In-home care services are arranged through your state's aging agency, a private care manager, or directly from licensed home care companies — not through a single national program

In-home care means a caregiver comes to your home to help with daily tasks like bathing, dressing, meal preparation, or medication reminders. The way you access it depends on whether you need help paying for it, whether you may have access to for Medicaid, and whether you want a licensed agency or an independent caregiver.

If you have Medicare alone, you will pay out of pocket or through private long-term care insurance. If you have Medicaid, your state's program covers in-home services under what is usually called Home and Community-Based Services (HCBS) or a waiver program. The first step is contacting your state's Unit on Aging or your local Area Agency on Aging — they can tell you what is available in your area and what you need to do next.

The process is not fast. From first contact to having a caregiver in your home typically takes four to eight weeks, longer if Medicaid approval is needed. Starting the conversation early, even before you think you need care, gives you time to understand your options.

Key Takeaways

  • Contact your state's Unit on Aging or local Area Agency on Aging to learn what in-home care programs exist in your area and what they cover.
  • If you have Medicaid, your state's Home and Community-Based Services waiver usually covers in-home care, but there may be a waiting list.
  • If you have Medicare only, you will need to pay privately or use long-term care insurance, unless you also have Medicaid.
  • Licensed home care agencies are regulated by your state; independent caregivers are not, and hiring them directly carries more legal and tax responsibility for you.
  • A geriatric care manager can help you find services and coordinate care, though you pay them directly and they are not covered by insurance.

Finding your local Area Agency on Aging

Every state has a network of Area Agencies on Aging (AAAs) that serve specific regions. These agencies know what in-home care programs exist locally, which ones have openings, and what the waiting lists look like. They also know about other services — meal programs, transportation, legal aid — that might help you stay at home longer.

To find your local AAA, go to the Eldercare Locator at eldercare.acl.gov or call 1-800-677-1116. You enter your zip code and get the phone number and address of the agency that serves your area. When you call, tell them you are interested in in-home care and ask what programs they know about.

The AAA does not provide the care itself — it refers you to programs and agencies that do. But the staff can explain which services are free or low-cost, which require Medicaid, and which you would pay for privately. They can also tell you if there is a waiting list and how long it typically is.

How Medicaid covers in-home care in your state

Medicaid is a joint federal-state program, so what it covers for in-home care varies significantly by state. Most states cover in-home care through a Home and Community-Based Services (HCBS) waiver, which lets Medicaid pay for care in your home instead of only in nursing facilities. Some states call this program something different — check with your state's Medicaid office or your AAA for the exact name.

To use Medicaid for in-home care, you must meet your state's financial limits (usually around $2,000 in assets for a single person, though this varies) and your state's medical need level. Your doctor or a state assessor will determine whether you need in-home care. If you do, Medicaid will cover the cost of a licensed home care agency, though the amount it pays per hour varies by state and by the type of care.

Many states have waiting lists for HCBS waivers because demand exceeds funding. Some states prioritize people at risk of nursing home placement or those with the highest medical needs. Ask your AAA or Medicaid office where you stand on the list and whether there are ways to move up — some states allow you to move up if your health declines.

If you are already in a nursing home or hospital and want to go home, some states have programs that help you transition. Ask specifically about Money Follows the Person (MFP) programs, which exist in most states and can help cover the cost of moving from institutional care to home-based care.

Medicare coverage for in-home care is limited and temporary

Medicare covers in-home care only under specific conditions: you must be homebound, your doctor must order the care, and it must be skilled care — meaning a nurse or physical therapist, not a personal care aide. Medicare will not pay for help with bathing, dressing, or meals unless it is part of a skilled nursing or therapy visit.

Medicare covers in-home skilled nursing and therapy for a limited time after a hospital stay or move to a skilled nursing facility. Once you no longer need skilled care, Medicare stops paying. If you need ongoing help with daily tasks, you will need to pay out of pocket, use private long-term care insurance, or have Medicaid.

If you have both Medicare and Medicaid (called "dual may be able to access"), Medicaid will cover the personal care and daily living help that Medicare does not. This is one reason to make sure you are enrolled in Medicaid if you think you might need it — even if you have Medicare, Medicaid fills gaps that Medicare leaves.

Hiring through a licensed agency versus an independent caregiver

A licensed home care agency is regulated by your state's health department or licensing board. The agency hires, trains, and supervises the caregivers. If something goes wrong — the caregiver steals from you, does not show up, or causes injury — you have recourse through the agency and the state. The agency also handles payroll taxes and insurance. You pay the agency, not the caregiver directly.

An independent caregiver works for themselves. You hire them directly, pay them directly, and are responsible for withholding taxes, reporting income to the IRS, and carrying workers' compensation insurance (required in most states). If the caregiver is injured in your home, you may be liable. If they steal from you, you have fewer legal protections. However, independent caregivers often cost less per hour than agencies.

If you use an independent caregiver, ask to see references and a background check. You can run your own background check through services like Care.com, though these are not as thorough as what an agency does. Consider using a payroll service like Care.com's payroll option or a service like Caring.com that handles the tax and insurance paperwork for you — these cost money but protect you legally.

Medicaid will only pay for care from a licensed agency, not from an independent caregiver you hire yourself. If you are on Medicaid, this decision is made for you.

Using a geriatric care manager to coordinate services

A geriatric care manager is a professional — usually a social worker or nurse — who helps you assess what care you need, finds providers, coordinates appointments, and monitors whether the care is working. They are not covered by Medicare or Medicaid, so you pay them directly, usually $100 to $300 per hour depending on your area.

A care manager is most useful if you are overwhelmed by options, if you live far from family who could help coordinate, or if you have complex medical needs and multiple providers. They can save you time and help you avoid hiring the wrong caregiver. You can find a geriatric care manager through the Geriatric Care Management Association at gcmanager.org, which has a directory searchable by location.

Some care managers work on an hourly basis for a one-time assessment and recommendation. Others charge a monthly fee to oversee your care ongoing. Ask upfront what they charge and what they will do for that fee.

What to expect in the assessment and approval process

Once you contact your AAA or Medicaid office, someone will assess your medical and functional needs. This usually happens in your home and takes one to two hours. The assessor will ask about your ability to bathe, dress, cook, take medications, and move around. They will also ask about your medical conditions and what help you currently have.

If you are explore for Medicaid coverage, the assessment determines whether you meet your state's medical need level. If you do, Medicaid will approve a certain number of hours per week of in-home care. The approval letter will say how many hours you get and what type of care (personal care, homemaking, skilled nursing, etc.).

Once approved, you will be given a list of licensed agencies in your area that accept Medicaid. You choose which agency to use. The agency will send a caregiver to meet you, and care usually starts within one to two weeks of that meeting. If you are paying privately, you can choose any licensed agency or hire an independent caregiver.

Frequently Asked Questions

What if I cannot afford in-home care and do not have Medicaid?

Contact your AAA about low-cost or free services like meal delivery, transportation, or cleaning that might help you stay home longer. Some nonprofits offer subsidized care. If your income is very low, you may be able to get Medicaid even if you did not think you may have access to — ask your local Medicaid office about spend-down programs that let you become may be able to access by using your income on medical expenses.

Can I use in-home care to stay out of a nursing home?

Yes, and many states prioritize Medicaid funding for people trying to avoid nursing home placement. Tell your doctor and your AAA that you want to stay home. Some states have programs specifically designed to help people transition from nursing homes back to home-based care, which may give you priority for funding.

What happens if the caregiver does not work out?

If you are using a licensed agency, call them and ask for a different caregiver. Agencies can usually send someone new within a few days. If you hired an independent caregiver, you can end the arrangement, though you should give notice and follow your state's employment laws. Document any problems in writing in case you need to report them to your state's licensing board.

Do I have to use the caregiver my Medicaid program assigns?

No. Medicaid approves you for a certain number of hours and type of care, but you choose which licensed agency provides it. You can switch agencies if you are unhappy. Ask your Medicaid caseworker for a list of agencies in your area that accept Medicaid.

What if I need care but am on a waiting list?

Ask your AAA about temporary or emergency programs that might help while you wait. Some states have programs for people at when ready risk. In the meantime, explore free or low-cost services like senior centers, meal programs, or volunteer visitor programs. A geriatric care manager can also help you find private-pay options while you wait for Medicaid approval.