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explore our window of opportunities!
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Who Pays for Service?
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Charges for home health services vary among agencies, and government health plans are subject to change. Potential home health clients should inquire about charges and coverage before accepting services. The fact that a patient's physician may order home health care does not guarantee that reimbursement sources will cover the care.
Medicare, Medicaid and private insurance may cover all or a portion of the cost of home health care. In Kentucky, only licensed home health agencies or hospices may be certified to receive Medicare and Medicaid reimbursement for providing home health or hospice care. Some providers of related home care services or supplies may be reimbursed by these payors but not for providing hands-on home health care.
To be eligible to receive home health services under Medicare or Medicaid programs, individuals must be eligible for these programs and must have health care needs which can be met by care provided on an intermittent basis (less than full time). There must be a need for skilled care services, and the individual must be essentially home bound. There is no requirement for a prior hospital stay in order to receive home health benefits. A home health agency can be of assistance in determining if the patient's health care needs meet the criteria for Medicare of Medicaid reimbursement.
Some agencies have a sliding fee schedule for those individuals without insurance coverage. Also some home health providers participate as a "Kentucky Fair Share Provider" as part of a voluntary network through which they provide limited services to individuals who are without financial resources, have no insurance, are not eligible for Medicaid or Medicare and have non-emergency health care needs. A physician participating in the Kentucky Physician Care Program may refer someone to home health through this network. The hotline number for accessing the "Kentucky Fair Share" Program is 800-633-8100.
All private insurance carriers in Kentucky must offer home health benefits; however, full home health care coverage may be an optional benefit. Coverage varies widely. Insurance plans may cover expanded services beyond specific identified benefits if such services are cost effective and medically appropriate alternatives to institutional care. Each potential patient should check with his/her insurance company or with a home health agency to determine how much home health coverage may be available.
A special Medicaid program called Home and Community Based Waiver Program provides supportive care in the home for those Medicaid recipients who are eligible for care in a nursing facility. The services are ordinarily not covered under Medicaid's traditional home health care. Special income and eligibility requirements must be met. Any home health care agency providing these services can explain requirements and assess whether the patient's needs qualify them for these services.
Through its Home Care Program, the Commonwealth of Kentucky provides limited funds for services to elderly individuals who do not need skilled care, but whose ability to remain at home unaided is limited. In many areas of the state, a home health agency may be the agency authorized to provide these special government funded services.
Workers Compensation may cover home health services needed as a result of a job related injury. Determination and eligibility information can be obtained from employer or workers' compensation representatives.
In some instances Veterans Benefits may include home health services for eligible veterans. Individual determinations are made by the Veterans Administration. The Champus program covers dependents of active military personnel, military retirees and their dependents and survivors.
Private pay patients always have the option to pay for home health services with personal funds. The charges should be agreed upon before services are accepted.
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154 Patchen Dr., Suite 90
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Lexington, Kentucky 40517-4415
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Phone: 859-268-2574
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Fax: 859-898-2175
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