Medicaid
Medicaid provides vital support for senior care services, including in-home care, through specific programs designed to assist low-income elderly individuals. These programs often cover a range of services, such as help with activities of daily living, skilled nursing care, and homemaker assistance, allowing seniors to remain in their homes while receiving essential care. Eligibility is determined based on income, assets, and medical necessity, ensuring that those with significant need can access the support they require. In Georgia, programs like the Community Care Services Program (CCSP) and Elderly and Disabled Waiver Program (EDWP) offer coverage for in-home care, enabling seniors to maintain their independence and quality of life.
Medicare
Medicare covers certain senior care services, including in-home care, primarily under Medicare Part A or Part B. Coverage typically includes skilled nursing care, physical therapy, speech-language therapy, or continued occupational therapy when medically necessary.
To be eligible for in-home healthcare through Medicare, the care recipient must:
- Be under the care of a doctor and receive services under a plan created and reviewed routinely by a doctor
- Have doctor certification that they need intermittent skilled nursing care or therapeutic services, or are homebound
- Receive care from a Medicare-certified home healthcare agency
However, Medicare does not generally cover non-medical personal care services, such as assistance with bathing or housekeeping. These services are provided on a part-time or intermittent basis and are aimed at helping seniors recover from illness or injury while maintaining independence at home.
Community Care Services Program (CCSP)
The Community Care Services Program (CCSP) allows older adults and those living with an injury or illness to live in their home or community instead of an assisted living facility. Individuals who receive care at home through the Elderly and Disabled Waiver must qualify for Medicaid and meet the following requirements:
- Qualify for the level of care offered by a nursing home
- Have needs that can be met by the program within the cost outlined by the care plan
- Have limitations that make independence and performing activities of daily living difficult
SOURCE (Service Options Using Resources in Community Environment)
SOURCE is a statewide Primary Care Enhanced Case Management Service under the Elderly and Disabled Waiver that links primary medical care with many long-term health services in a person’s home or community setting to prevent unnecessary emergency room visits and hospital stays and avoid institutionalization.
SOURCE serves aged, blind and disabled Georgians who are Medicaid eligible.
An assessment helps to determine how much care a participant needs. An individual care plan is designed based on the need for medical monitoring and assistance with functional tasks. Family members and other informal caregivers as well as staff from support agencies participate in care plans. In addition to the core services, SOURCE offers home delivered meals, adult day health care, personal care home and 24-hour medical access.
To be eligible for in-home healthcare through Medicare, the care recipient must:
- Be under the care of a doctor and receive services under a plan created and reviewed routinely by a doctor
- Have doctor certification that they need intermittent skilled nursing care or therapeutic services, or are homebound
- Receive care from a Medicare-certified home healthcare agency
However, Medicare does not generally cover non-medical personal care services, such as assistance with bathing or housekeeping. These services are provided on a part-time or intermittent basis and are aimed at helping seniors recover from illness or injury while maintaining independence at home.
The Georgia Pediatric Program Nursing Program (GAPP)
The Georgia Pediatric Program Nursing Program (GAPP) is designed to serve eligible members with nursing services based on medical necessity determination(s) under the age of 21. Members must be medically fragile with multiple systems diagnoses and require skilled nursing and personal care to be considered for services in the GAPP Program.
Applications to the Georgia Pediatric Program are completed by the individual Medicaid providers enrolled to offer services
through the program. To view current a list of providers please: visit www.mmis.georgia.gov, select Provider Information, select
Provider Manuals and select GAPP specifi c manual of interest.
GAPP applications must to be submitted to the Alliant Georgia Medical Care Foundation’s (GMCF) Medical Review Team at
least thirty (30) days prior to the start of GAPP service.
Medicare Advantage Plans
Medicare Advantage plans generally cover home health care services at the same level as Original Medicare, but may have additional rules, restrictions, or costs. Some plans may require prior authorization, referrals, or contracted providers. They also may charge copayments or coinsurance
Private Insurance
Private insurance can cover certain senior care services, including in-home care, depending on the specific policy and benefits offered. Some plans include provisions for personal care assistance, skilled nursing, or therapy services provided in the comfort of the home. Long-term care insurance policies, in particular, often provide broader coverage for non-medical support, such as help with daily activities, meal preparation, and housekeeping. Coverage details, such as duration and reimbursement rates, vary widely, so it’s important to review your policy or consult with your insurance provider to understand your specific benefits. Many private insurers also collaborate with certified care agencies to ensure quality services for their policyholders.
Private Pay
Private pay for senior care services, such as in-home care, allows families to directly cover the costs of personalized assistance for their loved ones. This payment option provides flexibility in selecting the type of care, frequency, and provider that best suits an individual’s needs. Services typically covered under private pay include help with daily activities like bathing, dressing, and meal preparation, as well as companionship and light housekeeping. Without the constraints of insurance or program guidelines, private pay ensures access to high-quality and customizable care. While it may require financial planning, this approach empowers families to make decisions that prioritize comfort, independence, and well-being for their senior loved ones.
How Medicaid Covers the Cost of In-Home Care for the Elderly
The Community Care Services Program (CCSP) allows older adults and those living with an injury or illness to live in their home or community instead of an assisted living facility. Individuals who receive care at home through the Elderly and Disabled Waiver must qualify for Medicaid and meet the following requirements:
- Qualify for the level of care offered by a nursing home
- Have needs that can be met by the program within the cost outlined by the care plan
- Have limitations that make independence and performing activities of daily living difficult
AREAS OF SPECIALTY
We can help you with the following home care needs:
The Cost of In-Home Care
Next Level Healthcare Agency will help you build an effective care plan you can afford.
