Medicaid Benefits: Online Database

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Benefits by Service: Home Health Services, includes nursing services, home health aides, and medical supplies/equipment (October 2006) Definition/Notes

Note: Totals include 50 states and D.C.

"Benefits Covered" Totals

"Benefits Not Covered" Totals

Is the benefit covered?

Is there a co-payment requirement?

Yes: 12

No: 39

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Alabama
Yes		Initiation of care and for medical equipment	104 visits/year with no more than 2 home health aide visits/week, therapies not covered	Cost based payment for government providers, fee for service using time units for private providers, med equipment and supplies paid fee for service	CN
Alaska
Yes		Specified med equipment		Percentage of charge	CN
Arizona
Yes		Yes		Fee for service	CN & MN
Arkansas
Yes		Specified med equipment	50 visits/year, only specified med equipment covered, med supplies covered up to $250/month and included in limitations with other providers	Fee for service, med supplies paid up to Medicare payment ceilings	CN & MN
California
Yes	$1/visit	Initiation and continuation of care		Fee for service	CN & MN
Colorado
Yes			Plan of care required	Fee for service, using maximum daily rate	CN
Connecticut
Yes		Therapies after first visit, continued nursing care after second visit	2 skilled nurse visits/week, 20 hours home health aide services/week	Fee for service, enhanced payment for complex care	CN & MN
Delaware
Yes				Fee for service	CN
District of Columbia
Yes			Plan of care required, 36 visits/year, 8 hours/home health aide visit, PT and OT must be in plan, SP not covered, only specified med equipment and supplies covered	Fee for service using Medicare cost ceilings	CN & MN
Florida
Yes	$2/day		4 nursing or home health aide visits/day up to 60/lifetime, therapies not covered, only specified med equipment and supplies covered	Fee for service	CN & MN
Georgia
Yes	$3/service	Therapies	50 nursing, home health aide and therapy visits/year; 2 months med equipment rental	Prospective cost based rate per visit	CN & MN
Hawaii
Yes		Initiation of care and for med equipment and supplies costing more than $50	One 2 hour visit/day first 2 weeks, 3 visits/week next 5 weeks, 1 visit/week next 7 weeks, then 1 visit/2 months	Fee for service	CN & MN
Idaho
Yes		Med equipment costing more than $100	100 nursing, home health aide and therapy visits/year; oxygen and related equipment covered for specified conditions	Fee for service using Medicare cost ceilings, med equipment rental paid at 1/10 purchase price for 10 months	CN
Illinois
Yes		Initiation of care		Fee for service	CN & MN
Indiana
Yes		Therapy not following hospital discharge	120 hours of care within 30 days of hospital discharge if ordered by physician, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge	Prospective cost based rates	CN
Iowa
Yes			Oxygen and related equipment covered for specified conditions	Cost based payment for most services with some paid on fee for service basis	CN & MN
Kansas
Yes	$3/skilled nurse visit	Med equipment and supplies	1 home health aide visit/day, therapies limited to 6 months, psychiatric nursing for homebound only, med equipment must be rented	Fee for service	CN & MN
Kentucky
Yes		Med equipment costing more than $150	B - 25 visits/year	Fee for service	A, B, C & D - See state-specific FN
Louisiana
Yes		Therapy services, med equipment and supplies	50 nursing and home health aide visits/year	Prospective rates based on historical cost	CN & MN
Maine
Yes	$.50-$3/day, depending on payment, up to $30/month	Yes		Fee for service using Medicare cost ceilings	CN & MN
Maryland
Yes		Care cost exceeding that of average nursing facility	Visit limits vary by type of service, 1 visit/type of service/day, home health aide visits require bi-weekly RN supervisory visits	Fee for service with rates set geographically	CN & MN
Massachusetts
Yes			Coverage limited by eligibility category	Fee for service using peer groups to set maximum payments	CN & MN - see state-specific FN
Michigan
Yes				Fee for service	CN & MN
Minnesota
Yes		After initial 9 skilled nurse visits	2 nursing or home health aide visits/day	Fee for service	A & B - See state-specific FN
Mississippi
Yes	$3/visit	Yes	25 skilled nursing and home health aide visits/year	Fee for service with nursing facility rate as upper limit or cost based payment	CN
Missouri
Yes			100 nursing and home health aide visits/year, adult coverage for therapies limited to those who are pregnant or blind	Fee for service	CN & MN
Montana
Yes	$3/visit	Yes	75 nursing visits/year; 100 visits/year including nursing, home health aide and therapy visits; services not covered at same time as personal care	Percentage of charge using a percentage of Medicare allowable cost as ceiling	A & B - See state-specific FN
Nebraska
Yes		Initiation of care	8 hours/day up to 40 hours/week	Fee for service	CN & MN
Nevada
Yes		Initiation of care and ongoing certification of need		Fee for service	CN
New Hampshire
Yes				Fee for service	CN & MN
New Jersey
Yes		Care after initial visit	Plan of care required, cost of care for 6 months must be less than in nursing facility	Cost based payment per time unit, med supplies paid fee for service	CN & MN
New Mexico
Yes	A - $5/visit, B - $7/visit - see state-specific FN	Yes		Cost based payment with limits	CN
New York
Yes			40 visits/year and must be in lieu of hospitalization	Prospective cost based payment	CN & MN
North Carolina
Yes		Specified equipment, supplies, prosthetics and orthotics	Services must be restorative, services not covered during same hours as personal care or private duty nursing	Prospective cost based rates for nursing, home health aide and therapies; other services paid on reasonable charge basis using Medicare limits	CN & MN
North Dakota
Yes				Prospective cost based rate per visit	CN & MN
Ohio
Yes				Fee for service for nursing, home health aide and therapies; med supplies paid 75% average list price if no payment limit available	CN
Oklahoma
Yes	$1/service		36 visits/year, therapies not covered	Fee for service	CN
Oregon
Yes	A - $3/visit	Med equipment and supplies over specified cost thresholds		Fee for service	A - See state-specific FN
Pennsylvania
Yes		Med equipment and supplies costing more than $100	Multiple staff/visit counts as 1 visit, 15 visits/month after first 28 days of care, 2 postpartum visits/pregnancy, 3 months rental of med equipment	Fee for service	CN & MN
Rhode Island
Yes		Med equipment and supplies, therapies		Fee for service	CN & MN - see state-specific FN
South Carolina
Yes	$2/visit, medical supplies are exempt from copayments	Med equipment and supplies	75 nursing, home health aide and therapy visits/year	Cost based payment using Medicare upper limits for visits, med equipment paid at 50th percentile of Medicare allowable charge	CN
South Dakota
Yes		Specified med equipment and supplies		Fee for service, med equipment paid at 75% of charge	CN
Tennessee
Yes					A & B - See state-specific FN
Texas
Yes		Yes		Cost based payment for visits, med equipment and supplies paid fee for service	CN
Utah
Yes		Services after initial evaluation	Home health aide, OT and services for patient or family convenience not covered	Fee for service, payment for med equipment and supplies may be negotiated	A & B - See state-specific FN
Vermont
Yes				Fee for service	A & B - See state-specific FN
Virginia
Yes	$3/visit including all therapy services	After initial 5 visits	Specified med equipment and supplies not covered	Fee for service using geographic adjustments	CN & MN
Washington
Yes		Rental or purchase of med equipment and supplies, therapies provided by med rehab facility on agency order	2 nurse visits/day, 1 home health aide visit/day, 3 nurse visits for high-risk pregnant women/pregnancy	Fee for service using prevailing charge as limit, rates vary geographically	CN & MN
West Virginia
Yes		Specified med equipment and supplies	124 nursing, home health aide, MSW and therapy visits/year	Visits paid at Medicare rates, med equipment and supplies paid 90% of Medicare rates	CN & MN
Wisconsin
Yes			30 visits/year	Fee for service using Medicare cost ceilings	CN & MN
Wyoming
Yes			Therapy must be restorative	Visits paid fee for service, med supplies paid reasonable charge	CN
American Samoa
Yes			Post-hospital care only, includes therapies		See territory-specific FN
Guam
Yes			Therapies not covered	Negotiated rate/service	CN
Northern Mariana Islands
Yes		Yes	Post-hospital care only, includes therapies		CN & MN - See territory-specific FN
Puerto Rico
No - see territory-specific FN
Virgin Islands
Yes				Fee for service	CN

Definition/Notes: Link to Home Health Services, includes nursing services, home health aides, and medical supplies/equipment Footnote


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