Medicaid covers home health care as a mandatory benefit in every state, meaning you don’t need a special program or waiver to access basic services like skilled nursing and medical equipment at home. Getting approved, however, requires navigating a specific process: confirming your eligibility, getting a physician’s order, completing a functional assessment, and connecting with an approved provider. The steps vary by state, but the overall framework is consistent nationwide.
What Medicaid Covers at Home
Federal law requires every state Medicaid program to cover home health services. This mandatory benefit includes skilled nursing visits, home health aide services, and medical supplies or equipment. These are clinical services, typically ordered after an illness, injury, surgery, or worsening of a chronic condition.
Beyond the mandatory benefit, states can choose to cover additional services. Many do. Optional home-based benefits include personal care assistance (help with bathing, dressing, eating), physical therapy, and private duty nursing for people who need more intensive or ongoing support. Whether your state offers these depends on its Medicaid plan, so checking with your local Medicaid office is the fastest way to find out what’s available where you live.
There’s also a broader category of home care available through special programs called Home and Community-Based Services (HCBS) waivers. These waivers cover non-medical support designed to help people stay out of nursing facilities: case management, homemaker services, adult day programs, respite care for family caregivers, and residential support. States can even design custom service categories tailored to their populations. HCBS waivers are where the most comprehensive home care packages come from, but they have their own eligibility rules and, often, waitlists.
Financial Eligibility Requirements
Medicaid eligibility for home health care depends on your income and assets, and the thresholds vary significantly by state. To give a concrete example, New York’s 2025 limits for long-term care services are $1,732 per month in income for an individual and $2,351 for a household of two. Asset limits are $31,175 for one person and $42,312 for two. Other states set their own figures, sometimes higher, sometimes lower.
If your income is slightly above your state’s threshold, you may still qualify. Many states have “medically needy” pathways or spend-down programs that let you subtract medical expenses from your countable income. Some states also disregard certain assets like your primary home or one vehicle. A Medicaid caseworker or benefits counselor at your local Area Agency on Aging can help you understand exactly where you stand.
The Application Process Step by Step
Start by applying for Medicaid itself if you aren’t already enrolled. You can do this through your state’s Medicaid agency, often online, by phone, or in person at a local office. You’ll need documentation of your income, assets, residency, and citizenship or immigration status.
Once you have Medicaid coverage, getting home health services requires a physician’s order. Federal rules require a face-to-face encounter with a doctor or authorized provider to document why you need care at home. For nursing and home health aide services, this visit must occur no more than 90 days before or 30 days after services begin. For medical equipment and supplies, the window is six months before the start of services. This visit can happen via telehealth, which makes it more accessible if getting to a clinic is difficult.
Your doctor doesn’t need to certify that you’re homebound. This is a common misconception. Federal policy explicitly clarifies that states cannot require someone to be homebound to receive Medicaid home health services. You qualify based on medical need, not on your ability to leave the house.
The Functional Assessment
If you’re applying for long-term home care services or an HCBS waiver (not just short-term skilled nursing), you’ll go through a functional assessment. This is an in-home interview conducted by a representative from your state or local health department, an Area Agency on Aging, or a contracted assessment organization. The evaluator will ask about your ability to perform daily activities like bathing, dressing, eating, managing medications, cooking, and handling finances. Nearly all states also assess cognitive and behavioral needs, clinical care requirements, and your home environment, including whether your living space is accessible and safe.
This assessment determines your “level of care,” which is the state’s way of deciding whether you need the kind of support that would otherwise require a nursing facility. Meeting this threshold is what qualifies you for the most comprehensive home care packages. The results also shape your care plan, determining how many hours of help you receive and what types of services are included.
HCBS Waivers and Waitlists
HCBS waivers offer the richest set of home care services, but they come with a significant catch: 41 states maintain waiting lists. The average wait in 2025 is 32 months. That number varies dramatically depending on the population served. Waivers for older adults and people with physical disabilities average about 15 months. Waivers for people with intellectual and developmental disabilities average 37 months. Waivers specifically for people with autism average 63 months.
The good news is that waiting for a waiver doesn’t mean going without all help. Most people on waiver waitlists are eligible for other Medicaid home care services in the meantime, including the mandatory home health benefit and, in many states, personal care assistance through the regular state plan. Getting on a waitlist as early as possible matters, because your place in line starts when you apply, not when you’re approved.
States that screen for eligibility before placing people on the waitlist tend to have shorter waits. If your state offers a pre-screening option, completing it promptly can save months.
Finding a Medicaid-Approved Provider
Once you’re approved for services, you need to connect with a home health agency that accepts Medicaid. Your state Medicaid office or managed care plan (if your state uses one) can provide a list of certified agencies in your area. Many states also maintain online provider directories. New York, for example, lists over 1,400 home health agencies in its state health profiles database, searchable by type: certified home health agencies, licensed home care services agencies, and long-term home health care programs.
If your state doesn’t have a user-friendly directory, call your Medicaid caseworker or the number on your Medicaid card. They can refer you to agencies currently accepting new patients. In rural areas, availability can be limited, so asking about telehealth options for skilled services or self-directed care programs is worth doing early in the process.
Self-Directed Care and Hiring Family
Many states offer self-directed care programs that give you control over who provides your services. Under these programs, you act as the employer: you recruit, hire, train, and supervise your own caregivers. In many cases, this includes hiring family members and paying them through Medicaid funds.
Self-direction is available through several Medicaid pathways, including HCBS waivers, the Community First Choice option, and dedicated self-directed personal assistance programs. The specific rules about which family members can be hired (some states exclude spouses or legal guardians, for instance) and how much they’re paid depend on your state’s program design. A support broker or fiscal intermediary, assigned as part of the program, handles payroll and tax paperwork so you can focus on managing your care.
This option works especially well when you already have a trusted family member providing unpaid care. It formalizes the arrangement, provides the caregiver with income, and often improves the consistency and quality of support you receive.
If You Have Both Medicare and Medicaid
Over half of people who use Medicaid home care are also enrolled in Medicare. If you’re one of them, understanding which program pays first matters. Medicare covers short-term skilled home health care, like nursing visits after a hospitalization, and acts as the primary payer for those services. Medicaid picks up where Medicare stops, covering long-term personal care, homemaker services, and the broader HCBS supports that Medicare doesn’t offer at all.
A common misconception is that Medicare is the main source of home care coverage for people with low incomes. It isn’t. Medicaid covered two-thirds of all home care spending in the United States in 2022. Medicare’s home health benefit is time-limited and focused on recovery, while Medicaid’s coverage can be ongoing and is designed to help you live at home long-term.