Finding In-Home Care Financial Assistance for Independent Living

Some of the most common services covered by in-home medical care include:

• Administering injections and medical tests
• Catheter, colostomy, feeding tube, tracheostomy, and ventilator care
• Medical social work
• Monitoring vital signs
• Occupational therapy
• Pain management
• Physical therapy
• Short-term nursing services
• Speech-language pathology
• Wound care

Where to Find In-Home Care Financial Assistance

The cost of in-home care varies widely depending on the nature (non-medical or medical) and frequency of your care. We’ll review some of the most common professional in-home care financial assistance sources in the following sections to help you get started.

Home & Community-Based Services (HCBS)

Also known as waiver-funded services or waiver programs, Home & Community-Based Services (HCBS) are created when the government waives medical assistance rules for institutional care. They provide support and services beyond what’s covered by Medicaid and are designed to help you remain in your home and community, rather than moving into a long-term care facility.

Home- and community-based services aren’t limited to medical care, and your coverage won’t run out if or when your condition stabilizes. If you’re a resident of Pennsylvania and satisfy eligibility requirements, you have access to the following financial help for in-home care:

• Community Living Waiver
  • Provides in-home and community support, companionship, respite care, shift nursing, therapies, transportation, supported living, and more.
• Community HealthChoices (CHC) Waiver
  • Provides daily living services, cognitive rehabilitation services, home-delivered meals, transportation services, personal assistance services, respite care, and more.
• Act 150 (State-Funded Program)
  • Provides personal assistance services, personal emergency response systems (PERS), non-medical home care, and more.
• Adult Community Autism Program (ACAP)
  • Provides homemaker services, residential and behavioral support, respite care, and more.
• Adult Autism Waiver (AAW)
  • Provides behavioral health services, residential habilitation, nutritional consultation, occupational therapy, respite care, speech and language therapy, and more.
• Consolidated Waiver
  • Provides in-home and community support, companionship, respite care, shift nursing, therapies, behavioral support, transportation, supported living, and more.
• Infants, Toddlers, & Families Waiver
  • Provides habilitation services that are designed to help children acquire, maintain, and improve self-help, domestic, socialization, and adaptive skills.
• Living Independence for the Elderly (LIFE) Program
  • Provides adult day health services, transportation and escort services, nursing care and/or skilled nursing, physical, occupational, and speech therapies, recreational therapy, nutritional counseling, personal care, homemaker chore services, home-delivered meals, and more.
• OBRA Waiver
  • Provides daily living services, respite care, transportation, and more.
• Person-/Family-Directed Support (P/FDS) Waiver
  • Provides in-home and community support, companionship, respite care, shift nursing, therapies, behavioral support, transportation, and more.

Medicaid

In most cases, Medicaid covers short-term in-home care for acute conditions following a stay in the hospital, rehabilitation center, or skilled nursing facility. Some Medicaid programs also cover limited periods of in-home care for individuals who qualify. However, Medicaid often limits funding to people whose condition is severe enough that they would already qualify for nursing home coverage.

If you’re eligible for Medicaid coverage, you may also receive the following benefits:

• Adult daycare
• Assistance with ADLs and IADLs
• Durable medical equipment
• Home and vehicle modifications
• Home healthcare
• Meal delivery
• Medical alerts
• Personal emergency response services (PERS)
• Physical, occupational, and speech therapy
• Transportation

It’s important to note that Medicaid will only cover care that’s provided by a Medicaid-certified home care agency and will not pay for independent or family caregivers. Many states allow recipients to direct their own in-home care, which is also known as self-directed care or cash and counseling. In most cases, this takes the form of a cash allowance based on Medicaid’s assessment of your needs.

Medicare

Obtaining in-home care coverage through Medicare is very difficult. In most cases, you’re only eligible for professional in-home care financial assistance if you were just discharged from a hospital or rehabilitation program. While home health care that’s considered medically necessary is at least partially covered by Medicare, funding is limited to homebound individuals.

The Centers for Medicare & Medicaid Services (CMS) offer a variety of programs with benefits and eligibility requirements that vary based on your state. You can also look into Medicare Advantage plans (also known as Medicare Part C), which offer supplemental benefits including home health aides, personal care assistance, meal delivery, transportation, and home modifications.

Program of All-Inclusive Care for the Elderly (PACE)

Designed to keep seniors out of nursing homes, this joint Medicare/Medicaid program covers things like in-home care, prescriptions, transportation for medical purposes, and family caregiver respite. The PACE program may also pay for some or all of the long-term care needs of individuals with Alzheimer’s disease. PACE is only available in certain states, and eligibility is limited to low-income seniors who qualify for both Medicare and Medicaid.

Veterans Benefits

Veterans who have served at least 90 days of active duty (with a minimum of one day during a wartime period) and received an honorable discharge may qualify for a veterans pension. This cash assistance comes in three forms: improved pension, housebound, and aid and attendance.

Qualifying for veterans benefits requires documentation from your medical provider, and the specific amount you receive is calculated using a rating system based on the severity of your disability. You may also receive financial help for in-home care through veterans-directed Home- & Community-Based Services or the Department of Veterans Affairs respite care program.

Pennsylvania Help at Home (OPTIONS Program)

If you’re a Pennsylvania resident age 60+ with unmet needs that impact your daily functioning, you may qualify for the Pennsylvania Help at Home (OPTIONS) Program. OPTIONS offers supervised adult day services, ongoing care management, personal care assistance, and delivered in-home meals.

You may also receive supplemental services from your local Area on Aging, including home health services, home support, specialized medical transportation, assistive devices, and much more.

Private Health Insurance

Many private insurance policies cover doctor-prescribed short-term home care for acute health issues, usually following a skilled nursing facility or hospital stay. However, it’s highly unlikely that a private insurance policy will cover long-term in-home care. Regardless, it’s important to understand what is or isn’t covered within your current policy and look into other private options if necessary.

Long-Term Care Insurance

Long-term care insurance may cover some of your in-home care costs, including hospice or palliative care. The cost of your policy is based on the type and amount of services you need, your age, and any additional benefits you may select.

Some long-term care insurance providers will only pay licensed home care agencies, so keep in mind that you won’t be able to use independent or family caregivers. However, other plans pay you a set amount of money that you can spend on the caregiver of your choice.

Life Insurance Policies for Long-Term Care

Depending on the plan you select, you may qualify for accelerated death benefits that let you cash in with your insurance company for 50-75% of the policy’s face value. In most cases, you’re only eligible for accelerated benefits if you need long-term care, are terminally ill, have a life-threatening diagnosis, or live in a nursing home.

Accelerated death benefits are essentially tax-free cash advances that are paid out while you’re still alive. This cash advance is then deducted from the amount your beneficiaries receive when you die. The exact amount varies based on your policy benefit amounts, monthly premiums, age, and health.

If you don’t qualify for accelerated death benefits, you can opt for a life settlement, which involves selling your policy to a life settlement company for a lump sum. Once you purchase a new policy, the settlement company pays the premiums until you die. Your life insurance benefits are then paid to the settlement company, rather than your original beneficiaries.

Reverse Mortgages

Reverse mortgages allow you to use the value of the equity in your home to receive a lump sum or monthly payments. To qualify, you must be at least 62 and own your home outright (or have a very low mortgage balance).

When you receive your tax-free loan, you must first pay off your existing mortgage and any other debt against your home. You can then use the money for any expense, including long-term in-home care. 

Rather than borrowing a set amount of money, your loan balance increases over time, allowing you to stay in your home until you die (even if the balance exceeds your home’s worth). When you die, your home must then be sold to repay the loan balance.

Annuities

You can purchase an annuity from your insurance company through lump sum or monthly payments and then receive a stream of payments for a specified time period. Designed to help you turn retirement savings or a pension into a steady income stream, annuities are a smart way to finance long-term in-home care.

Trusts

Setting up a trust allows you to transfer assets to a designated trustee who manages and controls your assets for you. They’re a good option if you don’t feel comfortable handling your own finances and want someone you trust to take over. You can use charitable remainder trusts and Medicaid disability trusts specifically to pay for long-term care.

Collective Sibling Agreements

If your parents, children, or siblings are unable to assist with your care due to various reasons, you can set up an agreement where they pay other family members who are able to care for you. Alternatively, family members can pay individuals or agencies directly with the understanding that they’ll be paid back from an inheritance or the proceeds of selling your house after you die.