Medicare and Medicaid In-Home Care Coverage in California

For seniors getting in-home care services, a primary concern is whether the health system covers for such services. There are two health systems that we will tackle for the purpose of this topic: Medicare and Medicaid, or Medi-cal in California.

Medicare is a federal health system applicable for Americans aging 65 and above. On the other hand, Medi-cal is a Medicaid health system in the state of California intended for those aging 65 years and older.

As a general rule, Medicare does not cover long-term home care services. The following are therefore not covered: 24-hour home care, bathing, meal delivery, dressing, cleaning, shopping and laundry. Also, such a program only covers speech-language pathology services, physical therapy, occupational therapy, and skilled nursing care at home.

To be covered, there must be a certification from the doctor that you are homebound. This means that the senior needs “major help” at home. Medicare only covers in-home care that is fewer than seven days a week and not more than eight hours a day. Home health aide is also only covered if you are receiving skilled nursing services from certified medical professionals.

Medicare has its own website from which you can select home care agencies in San Diego,California. Since many in-home care services are not covered by Medicare and agencies offer a range of home care services, you must first check the ABN, short for Advance Beneficiary Notice of Non-coverage.

Read the ABN before signing a contract with the home care company. Look into the terms and conditions of the agreement. Check the services that they will be providing. Most importantly, check whether or not certain services will be covered by Medicare. .

However, Medicaid, or Medi-cal, is different.

In-Home Care Services in California

The State of California’s in-home care program is applicable for those who meet the federal supplemental security income guideline, which is $9,007 a year if you are alone, or $13,244 if you are a couple. For such a program, they tap in state, county, and federal funds. They pay up to 283 hours of home care services a month.

This program is administered by the San Diego County Public Authority. Social workers interview the applications to determine whether they are qualified or not. If they meet the requirements and are unable to live in their home without help, they are assigned a certain number of in-home care hours which the program will pay for.

The in-home worker will provide the necessary care that the senior needs: personal care, companionship, light house cleaning, bathing, feeding, and others. However, the following are not covered: gardening, pet care, wind washing, payment of bills, and mail sorting.

Which caregiver to employ

The program does not require that you get caregivers from a select agency. The recipient is given the discretion to choose the caregiver he or she wants to employ. Seniors can freely choose whether they will get caregivers from home care agencies or hire independent caregivers. The program also maintains a directory containing a list of independent caregivers.

The recipient can even choose to hire a family member or a friend, as long as he or she passes the criteria set by the program. The main criterion is that the caregiver must pass a background check.

Those who have committed “Tier 1” and “Tier 2” crimes are barred for 10 years. “Tier 1” crimes include elder abuse, child abuse, and government fraud; while “Tier 2” crimes include fraud against public social services, sex offense, and other violent and serious felonies. However, if the recipient signs a “waiver,” the program still pays a person as caregiver even if that person has a record.

Your knowledge of these Medicare and Medicaid coverage in relation to in-home care services in California is helpful. Make sure that you consider these things before choosing an in-home care agency.

 

 

 

 

 

 

 

 

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