Who Covers Services?

Home care and who’s paying

Home care refers to at-home assistance provided with the goal of promoting an individual’s sense of normalcy and wellbeing. Home care services include:

• Daily Living Assistance:
  • Personal Care Assistance – assistance with bathing, dressing, medications, exercise, etc.
  • Homemaking – assistance with meal preparation, light cleaning, laundering, etc.
• Appointment Escort
• RN Supervision
• Respite Care
• Companionship & Emotional Support

Deciding which healthcare option is right for you can often be a difficult task. Care provided in the home setting presents the advantage of greater comfort and independence, which may foster a client’s sense of welfare. Moreover, home care may also alleviate stress for both the client and his or her loved ones, another important benefit. It may be a helpful solution for:

• Seniors or disabled individuals who need daily living assistance, but prefer to remain in the privacy of their own homes
• Individuals recently discharged from a hospital or recuperating from an illness or accident who need assistance with personal care and/or household tasks
• Elderly, chronically ill, or handicapped individuals in need of supervision, emotional support, and/or nursing care
• Terminally ill individuals in need of palliative nursing care or families of terminally ill individuals in need of assistance and support
• Families in need of relief with the responsibilities of caring for a physically or developmentally disabled child or adult
• Respite care to ease the responsibilities of the primary caregiver

Who pays for this? The following is a brief overview of the largest sources of funding for home care services:

Medicare is the federal health insurance program for retirees (or spouses of retirees) over the age of 65 and those with disabilities. Medicare offers a short-term solution, and individuals MUST be homebound to qualify for home care under Medicare. In the event that skilled nursing services are also needed, Medicare may cover services provided by a CHHA on a limited basis. Learn more about Medicare.

Medicaid helps cover home care costs for those with low income or limited resources. In New Jersey, Medicaid may cover home care services for those needing long-term care under the Personal Care Assistance Program (PCA). A potential setback associated with Medicaid, however, is that it may be out of reach for those with incomes above the eligibility bracket.

NJ FamilyCare is New Jersey’s publicly funded health insurance program that expands on Medicaid to provide coverage for eligible individuals and families. It may include home health benefits depending on your plan. Learn more about NJ FamilyCare.

To combat cost barriers, there are also additional programs and funding sources worth pursuing:

• Waiver Programs: Waiver programs have different eligibility criteria than traditional Medicaid, although they offer similar benefits. Waiver programs include:
  • Community Care Program for the Disabled and Elderly (CCPED)
  • Jersey Assistance for Community Care (JACC)
  • Caregiver Assistance Program (CAP)
• Respite Care Program: Respite programs offer funding for healthcare services as a means of providing relief for families and unpaid caregivers. Elderly individuals and disabled individuals over the age of 18 are eligible for respite care. Additional eligibility criteria include:
  • Resident of New Jersey
  • Chronic physical or mental disability that requires supervision or daily living assistance from a caregiver
  • Income at or below $1,682 per month ($3,384 for couples)
  • Liquid assets of less than $40,000
  • NJ Statewide Respite Care Program
• Veterans Administration: Qualified veterans are eligible for home care services. Contact your local Veterans Administration facility for more information.
  • NJ Department of Military & Veterans Affairs Phone: 1-888-865-8387 (1-888-8NJ-VETS)
  • Veterans Service Office Contact List by NJ County
• Older Americans Act and Social Service Block Grants: These federal programs subsidize the cost of certain services for elderly citizens. There are no income restrictions, and those over the age of 60 are eligible.
  • Older Americans Act Overview
• Insurance: Both long-term care insurance and standard health insurance may cover home healthcare services, though it’s often overlooked. Calling your insurance provider may yield some surprising results, especially if home care is covered in its entirety.
• Private Payment: Private payment is often necessary to pay for home care services or to supplement the limited funding provided by another source. This is particularly true for individuals who require supervision rather than “medically-related care.” Non-profit home care agencies may have sliding fee scales or subsidy funds to aid those with limited means.

Additional Resources

• A Helpful Contact List of Statewide Services for the Elderly
• An Overview of Statewide Services for the Elderly and Disabled
• An Overview of Statewide Veteran Services
• An Overview of Statewide Disability Services
• An Overview of Medicare
• An Overview of Medicaid
• National Respite Locator Service

Without a doubt, staying informed is a fundamental part of finding the best solution for healthcare for yourself or a loved one. To that end, we strongly encourage you to take advantage of the resources provided on this site to research your options—knowing where you can turn for help with your healthcare needs is vital.