Many individuals require professional care at home due to aging, illness, or a setback to ensure the best quality of life. Whether obtaining help with bathing, preparing meals, or recovering from a hospital stay, home health care supports an individual’s daily living without needing to move into a nursing home or other care facility.
Before deciding to hire home health services, understanding how to pay for care is essential. Different healthcare coverage options, including Medicaid, can help pay for some services. In Texas, Medicaid home health care coverage depends on numerous characteristics that determine eligibility. So, when asking, “Does Texas Medicaid pay for home health care?” The short answer is, “Yes, but based on eligibility criteria.”
Keep reading below for insights on home health care services, Medicaid coverage of such services, and how Boost Home Healthcare can support your loved ones’ in-home care needs to remain living safely at home.
What Is Home Health?
Home health is a wide range of medical and non-medical services you can receive after an illness, injury, or setback, in the comfort of your own home. This allows you to remain in familiar surroundings, promoting emotional well-being and recovery. It is usually less expensive, more convenient, and just as effective as the care you get in a hospital or skilled nursing facility (SNF). Support may include skilled medical care, help with daily activities, or a combination of both, depending on the individual’s condition. Services, however, may vary by state and license, according to each location’s regulations.
Services Covered by Home Health
The professional care services provided through home health care are done so by a home health agency’s team of nurses, therapists, or home health aides, who help with medical and non-medical support, such as:
Skilled Nursing Care: It is delivered by registered nurses (RNs), licensed practical nurses (LPNs), or licensed vocational nurses (LVNs) and includes monitoring of vital signs, administering medications or IV therapies, wound care for surgical or chronic wounds, managing complex medical conditions such as diabetes or heart disease, and more.
Physical Therapy: Visits by physical therapists (PTs) may focus on improving mobility, fall prevention, post-op rehabilitation, post-hospitalization deconditioning, and more.
Occupational Therapy: Occupational therapists (OTs) work on improving skills and daily activity tasks needed for personal care. OTs may also recommend home modifications for enhanced safety and other support types.
Speech Therapy: Speech-language pathologists (SLPs) help patients who struggle with communication, swallowing, or cognitive impairments. These services are especially beneficial for those recovering from strokes or neurological conditions. SLPs also provide education to patients and families. Learn more.
Medical Social Services: Social workers help provide emotional support, connect families with community resources or financial assistance programs, and advocate for proper emotional and medical care. Learn more.
Personal Care: Home health aides or personal care aides assist with personal hygiene, activities of daily living, instrumental activities of daily living, and other personal assistance duties.
Does Texas Medicaid Cover Home Health Care?
Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. It offers benefits that Medicare doesn’t normally cover, like nursing home care and personal care services. Additionally, while the federal government has general rules that all state Medicaid programs must follow, each state runs its own program. This means eligibility requirements and benefits can vary from state to state.
Texas Medicaid
Certain benefits are included in home health coverage provided by Medicaid in Texas; however, they depend on each individual’s eligibility, including the specific Medicaid program to which they belong. Seniors, adults with disabilities, and some children with disabilities who don’t have health insurance might be able to get health coverage through the Medicaid for the Elderly and People with Disabilities program.
For older adults, services may be provided through STAR+PLUS Home and Community Based Services Waiver Program, a Texas Medicaid-managed care program for adults who have disabilities or are age 65 or older. Adults in STAR+PLUS get Medicaid healthcare and long-term services and support through a health plan that they choose. Services may include:
- Activities of daily living like bathing, dressing and eating
- Other essential home and personal care tasks
- Respite
- Professional therapies like physical, occupational, and speech therapy
- Medical supplies
- Nursing
- Adaptive aids and minor home modifications
Services Not Covered by Texas Medicaid
While Texas Medicaid covers a wide range of health services, it does not usually cover:
- 24/7 custodial care unless medically necessary
- Non-medical services like companionship or cleaning, unless part of a waiver
- Room and board in assisted living facilities, unless under a specific waiver
- Services not considered a medical necessity
- Help from private companies not enrolled in Medicaid programs
Determining Eligibility & Applying
To qualify for Medicaid coverage for home health care, applicants must be Texas residents and U.S. citizens or qualified non-citizens. When applying, Medicaid will ask about income, age, and disability or medical need to determine eligibility. Access more information here. The American Council on Aging also provides a Medicaid Eligibility Test to help determine eligibility.
To apply for coverage, however, users should visit the site YourTexasBenefits.com, to complete the application, which may ask for information such as:
- Money obtained from jobs and other sources
- Social Security numbers and birth dates of everyone who wants to apply
- Costs for bills, such as rent, mortgage, water, gas, electricity, sewage, and phone
- The value of items being paid for or owned, such as vehicles, money in bank accounts, stocks, etc.
- Money paid or obtained for child support
- Health insurance information
Other Ways to Pay for Home Health Care
There are other ways to pay for home health care for individuals who don’t qualify for Medicaid. These include:
- Medicare and Medicare Advantage
- VA benefits
- Workers compensation
- Long-term care insurance
- Private pay
- Commercial and private insurance billing
For more information on these options, click here.
Considering Home Health Services
Caring for an aging loved one can be a rewarding yet complex experience, mainly because it may be hard to know when to ask for help. However, signs such as noticing increased fall risk, reduced mobility, or medication issues are a good signal that home health services may be needed.
Choosing the right home health agency is essential for ensuring quality care. At Boost Home Healthcare, we provide families with comprehensive home health services supporting care and quality of life. By offering a range of medical and non-medical services, we empower individuals to maintain independence and live comfortably in their own homes. Whether the care need is for skilled nursing care, therapy, or assistance with daily living, home health care is a flexible and compassionate solution.
Boost Home Healthcare delivers the care you need in the space you love. We offer more convenient – and often more affordable – care compared to hospitals or skilled nursing facilities. As an added benefit, our approach is entirely personalized for you and your changing needs.
Ensure your loved one’s at-home safety by considering home health services. Start your assessment today by connecting to a Boost Home Healthcare location near you.
Helpful Resources:
