Care at home benefits
Last checked: May 2026
Choosing a home care agency is harder when a benefit may pay the bill. The right agency depends on the benefit, the care needed, and the rules in your state or plan.
This guide explains the main paths: Medicare home health, Medicaid home care, and VA home care. It also gives you questions to ask before you agree to an agency.
Quick answer
If Medicare is paying, you usually need a Medicare-certified home health agency. Medicare home health is for part-time skilled care ordered by a doctor or other allowed provider. It is not the same as long-term nonmedical home care. Medicare says it does not pay for 24-hour home care, meal delivery, homemaker services that are not part of the care plan, or personal care when that is the only help needed. See Medicare’s official home health coverage page: Medicare.gov home health services.
If Medicaid is paying, the agency usually must be approved by your state Medicaid program, your Medicaid managed care plan, or a Medicaid home and community-based services program. Medicaid home care rules vary by state. Start with the Medicaid plan, state Medicaid office, or aging agency.
If VA benefits are paying, ask the veteran’s VA primary care team, VA social worker, or VA Caregiver Support team about Homemaker and Home Health Aide care, Veteran Directed Care, respite, or skilled home health. VA says Homemaker and Home Health Aide care is part of the VHA Standard Medical Benefits Package for enrolled veterans who meet clinical need. See the VA page here: VA Homemaker and Home Health Aide Care.
Who this helps
This guide is for a family caregiver who needs help at home and is trying to avoid a bad fit.
It may help if your parent, spouse, relative, or friend needs:
- Help after a hospital stay, surgery, stroke, fall, wound, or new illness.
- Help with bathing, dressing, toileting, meals, or safe movement.
- A home health nurse, physical therapy, occupational therapy, or speech therapy at home.
- Longer-term help to stay out of a nursing home.
- VA home care help because the person is an enrolled veteran.
This guide does not rank private agencies. It shows how to choose an agency when a public benefit or health plan may pay.
What may pay or help
The first step is to match the care need to the right payer. The words sound alike, but the programs are different.
| Benefit path | What it may cover | How agency choice usually works | Best first call |
|---|---|---|---|
| Medicare home health | Part-time skilled nursing, therapy, medical social services, and limited aide help when tied to skilled care. | Use a Medicare-certified home health agency. If the person has Medicare Advantage, the plan may have network and approval rules. | Doctor, hospital discharge planner, Medicare Advantage plan, or Medicare Care Compare. |
| Medicaid home care or HCBS | Personal care, homemaker help, respite, adult day services, or other home and community services. Services vary by state and program. | Use an agency in the state Medicaid or managed care network. Some states also allow self-directed care. | State Medicaid office, Medicaid managed care plan, waiver office, or Area Agency on Aging. |
| VA home care routes | Homemaker/Home Health Aide care, skilled home health, respite, Veteran Directed Care, or other VA home and community services if available and approved. | The VA medical center or VA program may refer to a contracted agency or a service route. | VA primary care team, VA social worker, or VA Caregiver Support Line. |
Medicare-certified home health is not the same as nonmedical home care
This is the most common point of confusion.
Medicare home health is medical care at home. Medicare says the person must need part-time or intermittent skilled services and be homebound. A doctor or other allowed provider must order the care. The agency must be Medicare-certified. Medicare explains these rules here: Medicare home health coverage.
Medicare may cover skilled nursing, physical therapy, speech-language pathology, continued occupational therapy under certain rules, medical social services, medical supplies, and limited home health aide services when the person is also getting skilled care.
Medicare does not usually pay for long-term help with bathing, dressing, cooking, cleaning, supervision, or errands when that is the only help needed. If that is the main need, look at Medicaid, VA, local aging programs, long-term care insurance, or private pay.
You can search for Medicare-certified home health agencies on Medicare Care Compare. CMS also explains that Care Compare is the official place to review home health quality ratings: CMS home health star ratings.
Tip: ask what “home health” means
Some agencies sell private-pay home care and also have a Medicare-certified home health branch. Others do only one type. Ask, “Are you Medicare-certified for home health, or are you a nonmedical home care agency?”
Medicaid agency choice depends on your state and plan
Medicaid is a joint federal and state program. The federal government sets broad rules, but states run their own programs. Medicaid.gov says home and community-based services help people get care in their homes or communities instead of institutions. See the Medicaid.gov overview: Home and Community-Based Services.
For caregivers, this means one state may use a Medicaid waiver. Another state may use a managed long-term services plan. Another may offer state plan personal care. Names and rules vary.
Do not pick an agency from a web search before you know the payer rules. Ask first:
- Is the person already approved for Medicaid home care or HCBS?
- Is there a managed care plan?
- Does the plan require a network agency?
- Is there an assessment before hours are approved?
- Can the family choose the aide or use self-directed care?
If income or assets are the barrier, read our guides to Medicaid spend-down and the Medicaid look-back period. If the issue is home care through a waiver, read Medicaid HCBS waivers explained.
Do this before calling agencies
Call the Medicaid plan or state Medicaid office and ask for the provider directory for personal care, home care, or HCBS services. Medicaid.gov says state Medicaid agencies are responsible for eligibility, enrollment, and running their programs. See Medicaid.gov contact information.
VA agency routes may go through the VA medical center
For veterans, the home care route may start with the VA health care team, not a private agency ad.
The VA says Homemaker and Home Health Aide care can help veterans with daily activities and can be used as an alternative to nursing home care or as respite for the family caregiver. VA states that all enrolled veterans are eligible if they meet clinical need for the service. See VA Homemaker and Home Health Aide Care.
VA also lists other home and community options, including Skilled Home Health Care, respite care, Home Based Primary Care, and Veteran Directed Care. Availability and costs can vary by service, local VA medical center, clinical need, and service-connected status. VA describes these options here: VA Home and Community Based Services.
Veteran Directed Care may allow more choice over who provides help. VA says this route is for veterans who need personal care services and help with activities of daily living. See VA Veteran Directed Care.
If the veteran has a disability pension with Aid and Attendance, that may also help pay for care in some cases. Read our guide to VA Aid and Attendance. Do not assume it pays the agency directly. Confirm the exact route with VA.
Who may qualify
These are general starting points. The final answer depends on the person’s records, assessment, payer, and local rules.
Medicare
The person may qualify if they are homebound, need part-time or intermittent skilled care, have a doctor or allowed provider order, and use a Medicare-certified home health agency. Medicare Advantage members should also check plan network and approval rules.
Medicaid
The person may qualify if they meet state Medicaid financial rules and the state’s medical or functional need rules for home care, personal care, or HCBS. Some programs have waitlists or service limits.
VA
The veteran may qualify for VA home care help if they are enrolled in VA health care, the service is available, and VA finds a clinical need. Some costs may depend on service-connected status and other VA rules.
Where to start first
Start where the payer decision is made. This saves time.
If the person is coming home from a hospital or rehab
- Ask the discharge planner what home health services are being ordered.
- Ask for the list of Medicare-certified agencies that serve the ZIP code.
- Ask if the Medicare Advantage plan must approve the agency first.
- Ask when the first nurse or therapist visit is expected.
If the person mainly needs bathing, dressing, meals, or supervision
- Call the Medicaid plan, state Medicaid office, or Area Agency on Aging.
- Ask for the home care, personal care, or HCBS assessment process.
- Ask if there is a provider network or waitlist.
- Ask if self-directed care is allowed if a family member wants to be paid. You can also read Can I get paid to be a caregiver?
If the person is a veteran
- Call the VA primary care team or VA social worker.
- Ask for a home and community services assessment.
- Ask about Homemaker and Home Health Aide care, respite, skilled home health, and Veteran Directed Care.
- If you are not sure where to call, use the VA Caregiver Support Line at 1-855-260-3274.
For local help outside Medicare, Medicaid, or VA, the Eldercare Locator can connect older adults and caregivers with local aging services. See Eldercare Locator or ACL’s getting started page: ACL getting started.
Questions to ask before you choose an agency
Ask these questions before you agree to a start date.
Payment and approval
- Are you approved by Medicare, my Medicaid plan, my state waiver program, or the VA?
- Do you need prior approval before services start?
- Who sends the authorization: the doctor, plan, VA, or Medicaid office?
- What services are approved, and how many visits or hours are approved?
- Will we get a written care plan?
Staffing and start date
- Do you have staff who can serve this address?
- What day can the first visit happen?
- What happens if the assigned aide calls out?
- Do you have weekend or evening staff if the plan approves those hours?
- Can we request a different aide if the match is unsafe or not working?
Care and safety
- What tasks are allowed under this benefit?
- What tasks are not allowed?
- Who supervises the aide?
- How do we report missed visits, late arrivals, falls, medication concerns, or rude care?
- What number should we call after hours?
Tasks aides can and cannot do
Task rules depend on state law, agency policy, payer rules, training, and the care plan. Always ask the agency and payer what is allowed.
A home health aide or personal care aide may be able to help with bathing, grooming, dressing, walking, toileting, transfers, eating, light meal help, light housekeeping tied to care, reminders, and reporting changes. Medicare lists limited aide help such as bathing, grooming, feeding, changing linens, and help with walking when the person is also getting skilled care. See Medicare.gov home health services.
An aide usually cannot do tasks outside the written care plan. In many cases, aides cannot make medical decisions, change wound orders, give injections, adjust medication doses, perform sterile procedures, lift in unsafe ways, or provide services that the payer did not approve. Some states allow trained aides to do certain health-related tasks under strict rules. Others do not.
⚠️ Do not guess on medication or wound care
If the person needs wound care, injections, tube feeding, catheter care, or medication changes, ask whether a nurse must do that task. Get the answer in the care plan.
Documents that may be needed
Keep a folder ready. You may not need every item, but these papers often help.
- Medicare card, Medicaid card, Medicare Advantage card, VA card, or other insurance card.
- Photo ID for the person needing care.
- Doctor’s order, discharge papers, or referral for home health.
- Recent hospital, rehab, nursing home, or emergency room papers.
- Medication list and pharmacy name.
- Diagnosis list and current care needs.
- Notes about falls, wounds, confusion, bathing problems, toileting needs, or unsafe transfers.
- Power of attorney, health care proxy, guardianship paper, or signed permission to speak, if needed.
- Medicaid approval letter, waiver approval, care plan, or managed care plan letter.
- VA enrollment information, VA provider name, and any VA care plan or approval letter.
- Denial letters, missed visit records, complaint numbers, and names of people you spoke with.
- Income and asset papers if applying for Medicaid long-term services.
For more caregiver paperwork help, see our caregiver checklists and guide to power of attorney for an aging parent.
What usually goes wrong
- The family asks Medicare for long-term personal care. Medicare home health is not built for long-term custodial care when that is the only need.
- The agency is not in the payer network. Medicaid plans, VA routes, and Medicare Advantage plans may limit which agencies can be used.
- The agency says yes before approval is in place. Ask who is paying and what is approved before services start.
- The care plan does not match the real need. If bathing, transfers, or toileting are the problem, say that clearly during the assessment.
- Hours are approved but no aide is available. Provider shortages can happen, especially in rural areas or for evening and weekend hours.
- The family does not track missed visits. Write down the date, scheduled time, aide name if known, and what care was missed.
- The agency refuses a task that is outside the plan. Ask whether the payer can update the care plan or send a nurse assessment.
Missed visits and complaints
A missed visit is not just an annoyance if the person cannot bathe, transfer, eat, or take medicine safely without help.
Start with the agency. Ask for the supervisor and a replacement visit. Then call the payer if the problem repeats.
Use this order
- Call the agency supervisor. Ask for the missed visit plan.
- Write down the date, time, name, and what care was missed.
- If Medicare Advantage or Medicaid managed care is paying, call the plan and report an access problem.
- If VA is paying, call the VA social worker, VA care team, or the VA program contact that approved the service.
- If care quality or safety is the issue, ask where to file a formal complaint.
For Medicare quality concerns, CMS says Beneficiary and Family Centered Care-Quality Improvement Organizations help Medicare beneficiaries with quality of care concerns. See CMS BFCC-QIO information. Medicare also explains complaint options here: Medicare complaints.
CMS says State Survey Agencies investigate complaints about quality of care in facilities and providers that receive federal funds. See CMS State Survey Agency contacts.
What to do if the agency refuses care
An agency may refuse a case because it has no staff, the home is outside its service area, the payer did not approve care, the care is more complex than it can provide, or the home has a safety issue. Some refusals are legal. Some need to be challenged.
Ask for the reason in plain words. Then ask what must change for the agency to accept the case.
If the refusal leaves the person unsafe
Call the doctor, hospital discharge planner, Medicaid plan, VA social worker, or Medicare Advantage plan the same day. Say, “The agency refused the case, and the person is not safe at home without care.” If there is immediate danger, call emergency services.
If Medicare home health is denied, ask whether the denial came from the agency, the doctor, Original Medicare, or a Medicare Advantage plan. Ask for a written notice and appeal rights. Our guide to how to appeal a Medicare denial may help.
If Medicaid home care is denied or hours are too low, ask for the written decision and fair hearing or appeal instructions. Deadlines vary by state. Do not wait if the letter gives a short deadline.
If VA home care is refused, ask the VA care team what clinical rule was not met, whether another VA home and community service fits better, and whether the veteran can be reassessed if needs change.
☎️ Short phone script for the first call
Use this when you call a Medicaid plan, Medicare Advantage plan, VA care team, or discharge planner.
“Hi, I’m helping my [parent/spouse/relative] choose a home care agency. We need help at home with [bathing/transfers/wound care/therapy/meals/toileting]. Can you tell me which agencies are approved under this benefit, whether prior approval is needed, and who sends the order or referral? Also, what should I do if the agency says it has no staff?”
If the person is already approved for hours, add:
“The care is already approved for [number] hours or visits. Which agencies in the network can start soon, and how do I report missed visits?”
What to do if the first path does not work
Do not stop after one “no.” A no from one agency is not always a no from the benefit program.
- If Medicare home health does not fit because the need is only personal care, ask about Medicaid, VA, respite, local aging services, or private-pay backup.
- If one agency has no staff, ask the payer for other approved agencies.
- If the person needs skilled care but the agency says the order is missing, call the doctor or discharge planner.
- If Medicaid says the person is over income, ask about spend-down, medically needy rules, Miller trusts where used, or other state options. Rules vary by state.
- If the family caregiver wants to be paid, ask whether the state has self-directed Medicaid care or VA Veteran Directed Care. Start with Can I get paid to be a caregiver?
- If the person is burning out and needs short breaks, see respite care for caregivers.
Official sources used and what we checked for this update
For this May 2026 update, we checked official federal pages first:
- Medicare.gov home health services coverage for Medicare home health eligibility and what Medicare does not cover.
- Medicare Care Compare home health search for finding Medicare-certified home health agencies.
- CMS home health star ratings for Care Compare quality rating context.
- Medicaid.gov Home and Community-Based Services for Medicaid HCBS background.
- Medicaid.gov contact page for the role of state Medicaid agencies.
- VA Homemaker and Home Health Aide Care for VA home aide eligibility basics.
- VA Home and Community Based Services for other VA home care routes.
- VA Veteran Directed Care for self-directed VA home care.
- VA Caregiver Support Line for caregiver contact help.
- ACL getting started and Eldercare Locator for local aging service routing.
- CMS BFCC-QIO information, Medicare complaints, and CMS State Survey Agency contacts for complaints and care quality concerns.
- 42 CFR 484.50 patient rights for Medicare-certified home health patient rights.
Resumen corto en español
Medicare puede pagar cuidado médico en casa si la persona cumple las reglas, necesita cuidado especializado por tiempo parcial y usa una agencia certificada por Medicare.
Medicaid puede ayudar con cuidado personal en casa, pero las reglas cambian por estado y por plan. Llame primero a Medicaid, al plan de Medicaid o a la agencia local de envejecimiento.
Para un veterano, llame al equipo médico de VA o al trabajador social de VA. Pregunte por Homemaker and Home Health Aide Care, respite, skilled home health o Veteran Directed Care.
About This Guide
CaregiverBenefits.org writes guides for family caregivers who need clear benefit steps, documents, phone scripts, and appeal paths. This guide focuses on choosing a home care agency when Medicare, Medicaid, or VA benefits may pay.
Plain disclaimer
This guide is general information. It is not legal, medical, tax, or benefits advice. Program rules can change. State Medicaid offices, Medicare plans, VA medical centers, and local agencies should confirm what applies to your case.
FAQ
Will Medicare pay for a home care aide every day?
Usually not for long-term personal care alone. Medicare home health is tied to part-time skilled care and homebound rules. If the person only needs help with bathing, dressing, meals, or supervision, check Medicaid, VA, local aging services, or private-pay options.
How do I know if an agency takes Medicaid?
Call the Medicaid plan or state Medicaid office before you call agencies. Ask for the approved provider list for the exact program, such as personal care, HCBS waiver, or managed long-term services.
Can I choose any agency if VA is paying?
Not always. VA home care may go through a VA medical center, VA approval process, or contracted agency. Ask the VA care team which agency routes are allowed.
What if the agency misses visits?
Call the agency supervisor first and ask for a replacement plan. Track each missed visit. If it repeats, report it to the payer, such as the Medicaid plan, Medicare Advantage plan, or VA care team. For Medicare quality concerns, you can also ask about the BFCC-QIO or State Survey Agency complaint route.
What if every agency says it has no staff?
Call the payer and say there is an access problem. Ask for other approved agencies, a case manager, a reassessment, or a different service plan. If the person is unsafe, call the doctor or discharge planner the same day.
Can a family member be paid instead of using an agency?
Sometimes. Some Medicaid and VA routes allow self-directed care. Rules vary by state and program. Ask the Medicaid office, Medicaid plan, or VA care team whether self-direction is available.
What should I ask before the first visit?
Ask what tasks are approved, who is coming, when they will arrive, who supervises them, what number to call after hours, and what to do if the aide cannot come.
