Paying for home care in Maryland

Most families in Maryland pay for non-medical home care privately, or through long-term care insurance, Veterans benefits, or a Medicaid waiver program if they qualify. Medicare does not generally pay for non-medical home care. It may cover short-term skilled home health care after a hospital stay, but not ongoing help with bathing, meals, companionship or housekeeping.

Here is how each option works, and where to start.

Private pay

Care agreements run for a minimum of three months, with two weeks’ notice required to cancel the agreement. Visits have a five-hour minimum and no weekly minimum. Please give 24 hours’ notice to change or cancel a visit; there is no late cancellation fee.

At Selectives, pricing is provided after a nurse evaluates your needs. There is currently no additional rate for evening, overnight or live-in care. Invoices are issued weekly or every two weeks, as agreed, and payment is by check or bank transfer. No deposit or card on file is required.

Long-term care insurance

If your parent bought a long-term care insurance policy years ago, it may cover in-home personal care — this is exactly what those policies are for. Check:

• The daily or monthly benefit amount and the elimination period (a waiting period, often 30–90 days, that you pay out of pocket before benefits start).
• Whether the policy requires care from a licensed agency (most do) and whether it needs an assessment showing help with a set number of activities of daily living, or a cognitive impairment.
• How claims are filed and what documentation the insurer wants.

A licensed agency can provide the visit records, care notes and invoices the insurer needs, and will usually help you start the claim.

Veterans benefits

Two VA benefits can help pay for in-home care:

• Aid & Attendance — an increased monthly pension for wartime veterans and surviving spouses who need help with daily activities and meet income and asset limits. The money is paid to the veteran or spouse, who can use it toward home care.
• Housebound benefits and, in some cases, VA-arranged Homemaker/Home Health Aide services through the VA Maryland Health Care System.

Applications take time, so start early. A Veterans Service Officer (through the Maryland Department of Veterans & Military Families or a veterans’ organization) can help you apply at no cost.

Maryland Medicaid waivers

For people who meet Medicaid’s financial and functional eligibility rules, Maryland offers home- and community-based services that can include personal care, so someone can stay at home rather than enter a nursing facility. The main programs are:

• Community First Choice (CFC) and Community Personal Assistance Services (CPAS) — Medicaid state-plan services providing personal assistance at home.
• The Home and Community-Based Options Waiver for older adults and adults with physical disabilities.

Eligibility and enrolment are handled through Maryland Medicaid and the local Area Agency on Aging / Maryland Access Point (MAP). Whether a specific agency can bill a specific program depends on its enrolment as a provider.

Why not Medicare?

Medicare is health insurance, and non-medical home care isn’t health care in Medicare’s terms. Medicare will pay for home health care — skilled nursing and therapy — for a limited time when a doctor orders it and the person is homebound. It will not pay for a caregiver to help with bathing, cook meals, keep company or drive to appointments on an ongoing basis. Some Medicare Advantage plans have begun offering limited in-home support benefits; check your specific plan.

Where to start

Call your local Area Agency on Aging or Maryland Access Point for a free benefits screening. If there’s a long-term care policy, dig it out and read the home care section. If your parent is a veteran, contact a Veterans Service Officer. And ask any agency you’re considering exactly which insurance, Veterans and Medicaid programs it is set up to bill.

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Selectives focuses on private pay and also works with long-term care insurance and Veterans benefits. Contact us about Maryland Medicaid and developmental disabilities waiver arrangements; current intake availability, program eligibility and authorization must be confirmed before care begins. A coordinator can discuss the options on a free first call; your price is provided after a nurse evaluates your needs.

This article is general information, not medical, legal or financial advice. For clinical questions, speak to your doctor.