Home Health After Hospital Discharge in Maine

Your parent is being discharged from the hospital but isn't ready to manage on their own. They need a nurse to check the surgical site, a physical therapist to rebuild strength, or a home health aide to help with bathing and medication. Medicare covers home health services — but only if specific eligibility requirements are met.

Here's how home health works after a hospital discharge in Maine, including the qualifying criteria that trip up most families.

Medicare Home Health Eligibility

Medicare covers home health without requiring a prior hospital stay — there's no three-day inpatient rule for home health like there is for skilled nursing facility coverage. But three conditions must all be met:

1. The patient must be "homebound." This doesn't mean bedridden. Medicare defines homebound as: leaving home requires considerable and taxing effort, and any absences are infrequent, short in duration, or for medical appointments. A parent who can walk to the mailbox with a walker but can't drive or ride a bus to the grocery store typically qualifies.

2. The patient needs skilled care. At least one of: skilled nursing (wound care, injections, medication management), physical therapy, speech therapy, or occupational therapy. If a patient only needs help with bathing and housekeeping — without a skilled component — Medicare won't cover home health.

3. A physician must certify the plan of care. The attending physician or a qualifying nurse practitioner must order the home health services and certify that the patient meets the homebound and skilled-care criteria. The hospital discharge planner usually coordinates this, but you should confirm it's been done before discharge day.

What Home Health Covers (and Doesn't)

Covered under Medicare home health:

• Skilled nursing visits (wound care, IV medications, catheter care, disease management teaching)
• Physical therapy, occupational therapy, and speech-language pathology
• Medical social worker services
• Home health aide services (bathing, dressing, light meal prep) — but only alongside skilled care
• Medical supplies (wound dressings, catheters)

Not covered:

• 24-hour home care or live-in care
• Homemaker services without a skilled care component
• Meal delivery
• Personal emergency response systems

Home health is intermittent by design — a nurse or therapist visits several times a week, not around the clock. If your parent needs constant supervision, home health alone won't be enough. You'll need to explore MaineCare Section 19 waiver services or private-pay home care to fill the gaps.

How to Arrange Home Health Before Discharge

Don't leave the hospital without confirming these steps:

1. Ask the discharge planner for a home health referral. The hospital should submit a referral to a Medicare-certified home health agency before discharge. In Maine, agencies operate statewide, but availability varies — rural areas may have fewer options.

2. Verify the physician's order is signed. Medicare requires a face-to-face encounter with a physician or nurse practitioner within 90 days before or 30 days after the start of home health services. This is usually the hospitalization itself.

3. Schedule the first visit. The home health agency should contact you within 24-48 hours of referral to schedule an initial assessment visit. If they don't, call them directly.

4. Confirm the services ordered. Make sure the referral includes everything your parent needs — PT, OT, skilled nursing, aide visits. If the discharge planner only ordered nursing but your parent also needs physical therapy, ask for the order to be expanded.

When Home Health Isn't Enough

If your parent needs more than intermittent visits — daily personal care assistance, supervision due to cognitive decline, home modifications — MaineCare Section 19 waiver services can cover what Medicare home health doesn't. Section 19 provides personal care attendants, respite care, assistive technology, and home modifications for adults 65+ who meet Nursing Facility Level of Care criteria.

The catch: Section 19 requires a Medical Eligibility Determination from Maximus (1-833-525-5784). If the assessment is done while your parent is still hospitalized, the turnaround is 24 hours. After discharge, it takes up to 10 business days.

The Hospital-to-Home Maine toolkit walks you through coordinating Medicare home health with MaineCare waiver services so there's no gap in care coverage after discharge.

See more Maine guides →