Medicare Home Health vs Medicaid Home Care in New Hampshire

The Distinction That Changes Everything

Medicare and Medicaid both put the word "home" in front of their services, which creates an assumption that they do the same thing. They don't. Confusing the two leads families to expect coverage that doesn't exist, delay applications for programs they actually need, and plan around benefits that expire far sooner than anticipated.

Here's the core difference in one sentence: Medicare pays for short-term skilled medical care at home. Medicaid pays for long-term daily help with basic activities at home.

Everything else — eligibility rules, duration, what's covered, who provides it — flows from that fundamental split.

What Medicare Home Health Covers

Medicare home health is a medical benefit. It covers intermittent skilled care provided by licensed professionals — registered nurses, physical therapists, occupational therapists, speech-language pathologists — when ordered by a physician.

To qualify, your parent must meet three conditions:

1. Homebound status. Leaving home requires considerable effort, and absences are infrequent, short, or related to medical care. A parent who goes to church on Sundays or gets their hair cut monthly can still qualify. A parent who goes out for dinner three times a week probably can't.

2. Physician order. A doctor must certify that the patient needs skilled nursing care, physical therapy, or another skilled service, and establish a home health plan of care.

3. Intermittent need. The care must be part-time or intermittent — typically a few visits per week, not continuous daily coverage.

Medicare home health covers:

• Skilled nursing visits (wound care, injections, medication management)
• Physical therapy, occupational therapy, speech therapy
• Home health aide visits — but only when provided alongside a skilled service
• Medical social worker visits

What Medicare home health does not cover:

• 24-hour continuous care at home
• Ongoing help with bathing, dressing, eating, or toileting when that's the only care needed
• Homemaker services (cooking, cleaning, laundry)
• Personal care assistance without a concurrent skilled nursing or therapy need

When the skilled care need ends — the wound heals, the physical therapy goals are met, the patient plateaus — Medicare home health ends too. The home health aide visits that came along with it also stop. There's no transition to ongoing coverage.

What Medicaid Home Care Covers

New Hampshire's Choices for Independence (CFI) waiver is a Medicaid program that covers long-term, ongoing home care for people who need nursing-facility-level assistance but want to remain at home.

The CFI waiver covers:

• Personal care assistance (bathing, dressing, toileting, transferring, eating)
• Homemaker services (cooking, cleaning, laundry, grocery shopping)
• Home health aide services
• Adult day health programs
• Personal Emergency Response Systems (PERS)
• Home modifications (ramps, grab bars, bathroom renovations)
• Non-medical transportation
• Caregiver respite
• Self-directed care (hiring a family member as a paid caregiver)

There's no expiration date tied to a treatment outcome. As long as your parent continues to meet the clinical standard (two or more ADL deficits) and financial eligibility requirements (gross monthly income under $2,982, assets under $8,500 after the He-W 856.07 resource disregard), services continue year after year through annual redeterminations.

Side-by-Side Comparison

When You Need Both

The two programs aren't mutually exclusive, and many families benefit from using both simultaneously.

Scenario 1: Post-hospital recovery. Your parent breaks a hip, comes home from the hospital, and needs physical therapy (Medicare home health) alongside daily help with bathing, dressing, and meals (Medicaid CFI waiver). Medicare covers the PT visits. Medicaid covers the personal care aide who comes every morning.

Scenario 2: Chronic condition management. Your parent has diabetes that requires periodic skilled nursing assessments and insulin management (Medicare home health episodes as needed) alongside ongoing help with ADLs due to neuropathy and mobility limitations (Medicaid CFI waiver).

The programs bill to different payers and serve different care needs. Your parent's home health agency handles Medicare. Your parent's personal care attendant or Case Management Agency handles Medicaid. They coordinate through the care plan but operate independently.

The Mistake Families Make

The most common error is assuming that Medicare home health will eventually become long-term home care if the need continues. It won't. Medicare home health ends when the skilled care need resolves, regardless of whether your parent still needs help with bathing, dressing, and getting out of bed.

If your parent needs ongoing daily assistance at home, the CFI Medicaid waiver is the program to apply for — and because the application process takes 45 to 90 days, the time to start is when you first recognize the need, not when Medicare home health is about to discharge.

Contact ServiceLink at 1-866-634-9412 to begin the CFI waiver process. They'll walk you through both the clinical assessment and financial eligibility screening.

The Aging in Place in New Hampshire guide covers both Medicare and Medicaid home care in detail, including the step-by-step CFI waiver application process and the document preparation checklist that prevents delays.

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