Some families become confused about the difference between Medicare and Medicaid as it pertains to in-home care services. In California, Medicaid is covered through Medi-Cal. Medicare is designed for people 65 or over and will provide coverage for specific types of in home care support if a doctor has certified that the individual is homebound.
This basically means a person cannot get around without significant physical support, which may include needing assistance bathing, toileting, and even preparing meals. Medicare will only provide coverage, though, if they are not needed for seven days a week and 21 days is the maximum. If a person needs home health aides, meal delivery, help going to the bathroom but no real assistance other than that, and other factors, then Medicare isn’t covering that level of support.
Medi-Cal (or Medicaid) is for those who meet federal supplemental security income guidelines and may provide reimbursement for a range of in-home care support services, as long as they’re certified as necessary by a medical doctor.
As noted by The San Diego Union Tribune, in the news blog, Does Medicare, Medi-Cal pay for in-home care? written by Paul Sisson:
“The San Diego County Public Authority administers the program and uses social workers to interview each applicant and determine whether he or she is “unable to live at home safely without help,” assigning a specific number of hours that the program will pay to hire an “individual provider” to work in the home.
Each recipient serves as the employer of the specific in-home worker, who can provide a range of personal care, from feeding and bathing to light housecleaning and minor medical activities as ordered by a doctor. The program won’t pay for taking care of pets, gardening, window washing, mail sorting or bill paying.”
Some seniors or family members may assume that since the government is covering these expenses through reimbursement that they can’t choose the agency or caregiver they rely on, but that’s not the case. While there may be limits as far as which providers a senior can use, they have the choice on whom to hire and can terminate said caregiver if there are issues or feelings of discomfort experienced by the elderly client.
Medicare requires clients to hire a certified medical professional, but Medi-Cal does not have the same specific requirements in this regard. Home care agencies are required to inform clients which services they will be providing, and they must do this in writing.
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