Advocacy to Protect Medicaid-Funded Home Health Care

Federal law requires that each state’s Medicaid program provide home health care services.  These home health services allow low-income older Americans to stay at home longer.

Under federal law, a state Medicaid program is not allowed to impose a “homebound” requirement for receipt of home health services.  So, home health services cannot be denied just because the person leaves the house occasionally to run errands or visit family.  A letter from the federal government on this issue is here; see pages 18-19 (Attachment 3-g).

In recent years, the federal government has found that the Missouri Medicaid program in two ways imposes illegal limitations on home health services.  First, Missouri illegally has required that persons be “homebound” in order to have Medicaid coverage of home health services.  This is a violation of the Americans with Disabilities Act and federal Medicaid law, since the limitation discriminates improperly against persons with disabilities.

Second, Missouri requires that a person need skilled nursing or therapy services in order to receive coverage for services provided by a home health aide.  This requirement is unfair for those persons who do not need nursing services but nonetheless need help from a home health aide.  This limitation also violates the Americans with Disabilities Act and federal Medicaid law.

The federal government warned Missouri in letters sent in 2005 (see p. 7) and 2009. In 2010, the federal government has given Missouri 30 days to come into compliance, and has threatened to withhold federal funding if Missouri does not correct its Medicaid home health standards.

Click here for NSCLC’s comprehensive issue brief on these issues, To Be or Not to Be Homebound: The Limits of States’ Discretion in Medicaid’s Coverage for Home Health Services.


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