Home Care is Health Care
Home care is an essential support for community living for over 5 million people across the United States. Medicaid is the primary payer for home care. With these services, disabled and aging individuals can get supportive services to assist with daily self-care. This is an important alternative for people who might otherwise have to live in a nursing facility. Under Medicaid, home and community-based services (HCBS) are optional, with hundreds of thousands of people nationwide ending up on HCBS waiting lists while living in institutional or community settings. Most people waiting for these services have intellectual and developmental disabilities. Individuals with spinal cord injuries, mental health challenges, and traumatic brain injury are among the other disabled groups pursuing services.
The need for home care is great, but these services have been historically underfunded as Medicaid budgets tighten. This means that recipients are typically limited to the individuals with the greatest need for 24-hour support with things like eating, bathing, toileting and moving around their home. People on waiting lists wait an average of 32 months to receive these basic services. While waiting for HCBS, some individuals living in their communities might be eligible to pursue home care services offered through their state Medicaid plan, though the hours of support might be limited. Home care can be provided as a state plan benefit or specialized waiver program. States offer varying waiver programs and benefits. Waiver programs are often designed for certain target populations.
Medicaid helps to support paid care staff and can often supplement family caregiving with respite options so that they can get care coverage for when they have their own appointments and commitments. Some states also offer payments to family caregivers to make up for lost income from outside employment. Medicaid was also the primary health insurance for 8 million family caregivers in 2025, according to a report from AARP.
To receive Medicaid home care, people qualify based on having a disabled or being over 65 years old. This is different from the traditional income-based eligibility for most Medicaid programs. However, recipients still need to demonstrate that they have limited financial resources or savings. Typically, an individual can make no more than $2,901 per month (2025) and have under $2,000 in assets to qualify. Over the coming year, HCBS recipients may see cuts to services and eligibility as HR1 is implemented.
On Tuesday, the House held a congressional hearing on the issue of Medicare and Medicaid fraud. To learn more about how Medicaid is being directed to handle accusations of funding fraud, and why we need to protect it, check out these articles:
- CMS’ New Approach to Federal Medicaid Spending in Cases of Potential Fraud, Kaiser Family Foundation – March 16, 2026
- Understanding Medicaid Home Care Amid CMS Focus on Potential Fraud and Abuse, Kaiser Family Foundation – February 24, 2026
- Memo – The efficiency and necessity of Medicaid home and community-based services (HCBS), Caring Across Generations
Medical Debt Crisis
Coverage for home and community-based services is just one major health-related concern for people with disabilities across the country. The issue of medical debt is a universal vulnerability right now, with millions of Americans owing over $220 billion in medical debt alone. The Commonwealth Fund writes about some of the state-level efforts underway to address the burden of expanded cost-sharing on their residents. With the loss of enhanced premium tax credits under the ACA and reductions in Medicaid funding, costs are being diverted to individual enrollees. When imagining how coverage can remain affordable through challenging federal conditions, the Commonwealth Fund indicates that “the next phase of state policy must focus on prevention, with stronger standards for free and discounted care for underinsured and uninsured patients and lowering barriers to financial assistance. At the same time, states will need to back these rules with enforcement and data so that protections on paper translate into less debt in people’s lives.”
Resources
- The Kaiser Family Foundation has updated their Health Insurance Marketplace Calculator with information on premiums for 2026 plans. This update allows consumers to see the current cost of coverage under the Affordable Care Act. For more information on how the expiration of ACA enhanced premium tax credits is affecting premiums, visit the ACA Enhanced Premium Tax Credit Calculator.
- New Fact Sheet from Justice in Aging: Understanding the Impact of H.R.1 on Older Immigrants’ Access to Health Care
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