Questions about paying for eldercare services, such as home health care, often weigh on families’ minds. How will we afford in-home care services? Will Medicare or Medicaid cover some or all of the costs? What is the process for qualifying for Medicaid or Medicare coverage of home health care for Florida seniors?
Medicaid v. Medicare: Terminology, What’s Covered, Eligibility
First, it is essential to understand the basic differences between Medicaid and Medicare. The two terms are so similar they can be confusing.
Medicare is “the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease”. Payroll taxes go into paying for the program, and this along with other sources of revenue, provides coverage for retirees and others who qualify. Different parts of Medicare pay for different services. Medicare is not means-tested (eligibility based on what means the person or family has), though some costs are now tied to a recipient’s income. You can get a good overview in our Medicare Fact Sheet.
Medicare covers skilled home health care in specific circumstances. You can also download our resource sheet about paying for home care. Medicare is considered more of an acute-care health insurance, so the coverage it provides for such services tends to be for short-term and/or intermittent needs. Medicaid, long-term care insurance and private pay (patient’s and family’s funds) are the typical means of paying for longer term or more “custodial” (non-skilled) care (which is often needed as people age or manage with chronic illness).
Medicaid is defined on Wikipedia as “a social health care program for families and individuals with low income and limited resources”. It is a means-tested program, jointly funded by states and federal government and managed by each state. The states have discretion in many areas of how they manage the program, including eligibility.
For home and community based Medicaid services (such as home health care, i.e. homemaker and personal care services) in Florida, most services are administered under the Statewide Medicaid Managed Care Long-term Care Program (SMMC LTC).
Medicaid recipients must meet a means test (financial eligibility) and be determined eligible via a level of care assessment (done by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) unit at the Department of Elder Affairs). SMMC LTC is for people who qualify as needing “nursing home level care”, even though the program aims to serve them outside of a nursing home setting when possible. Contact us about resources/help applying for Florida Medicaid.
For individuals who meet these criteria, they choose a managed care company to manage an array of services available to them, including home health care.
EasyLiving is a preferred provider with two of these managed care companies: Sunshine Health and Molina Healthcare of Florida, Inc. An elder has been determined eligible for Florida Medicaid and enrolled with either of these providers can receive EasyLiving services under the plan of care. Enrollees are assigned a case manager who works with the client and providers on an ongoing plan of care for the various services needed.
Professional advocacy from our care management team can help you: determine which programs/benefits might help, navigate the Medicaid eligibility and choice process, and ensure you have the services and plan of care you need.
We offer families a free consultation to answer your many questions about Medicaid and help get you started in the right direction. Call us at 727-447-5845 or 813-333-5020 to ease your worries!