Does Medicaid Cover Home Health Care? (2026)

The Federal Floor: What Every State Must Cover

Federal Medicaid law at 42 CFR 440.70 sets a minimum that every state must meet. For any Medicaid enrollee who has a physician (or nurse practitioner, clinical nurse specialist, or physician assistant) order and qualifies medically, states must cover three core home health services:

Critically, the regulation says Medicaid home health coverage cannot be restricted to beneficiaries who are homebound. Unlike Medicare home health (which requires homebound status), Medicaid home health does not impose that gate. This matters for working-age adults and people who can leave their home with difficulty.

• Part-time or intermittent skilled nursing, provided by a licensed RN or through a home health agency, based on a written care plan
• Home health aide services: help with activities of daily living (bathing, dressing, grooming, ambulation) provided by a certified aide
• Medical supplies, equipment, and appliances suitable for home use (broader than Medicare's durable medical equipment list, so states can cover items Medicare would not)

State-Optional Services: Personal Care and HCBS Waivers

Beyond the federal floor, states can offer a much wider range of home-based services. The most important optional pathways are personal care services under the state plan and HCBS waivers under Section 1915(c) of the Social Security Act.

As of 2026, 33 states offer personal care services as a Medicaid state plan benefit, which typically covers help with bathing, dressing, grooming, and similar non-medical tasks by a home care worker. Separately, 47 states operate Section 1915(c) HCBS waivers that can cover an even wider range: homemaker services, adult day programs, respite care for family caregivers, assistive technology, home modifications, and transportation. HCBS waiver enrollment is often capped by slot availability, meaning waitlists are common, sometimes years long.

A third pathway, available in 10 states, is the Community First Choice (CFC) option under Section 1915(k), which provides personal care and related services as an entitlement (no waitlist) with enhanced federal matching funds. Managed Long-Term Services and Supports (MLTSS) programs, used by 25 states as of 2026, bundle home health, personal care, and HCBS into a single managed care plan.

Dual-Eligible Beneficiaries: Stacking Medicare and Medicaid Home Health

About 12 million Americans are dual-eligible, enrolled in both Medicare and Medicaid. For them, Medicare is the primary payer for home health and Medicaid wraps around it. Medicare covers home health when the beneficiary is homebound, needs skilled care (skilled nursing or therapy), has a physician order, and the agency is Medicare-certified. Medicaid then fills critical gaps: it can cover home health aide hours beyond what Medicare authorizes, personal care services (non-medical help) that Medicare never covers, and medical supplies not on Medicare's equipment list.

In states with MLTSS programs or Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs), a single managed care organization coordinates all home health and HCBS benefits under one plan. As of 2026, Medicare-Medicaid demonstration plans (MMPs) have ended. Enrollees who were in MMPs now need to select new integrated coverage options.

How to Access Medicaid Home Health Services

Getting Medicaid home health services requires meeting both financial eligibility for Medicaid and clinical criteria for home health. The steps are:

Visit your state's Medicaid agency website or Benefits.gov to apply. If already enrolled in Medicaid, contact your Medicaid managed care plan or case manager and request a home health assessment. Your doctor must write an order for home health services and document medical necessity. A state assessor or managed care nurse will conduct a level-of-care assessment. Approved services begin with a written care plan signed by your physician.

• Financial eligibility: income and asset limits set by your state (expansion states cover adults up to 138% FPL; non-expansion states have stricter limits)
• Medical necessity: physician order documenting the need for skilled nursing, aide services, or equipment
• Level-of-care assessment: a state-conducted functional assessment measuring ability to perform ADLs
• For HCBS waivers: meet additional clinical criteria (often needing nursing facility level of care) and availability of a waiver slot

What Medicaid Home Health Does Not Cover

Even with the broad federal mandate, there are limits to what Medicaid home health covers. Understanding these gaps prevents surprise denials.

• 24-hour custodial care in the home (full-time non-medical supervision). Not a mandatory benefit, though some HCBS waivers come close
• Homemaker-only services (cooking, cleaning, laundry) without a related health need. Coverage varies significantly by state
• Services from an agency that does not meet Medicare Conditions of Participation. Medicaid home health agencies must meet the same federal standards
• Services without a physician or eligible practitioner order. Coverage requires a written order and written care plan
• Room and board costs in assisted living facilities (Medicaid covers services, not room and board, in those settings)

Is home health care a mandatory Medicaid benefit in all states?

Yes. Under 42 CFR 440.70, home health services are a mandatory Medicaid benefit that every state must cover. The federal floor requires coverage of part-time intermittent skilled nursing, home health aide services, and medically necessary supplies and equipment for any Medicaid enrollee with a physician order. States cannot eliminate this benefit or restrict it only to homebound individuals.

Does Medicaid require beneficiaries to be homebound to get home health?

No. Unlike Medicare home health (which requires homebound status), Medicaid home health under 42 CFR 440.70 explicitly cannot be limited to homebound beneficiaries. Any Medicaid enrollee who has a physician order and meets medical necessity criteria qualifies, regardless of their ability to leave their home.

What is the difference between Medicaid home health and a Medicaid HCBS waiver?

Medicaid home health (42 CFR 440.70) is a mandatory state plan benefit covering skilled nursing, home health aide services, and medical supplies, guaranteed for all qualifying enrollees. HCBS waivers (Section 1915(c)) are optional state programs covering broader non-medical services like homemaker help, adult day programs, and respite care. HCBS waivers often have enrollment caps and waitlists; the core home health benefit does not.

How many hours of home health aide can Medicaid cover?

There is no federally mandated minimum number of hours. States set their own hour caps and prior authorization requirements for home health aide services. Some states authorize a few hours per week for basic assistance; others authorize substantial daily hours for complex medical needs. Dual-eligible beneficiaries may get additional hours from Medicaid beyond what Medicare authorizes.

Can I get Medicaid home health if I also have Medicare?

Yes, and the combination is powerful. About 12 million Americans are dual-eligible. Medicare is the primary payer for skilled home health when you are homebound and need skilled care. Medicaid then covers gaps: personal care services (non-medical help) that Medicare never covers, aide hours beyond Medicare's authorization, and medical supplies not on Medicare's list. MLTSS plans in 25 states coordinate both benefits in one plan.

Does Medicaid cover 24-hour in-home care?

Not as a mandatory benefit. Round-the-clock custodial care is not required under the federal home health mandate. Some states offer substantial aide hours through HCBS waivers for medically complex individuals, and a few states cover consumer-directed personal care programs that can come close to full-day coverage. But families seeking 24-hour supervision should expect to combine Medicaid benefits with unpaid family care.

Does Medicaid cover home health for people under 65?

Yes. The mandatory home health benefit applies to all Medicaid enrollees who meet medical necessity criteria, regardless of age. Working-age adults with disabilities, people with chronic conditions, and even children on Medicaid can receive home health services when medically necessary. HCBS waivers serving adults with intellectual or developmental disabilities are available in 48 states.

How do I find out what home health services my state Medicaid covers?

Contact your state Medicaid agency directly or log in to your Medicaid managed care plan's member portal. Your state's Medicaid website lists covered benefits and any HCBS waiver programs available. Medicaid.gov's state profiles also show each state's covered services. If you are denied a service you believe is covered, you have the right to appeal the denial through your state's fair hearing process.