Isaac Prentice
May 31, 2026
When families start exploring home care options for an elderly or disabled family member, two programs come up almost immediately: Medicare and Medicaid. They sound similar, they are both government-funded, and they often cover some of the same people. But they work very differently, and what they cover for home care is not the same.
Understanding the difference can save families significant time, money, and frustration when navigating the care system.
Medicare covers skilled home health services including nursing visits, physical therapy, occupational therapy, and speech therapy for homebound individuals following a qualifying medical event. It does not cover custodial or personal care services unless skilled services are also being provided. Medicaid covers a much broader range of home and community-based services including personal care, home health aide services, and long-term supportive care for eligible low-income individuals. Many people qualify for both programs (dual eligibles), but each has distinct eligibility and coverage rules.
What Medicare covers:
Medicare Part A and Part B cover home health services when specific conditions are met. Covered services include:
Medicare home health eligibility requirements:
What Medicare does NOT cover:
Medicare home health benefits are typically time-limited and tied to recovery or improvement goals. They are not designed to fund long-term ongoing personal care.
What Medicaid covers:
Medicaid covers a much broader range of home-based services, including the custodial personal care that Medicare excludes. Coverage varies significantly by state, but most state Medicaid programs cover:
Medicaid home care eligibility:
HCBS waiver programs:
Most long-term personal care services are provided through Medicaid Home and Community-Based Services (HCBS) waiver programs rather than standard Medicaid. These waivers allow states to offer services that go beyond standard Medicaid to help people remain at home rather than entering a nursing facility.
| Medicare | Medicaid | |
| Who it covers | Adults 65+ and certain disabled individuals | Low-income individuals of any age who meet eligibility criteria |
| Personal care coverage | Only when skilled services are also provided | Yes, as primary benefit |
| Long-term home care | Not designed for it | Primary funder of long-term home care |
| Skilled nursing at home | Yes (time-limited) | Yes |
| HHA services | Yes, with skilled care | Yes, as standalone benefit |
| Income-based | No | Yes |
| Consumer direction | Limited options | Yes, through CDPAP and HCBS waivers in most states |
Many low-income seniors qualify for both Medicare and Medicaid, a status known as dual eligibility or being a dual eligible. For these individuals, the two programs work together: Medicare covers primary medical care and short-term skilled services, while Medicaid fills the gaps by covering long-term personal care and other services Medicare excludes.
Dual-eligible individuals often have access to Special Needs Plans (SNPs) or Dual Eligible Special Needs Plans (D-SNPs) that coordinate benefits across both programs.
Does Medicare pay for a home health aide?
Medicare pays for home health aide services only when a skilled service (nursing or therapy) is also being provided and the patient is certified as homebound. Medicare does not pay for home health aide services alone when personal care is the only need.
Does Medicaid pay for 24-hour home care?
Medicaid can fund significant home care hours, but 24-hour live-in coverage through Medicaid is only available in certain states and programs. The number of approved hours depends on the individual’s assessed care needs.
How do I apply for Medicaid home care?
Contact your state Medicaid office or your local Area Agency on Aging (find yours at eldercare.acl.gov) to begin the eligibility and assessment process. You can also ask your family member’s physician or a hospital social worker to initiate a referral.
Can I choose my own home health aide through Medicare or Medicaid?
Under Medicare, your care must be provided by a Medicare-certified agency, and the agency assigns staff. Under Medicaid HCBS waiver programs and consumer-directed programs like CDPAP, you often have the ability to select and direct your own caregiver, including family members in many states.
Understanding your coverage is the first step. Finding and training a qualified caregiver is the next. NCOOA’s HHA and PCA certification programs prepare the professionals who provide the home care services covered by both Medicare and Medicaid.
