Understanding Waiver Programs and Insurance Options for Home Care

Very few Americans look forward to spending their final days in a nursing home. One study confirms this. It found that 77% want to age in place. They want to live out their lives where things are familiar, surrounded by neighbors, family, and memories.

The idea of aging in place is appealing, but it can be challenging for older adults or those living with disabilities.  

Home care is an excellent option for aging in place for such people, but it can cost an average of $4,000/month. Fortunately, you don't have to bear the cost alone, as waiver programs and insurance options exist to make it more accessible and affordable.

Here, we’ll walk you through the waiver programs and insurance options available for home care. But before that, let’s highlight when home care is helpful. 

When is Home Care Helpful?

Here’s a quick rundown of when home care can be helpful:

1. To Manage Ongoing Needs

Home care is ideal for people managing long-term, chronic conditions like Parkinson’s and Alzheimer's.  Round-the-clock care ensures someone is always available for support. This constant presence helps maintain a stable, consistent routine. Meals, hygiene, and medications all stay reliably on track.

Caregivers monitor symptoms and watch for behavioral changes. They can identify warning signs like confusion or swelling before things get serious. This helps prevent costly, unnecessary hospital visits.

2. To Provide Care After a Serious Medical Episode

Sometimes the need for care follows a major event. Caring Family Home Care notes that home care is especially helpful after a serious medical event like a stroke, heart attack, major surgery, or severe fall. It further adds that doctors often recommend professional care to support recovery and rehabilitation at home after the patient leaves the hospital. 

This usually includes things like nursing or therapy visits. Therapists might include physical, speech, or occupational specialists. This help is meant to be a bridge back to health. This skilled care must be intermittent, or less than full-time.

3. To Prevent Caregiver Burnout

One in five family caregivers is at risk of burnout. Seeking support from a professional caregiver gives you a chance to rest, run errands, or simply breathe. Regular breaks help prevent burnout and allow you to return refreshed.

A trained caregiver can step in to help with daily tasks, personal care, meal preparation, or companionship, giving you space to rest, focus on other responsibilities, or simply have a moment to breathe. 

Types of Waiver Programs Available for Home Care

A waiver is essentially an extra set of Medicaid benefits to help people with long-term care needs. The main purpose is to let individuals receive needed care at home or in the community.

Here are two common types of waiver programs that make funding home care easier:

1. Medicaid Home and Community-Based Services Waivers

Among all, this waiver is the most common one. These programs allow states to waive the usual Medicaid requirement that care be provided in a nursing home.  

Under Medicaid Home and Community-Based Services (HCBS) waivers, individuals can receive services such as:

• Personal care assistance

• Adult day health care

• Homemaker services

• Respite care for family caregivers

• Case management

• Home modifications (like wheelchair ramps or bathroom safety equipment)

Each state runs its own HCBS waiver programs, so the services, eligibility rules, and waiting lists can vary widely. Some states even have specialized waivers for people with specific needs, such as intellectual disabilities, traumatic brain injury, or Alzheimer’s disease.

2. 1915(c) Waivers

Named after a section of the Social Security Act, 1915(c) waivers are specifically designed to let Medicaid pay for long-term care outside of institutional settings. 

States can tailor these programs to different populations, like seniors, children with disabilities, or adults with mental health conditions.

A person who qualifies under a 1915(c) waiver might get support such as:

• Assistance with daily living activities

• Nursing and therapy services

• Transportation to medical appointments

• Specialized medical equipment

Insurance Options for Home Care

If your loved one doesn’t qualify for a waiver, insurance can help offset the costs. Let’s look at the main coverage options.

1. Medicare

Medicare is excellent for acute hospital stays and recovery care. Medicare, however, is not intended to be a source for long-term home care. Medicare strictly pays only for skilled services provided at home. Skilled care involves nursing, physical, or speech therapy.   

This skilled care must be provided only part-time or "intermittent". Intermittent generally means less than eight hours of combined care per day. Total skilled care cannot exceed 35 hours per week of service. 

Medicare does not cover 24-hour care at home. It also does not cover non-skilled personal care if that is the only help needed. It covers only custodial care, like help with bathing or dressing, alongside required skilled care.

2. Private Long-Term Care Insurance (LTC)

LTC insurance is a private contract designed to protect your life savings and assets. It covers care in both home and institutional settings. As it is medically underwritten, you must buy it while you are healthy. 

Benefits begin after you meet a specific trigger. This trigger often involves needing help with two essential daily activities. 

Before receiving payment, you must first complete an elimination period. This period acts like a deductible, measured in time, not dollars. You’ll have to bear all care costs out of your pocket during this elimination period.  

3. Veterans’ Aid and Attendance (A&A)

This program is for eligible wartime veterans as well as surviving spouses. A&A is a tax-free monthly payment added to the basic VA pension. 

To qualify, you must require the aid and attendance of another person for daily activities. These funds are excellent for directly covering costs like home care or adult day services.

Taking the Next Steps

The world of home care funding is complicated, but finding a viable path is absolutely possible. Your most powerful tool is starting your planning and asking questions today.  

The earlier you explore your options, the more choices you’ll have and the more time you’ll have to make the right decisions for your loved one.

Reach out to your local Area Agency on Aging, speak with a social worker or care coordinator, and review what insurance benefits you may already have. If Medicaid waiver programs are available in your state, get on the waiting list as soon as possible. Small steps now can remove a lot of stress later.