If you’re exploring long-term care options for a loved one, you’ve likely asked: Will Medicaid pay for 24-hour home care? The answer depends on several factors—including your loved one’s state of residence, medical needs, and financial situation. This guide will walk you through everything you need to know to make informed decisions about Medicaid-covered home care.
What Is 24-Hour Home Care?
24-hour home care refers to around-the-clock support provided by professional caregivers. Unlike hourly visits or part-time help, this type of care ensures someone is always available to assist with essential needs like:
- Medication management
- Mobility assistance
- Personal hygiene and toileting
- Meal preparation and feeding
- Dementia supervision
- Safety monitoring and emergency response
This level of care is ideal for seniors with serious medical conditions, mobility limitations, or memory disorders such as Alzheimer’s or dementia.
Does Medicaid Cover 24-Hour Home Care?
Short Answer: Sometimes—But with Limitations
Medicaid can cover 24-hour home care, but full coverage is not guaranteed, and it’s rarely automatic. Most states offer coverage through Medicaid Home and Community-Based Services (HCBS) waivers or specific Medicaid state plans, which may fund 24-hour care if it’s medically necessary.
Coverage typically depends on:
- Eligibility (both income and health requirements)
- State-specific Medicaid programs
- The level of care required
- Availability of waiver slots
Let’s break this down further.
3 Primary Ways Medicaid May Fund 24-Hour Home Care
1. HCBS Waivers (Home and Community-Based Services)
HCBS waivers allow states to use Medicaid funds for services provided outside of nursing homes. Many of these waivers include personal care assistance, and in some cases, 24-hour care when justified by a physician.
- Pros: Flexibility in care setting (home, adult family home, assisted living)
- Cons: Waitlists are common; not available in every state
- Important Note: Washington State does offer HCBS waivers through programs like COPES and Medicaid Personal Care (MPC), which Bright Hope AFH is familiar with.
2. State Medicaid Plans
Some states offer 24-hour care under their core Medicaid plans (not waivers). These are more standardized and often easier to access, but they may cap the number of caregiving hours.
- Covered Services May Include:
- Assistance with daily living
- Health monitoring
- Skilled nursing support
3. Program of All-Inclusive Care for the Elderly (PACE)
PACE is a Medicaid and Medicare program available in select areas, including parts of Washington. It’s designed for seniors who qualify for nursing home care but prefer to stay at home. PACE often includes 24/7 care as part of its comprehensive benefits.
Is 24-Hour Home Care Always Covered?
Not necessarily. Here’s when it might not be covered:
- The senior doesn’t meet the state’s medical necessity threshold
- The care needed is considered non-medical supervision only
- The state lacks a waiver program that supports 24/7 care
- The family’s income is above Medicaid limits, and they don’t qualify
In many cases, Medicaid may only pay for a limited number of hours per week unless there’s documented need for continuous care.
Medicaid and 24-Hour Home Care in Washington State
For residents in Renton, WA or surrounding areas, Medicaid may cover 24-hour care through the Community First Choice Option (CFCO) or the COPES Waiver. These programs support seniors living at home or in adult family homes like Bright Hope AFH.
What Bright Hope AFH Offers:
- 24/7 on-call and on-site care
- Medication supervision
- Personalized care plans
- Memory care support
- Assistance with Medicaid applications and care coordination
We’re familiar with Washington Medicaid programs and can help guide families through the eligibility process.
How to Apply for Medicaid 24-Hour Home Care
Step 1: Determine Medicaid Eligibility
- Income and asset limits apply (varies by state)
- Must demonstrate need for long-term care support
Step 2: Schedule a Functional Needs Assessment
Most programs require a clinical assessment to determine if 24-hour care is necessary.
Step 3: Apply for Waivers (if needed)
You may need to join a waitlist if using HCBS waivers.
Step 4: Choose a Qualified Care Provider
Work with a licensed adult family home like Bright Hope AFH that accepts Medicaid and offers 24/7 care.
FAQs: Will Medicaid Pay for 24-Hour Home Care?
Q: Does Medicaid cover 24/7 care at home or only in nursing facilities?
A: Medicaid covers 24/7 care in both settings—but home care coverage typically requires approval through waivers or specialized programs.
Q: Can Medicaid pay for 24-hour care provided by a family member?
A: In some states, yes. Medicaid’s Consumer-Directed Programs may allow a relative to be paid as a caregiver, depending on qualifications.
Q: Is there a waitlist for Medicaid home care waivers?
A: Yes, especially for HCBS waivers. Washington State often has waitlists, but some services may be available sooner under CFCO.
Q: What if I don’t qualify for Medicaid?
A: You may explore private pay, long-term care insurance, or local senior assistance programs. Bright Hope AFH can help with resources.
Q: How do I find out which program I qualify for in Washington?
A: Call the DSHS Home and Community Services office or reach out to Bright Hope AFH—we’ll help walk you through it.
Don’t Navigate Medicaid Alone
Understanding Medicaid’s 24-hour care coverage can be overwhelming—but you don’t have to figure it out by yourself. At Bright Hope Adult Family Home in Renton, WA, we specialize in around-the-clock care and can help you explore every available funding option.
📞 Ready to learn more?
Call us today at (425) 543-8000 or contact us online to find out how we can support your family with 24-hour home care and Medicaid assistance.
