Who Qualifies for Home Health Services?

Anyone who needs healthcare assistance in the home may qualify for Home Care.  The Home Care team will be operating under the supervision of the patient’s physician through doctor’s orders for the services.  

In addition, rules outlined by Medicare, Medicaid and private insurers must be followed in order to qualify for reimbursement for Home Care services. Home Care services may be covered by a variety of insurance programs, or may be continued on a private pay basis. The Home Care staff can talk with the insurance company directly to determine the patient’s eligibility.

The eligibility requirements are not set by Regional Hospital or the Home Care Department. These requirements are determined by Medicare, Medicaid, or the insurance company covering the services. Families are able to privately pay for services not covered by insurance or Medicare. 

Medicare Conditions for Home Health

To be eligible for home health services under Medicare, the patient must:

• Be essentially homebound. Homebound means that the patient is unable to leave home without considerable taxing effort. Infrequent, short absences from home for necessary appointments or medical office visits do not invalidate homebound status.
• Be under a physician’s plan of treatment that includes orders for home health.
• Require one or more of the primary services such as skilled nursing, physical, or speech therapy on an intermittent basis.

Medicaid, Veteran’s Administration and most private insurers have very similar requirements for home health coverage.