Medicaid Home Care Services: What’s Covered (2025 Guide)

If you’re trying to keep care at home, Medicaid can be a lifeline—but what it covers depends on which Medicaid path you use. This guide breaks down, in plain English, what’s always covered, what’s optional, and what’s available through home- and community-based services (HCBS) so you can plan care with confidence.

Quick take: Home health nursing/aide and medical supplies/equipment are mandatory benefits in every state; personal care and many HCBS supports (like homemaker, respite, adult day health, home mods) are optional but available in most states through waivers or state plan options. (Medicaid, GovInfo)

Medicaid at Home: The Big Picture (and the rules that matter)

Two core concepts:

1. Home Health (mandatory) – All states must cover home health services under the state plan:
   • Skilled nursing (part-time/intermittent)
   • Home health aide
   • Medical supplies, equipment, and appliances (DME) suitable for home use
   • Therapies (PT/OT/SLP) may be included at the state’s option under the home health benefit (many cover them under other authorities)
     Regulations also require a face-to-face encounter to start services. (Medicaid, GovInfo, Legal Information Institute)
2. Personal Care & HCBS (optional but widespread) – States add non-medical supports via:
   • Personal Care Services (PCS) under §1905(a)(24) (help with bathing, dressing, meal prep, etc.). (Social Security)
   • HCBS Waivers – §1915(c) (custom packages like homemaker, adult day, respite, habilitation, home mods). (Medicaid)
   • State Plan HCBS – §1915(i) (lets states cover HCBS without a waiver; supports may include respite, case management, supported employment, environmental mods). (Medicaid)
   • Community First Choice – §1915(k) (attendant services with a federal match bonus for states that adopt it). (CMS, Medicaid)

Don’t mix up Medicaid with Medicare. Medicare’s home health is narrower and short-term. This article is about Medicaid. (For mixed eligibility, coordinate both.)

What Medicaid Typically Covers at Home (by category)

A) Mandatory Home Health (available in every state)

• Skilled nursing (part-time/intermittent) ordered in a plan of care
• Home health aide services
• Medical supplies, equipment, and appliances (DME) suitable for home use
• Face-to-face encounter requirement to initiate services
• Therapy (PT/OT/SLP) – optional under home health; states can include it here or elsewhere
  Regulatory basis: 42 CFR §440.70 and CMS benefits list. (GovInfo, Medicaid)

B) Personal Care Services (PCS) (state plan option)

• Hands-on help with Activities of Daily Living (ADLs) such as bathing, dressing, toileting, eating, mobility
• Help with Instrumental ADLs like meal prep, laundry, shopping, housekeeping
• Often delivered at home and sometimes in the community
  Authorized in §1905(a)(24); states choose whether to offer PCS and set details. (Social Security)

C) HCBS Waivers (1915(c)) – “What’s covered” menu

States can mix medical and non-medical supports such as: case management, homemaker, home health aide, personal care, adult day health, habilitation (day/residential), respite, plus other services that help people stay out of institutions—including environmental/home modifications and transition supports. (Medicaid)

D) State Plan HCBS (1915(i))

Lets states cover HCBS without a waiver using state-defined needs criteria—often including respite, case management, supported employment, environmental modifications, and more. (Medicaid)

E) Community First Choice (1915(k))

Provides attendant services and supports (often with self-direction) to help with ADLs/IADLs; states that opt in get a 6-percentage-point FMAP boost—so adoption varies but is growing. (CMS, Medicaid)

F) Self-Direction (including 1915(j))

In many programs, you (or your representative) can hire, train, schedule, and supervise your workers; in some states you can even hire legally liable relatives (e.g., spouse or parent) under 1915(j) and certain waivers. Details vary by state and authority. (Medicaid)

G) Transportation to Medical Care (NEMT)

States must assure transportation to and from Medicaid-covered services (often rides, mileage, or transit passes). (eCFR, Medicaid)

H) Children & Teens (EPSDT)

Under EPSDT, Medicaid covers all medically necessary services for enrollees under 21—including private duty nursing, therapies, and DME—if needed to correct or ameliorate conditions. Ask your plan/provider to cite EPSDT when requesting services. (Medicaid, CMS)

What Medicaid Usually Doesn’t Cover at Home

Note: Many states do cover home modifications (e.g., ramps, bathroom changes) and personal emergency response systems (PERS) under HCBS; ask about your state’s HCBS benefit. (Medicaid)

Home Health vs. Personal Care vs. HCBS: How they differ

Many states maintain HCBS waitlists for capped waiver slots (hundreds of thousands nationally each year). If you’re placed on one, ask about state plan PCS or 1915(i) alternatives. (KFF)

Will Medicaid Pay a Family Member to Provide Care?

Often, yes—depending on program and state. Under self-direction (including 1915(j) and some waivers), states may allow hiring relatives, sometimes even spouses or parents of minors if it’s beyond typical parental or spousal duties. Policies vary, and some authorities disallow legally responsible relatives under standard PCS. Ask specifically about self-directed options in your state. (Medicaid, NASHP)

Coverage Snapshots (what people ask about most)

• Therapies at home (PT/OT/SLP): May be included under home health at the state’s option or covered via other benefits; not universally mandatory under the home health benefit. (GovInfo)
• Private duty nursing (PDN): Optional under state plan; commonly covered for children via EPSDT when medically necessary. (Medicaid)
• Home modifications (ramps, roll-in showers): Often covered under 1915(c) waivers or 1915(i) as environmental/home adaptations. (Medicaid)
• Meal delivery: Sometimes covered under HCBS; check your state’s waiver/service definitions. (Medicaid)
• PERS / medical alert: Frequently an HCBS service (state-specific). (Medicaid)
• Transportation: Yes—states must assure transportation to Medicaid-covered care. (eCFR)

How to Qualify & Get Services (fast-track checklist)

1. Confirm eligibility. Medicaid is income/resource-based; for long-term services & supports (LTSS), medical need also matters.
2. Ask your doctor for a plan of care if you need home health (nursing/aide/DME) and schedule the face-to-face encounter if your state requires it. (Legal Information Institute)
3. Call your state Medicaid office / health plan and ask:
   • “Do we have state plan PCS (personal care)? How do I get assessed?” (Medicaid)
   • “Which HCBS waivers (1915(c)) serve my needs? Is there a waitlist? What’s my slot number?” (Medicaid, KFF)
   • “Do we offer 1915(i) or Community First Choice (1915(k))?” (Medicaid)
   • “Can I self-direct and hire a family member?” (ask about 1915(j) rules). (Medicaid)
4. If you have children (<21): invoke EPSDT—“I’m requesting EPSDT-covered [PDN/therapy/DME] as medically necessary.” (Medicaid)
5. Appeal denials in writing and request a fair hearing if needed.

Costs, Copays & Estate Recovery (what to know)

• Many states have no or minimal copays for Medicaid services; rules vary.
• If you’re 55+, federal law requires states to pursue estate recovery for LTSS costs such as HCBS (and related hospital/Rx)—policies vary, but it’s important for family planning. Consider this when choosing services and discuss with an elder-law professional. (Medicaid)

Pros & Cons of Using Medicaid for Home Care

Pros

• Broad coverage for nursing, aides, DME, plus robust HCBS in many states. (GovInfo, Medicaid)
• Transportation to care is required. (eCFR)
• Self-direction increases choice; potential to pay family caregivers. (Medicaid)

Cons

• Variation by state; some benefits are optional and capped. (Medicaid)
• HCBS waitlists exist in many states for waiver slots. (KFF)
• Estate recovery after age 55 for LTSS, including HCBS. (Medicaid)

Quick Comparison Table: Covered vs. Not Typically Covered

Conclusion: Getting the most from Medicaid at home

Start with home health for medical needs, then layer in PCS or HCBS for daily living support. Ask your state about 1915(i) and 1915(k) (not just 1915(c)) and whether you can self-direct—it can be the fastest way to staff care and even pay a family caregiver where allowed. If a waiver has a waitlist, request state plan options while you wait, and for kids, use EPSDT to get medically necessary care approved. Finally, if you’re 55+, understand estate recovery rules before choosing services. (GovInfo, Medicaid)

FAQs

Does Medicaid cover 24-hour in-home care?
Medicaid covers hours based on assessed need, but 24/7 coverage is uncommon outside of certain private duty nursing or intensive self-directed arrangements, which vary by state and program. Ask about 1915(c) waivers, 1915(k) Community First Choice, and state plan PCS. (Medicaid)

What home health services are guaranteed in every state?
Skilled nursing, home health aide, and medical supplies/equipment are mandatory under the Medicaid home health benefit; therapies are optional under the home health benefit. (Medicaid, GovInfo)

Can Medicaid pay a family caregiver?
In many states, yes—especially under self-directed programs (e.g., 1915(j)) and some waivers; rules on paying spouses/parents differ by authority and state. Ask specifically about self-direction. (Medicaid)

Will Medicaid pay for a ramp or bathroom remodel?
Often yes under HCBS as environmental/home modifications when they support independence and reduce risk; coverage and dollar caps are state-specific. (Medicaid)

Are rides to appointments covered?
Yes. States must assure non-emergency medical transportation to and from covered services. (eCFR)

How do children qualify for home care services?
Through EPSDT, children under 21 can receive all medically necessary services (e.g., private duty nursing, therapies, DME), even if not otherwise covered for adults. (Medicaid)

Does Medicaid cover room & board in assisted living or at home?
Generally no—Medicaid doesn’t pay room & board in HCBS settings, though some states offer separate financial help or limits on what facilities can charge. (MACPAC)

What if my state’s waiver has a waitlist?
Get on the list and ask about state plan PCS or 1915(i) options you can use now; many states report long HCBS waitlists for capped waivers. (KFF)

Sources (key federal/authoritative references)

• CMS/Medicaid – Mandatory & Optional Benefits; NEMT (transportation) listed as mandatory. (Medicaid)
• eCFR – 42 CFR §440.70 Home health services (what’s required/optional; F2F). (Legal Information Institute, GovInfo)
• SSA §1905(a)(24) – Personal care services definition. (Social Security)
• Medicaid.gov – HCBS 1915(c); 1915(i); CFC 1915(k); Self-Directed Services; 1915(j). (Medicaid)
• CMS EPSDT guidance (2024) & press. (Medicaid, CMS)
• MACPAC/KFF – Room & board policies; HCBS waiting lists; current program mix. (MACPAC, KFF)
• Medicaid.gov – Estate Recovery (55+ LTSS including HCBS). (Medicaid)