid rules.
Home health care (medical)
The federal government requires state Medicaid programs offer medical home health care to those who medically and financially qualify, according to Medicaid.gov.
Some medical home health care services are mandatory, Medicaid.gov notes, such as:
— Inpatient services
— Outpatient services
— Transportation to medical care
— Lab and X-ray services
Optional home health services include:
— Physical, occupational or speech therapy
Even though Medicare also often covers the above items, Medicaid can provide longer-term coverage.
Personal in-home care (nonmedical)
Personal in-home care is not federally mandated, which means state Medicaid coverage varies.
Personal in-home care services include:
— Assistance with activities of daily living (ADLs), such as showering or eating
— Mobility assistance, such as help walking or moving from bed to a wheelchair
— Meal prep or light housekeeping
Medicare does not cover any personal or custodial (nonmedical) in-home care.
Medical vs. nonmedical services
The table below shows which services are medical and nonmedical.
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Even when medical services are approved for Medicaid coverage, they are often authorized conservatively, with modest in-home aide hours, says Jill Poser, the founder and principal of Life Care Concierge of South Florida in Boca Raton, Florida.
“As a result, families typically remain responsible for the lion’s share of long-term care expenses, especially for extended custodial care,” she explains.
Key coverage limitations and exclusions
Medicaid often does not cover services not deemed medically necessary, including:
— 24/7 supervision
— Purely custodial care without a documented functional limitation
— Luxury home modifications, such as a structural add-on
— Housekeeping
Medicaid is more suited for ongoing needs but is stricter about income, assets and functional eligibility.
[READ: Understanding Home Health Care Service Options]
How Does Medicaid Coverage for Home Care Vary by State?
Every state has different Medicaid eligibility and coverage due to joint state and federal funding, says Ocean Van, CEO of Home Helpers Home Care of North San Diego.
What’s key is finding the right care delivery models. These models depend on the Medicaid benefit or waiver you are accessing and how your state has elected to run that program, meaning your state can use multiple models simultaneously. Understanding the care delivery models in your state helps you know who runs your care and how you can navigate the system more effectively.
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For more information on your state’s Medicaid care delivery model, eligibility requirements and in-home care benefits, visit your state’s Medicaid website.
[READ: 12 Signs It’s Time for In-Home Health Care]
How Medicaid Pays for Home Care
There are several ways that Medicaid pays for in-home care:
1. Baseline state Medicaid. This option is available to all individuals who meet the financial and medical criteria. Medicaid usually provides basic home health services and limited personal care in some states. But it’s not enough for extensive, long-term daily care.
2. Home and Community-Based Services (HCBS) waivers. This is the most common benefit seniors use to get extensive in-home care. These programs are designed to keep people from going into nursing homes. They offer more personal care, including respite care, but often have long waiting lists. Understanding HCBS waiver eligibility in 2026 can help you plan ahead.
3. Community First Choice (CFC). This state benefit was established under the Affordable Care Act of 2010, not a capped waiver program, so most people who qualify won’t face long waiting lists. CFC also offers more flexibility in personal care coverage because it provides a broader list of approved services. Even though CFC is a Medicaid benefit without caps, many states rely on capped waivers, like HCBS, to control costs.
In addition to Medicaid, there is a variety of alternative programs that may be available to seniors based on income, age and disability status, says Evan H. Farr, a certified elder law attorney and retirement planner at Farr Law Firm P.C. in Virginia, Maryland and Washington D.C.
This includes:
— Programs of All-Inclusive Care for the Elderly (PACE), which is designed to support seniors living at home
— Aid and Attendance program, which is a VA pension benefit that pays for in-home care for qualifying veterans
— VA Community Care program, which provides in-home and community care for eligible veterans
Can Family Members Get Paid? (The “Self-Directed” Option)
Yes, in many states, a family member can get paid by Medicaid for performing home care; this is called “self-directed,” “consumer-directed” or “participant-directed care”. However, Medicaid will not pay your unlicensed family member to provide services that must be performed by a licensed professional. In some states, your family member may need to take a training course or pass a background check.
How to get Medicaid to pay for a caregiver
With participant-directed or self-directed care, the Medicaid recipient acts like the employer and can hire family members.
Let’s say your grandmother would prefer to avoid assisted living but could benefit from some in-home care. In this case, Medicaid would set a budget and allocate hours for a caregiver to provide her in-home care. Your grandmother would act as the “employer” and choose who would provide the care, as long as it is within state rules (some states do not allow a spouse to be the caregiver, for example). Then your grandmother would designate an intermediary to handle payroll and taxes. The benefit of this approach is that those who need care have greater autonomy and continuity in their care.
Eligibility Requirements for 2026
While 2026 Medicaid eligibility requirements vary by state, the main categories for eligibility are:
— Asset limit. The Medicaid asset cap in 2026 is typically around $2,000 for individuals, and $3,000 to $4,000 for married couples, but some states, like California, have much higher asset limits. Van says in California, the limit for countable assets is $130,000 for an individual and $195,000 for a couple. Additional household members add $65,000 each, up to 10 people. Countable assets include cash, bank accounts and property, but Medi-Cal pathways treat a primary home and one vehicle as exempt, with details depending on eligibility category.
— Income limit. In many states, Medicaid income limits for long-term care allow people to qualify for Medicaid even if they earn more than the typical Medicaid limits. For example, several states allow up to three times the federal Supplemental Security Income amount ($994 for an eligible individual in 2026), which would potentially add up to $2,982 per month in 2026.
— Functional needs. To qualify for many Medicaid in-home care waivers, seniors must demonstrate a need for help with ADLs. In 2026, many states require that seniors need assistance with three or more ADLs to qualify. The functional assessment is often performed by a nurse or social worker and usually covers the senior’s living situation, how much support they need with each ADL and how long each ADL takes each day.
— Medical necessity. This is a clinical determination by a licensed health care provider that certifies that you need Medicaid-covered care for health reasons and not out of personal convenience.
Does Medicaid Cover 24/7 Home Care?
Medicaid rarely covers round-the-clock personal care in a private home. In-home personal care is expensive for state Medicaid programs, so they are strict about approving it. If you need advanced medical support with round-the-clock skilled nursing, however, you may qualify for 24/7 home care.
“In some cases, we can get clients more than the typical cap hours, though with recent Medicaid cuts, this is becoming more difficult, and both Virginia and D.C. are aggressively cutting back on in-home hours,” Farr says.
Farr says typical cap hours per day in states in which he practices include:
— Virginia: Up to eight hours per day under the Commonwealth Coordinated Care Plus waiver
— Washington, D.C.: Up to 16 hours per day under the Elderly and Persons with Physical Disabilities waiver
— Maryland: No workable in-home care waiver program. “Although their Community Options waiver does exist, it has a 15-year waiting list that only allows up to 700 (hours) per year to use,” Farr explains.
Instead of 24/7 care, Medicaid may recommend:
— Combining daily home care hours with adult day services
— Private duty nursing, if in-home medical care needs are high
— Covering some hours of in-home care, but not all 24 hours in a day
For most individuals, 24/7 care is more likely to be approved in a senior care facility than at home.
How to Apply for Medicaid In-Home Care
To apply for Medicaid in-home care, start by following these three steps:
1. Contact your local Area Agency on Aging (AAA). Your AAA can explain your state’s Medicaid programs and help you start your application.
2. Gather financial documents. You will need bank statements, income records and insurance and asset information. Remember that Medicaid has a five-year look-back period, which allows state Medicaid agencies to review your past five years of financial records prior to your application. Medicaid wants to ensure you have not transferred or sold assets for less than market value to qualify for benefits. For help with the financial planning, the Medicaid spend-down process and the five-year look-back, contact a financial planner who specializes in Medicaid planning.
3. Schedule a functional assessment. A functional assessment determines your ability to perform ADLs, your medical needs and the type and level of care you require.
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Does Medicaid Cover In-Home Care? A 2026 Guide to Benefits and Eligibility originally appeared on usnews.com
