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Service Reimbursement

Another way to ensure program sustainability is to obtain reimbursement for services provided. Some aging in place programs may seek reimbursement through Medicaid Home & Community Based Services (HCBS) or Medicare Part A home health services for certain activities. For example, some states have passed laws that enable older adults to receive the same financial reimbursement if they stay in their home and receive private home care as opposed to going to a long-term care facility. If an individual qualifies for the Medicare Home Health Care Benefit (Part A and B), certain services will be covered, including but not limited to:

  • Home health services and skilled nursing services for a limited number of hours per day and per week.
  • Home health aide services, such as personal care services. This may include bathing and using the toilet, if skilled services are required.
  • Skilled therapy services such as physical, speech, and occupational therapy necessary for treating an illness or injury.
  • Eighty percent of an approved amount for durable medical equipment and certain medical supplies provided by the Medicare-certified home health agency.
  • Medical social services ordered by a physician to help with social and emotional concerns related to an illness.

For more information, see the Reimbursement for Care Coordination Services section of the Rural Care Coordination Toolkit and the sustainability module of the Community Health Workers Toolkit.

Resources to Learn More

Medicaid Home & Community Based Services (HCBS) Service Reimbursement
Website
HCBS provide opportunities for Medicaid beneficiaries to receive services in their own home or community instead of institutional facilities. State Medicaid agencies have several HCBS options, including waivers and state plan options.
Organization(s): Centers for Medicare & Medicaid Services

Medicare Part A Home Health Service Reimbursement
Website
A home health agency can offer services under Medicare Part A and/or Medicare Part B. Covered services include intermittent skilled nursing care, physical therapy, and more.
Organization(s): Centers for Medicare & Medicaid Services