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Home Health Services
Medicaid Home Health Services include home health nursing, home health aide services, and/or skilled therapies (physical therapy, occupational therapy, and speech-language pathology).
Home Health Services

To be considered a Medicaid home health service, these services must be provided to an eligible individual by a Medicare Certified Home Health Agency on a part-time and intermittent basis.

Part-Time or Intermittent Home Health is:

  • no more than a combined total of 8 hours per day of home health nursing, home health aide, and skilled therapies;
  • no more than a combined total of 14 hours per week of home health nursing and home health aide services except as covered by the post-hospital benefit, for individuals under age 21 with medical need for increased services as ordered by the treating physician, or as prior authorized by ODM or its designee; and
  • visits are not more than four hours.

The medical necessity for home health services must be certified by the individual's qualifying treating physician. A face-to face encounter with the individual and the physician, advanced practice nurse in collaboration with the physician, or a physician assistant under the supervision of the physician is required for certification of medical necessity. A face-to-face encounter must be conducted within 90 days prior to the start-of-care date, or within 30 days following the start-of-care date.

In order to be eligible to receive home health services, an individual must be eligible for Medicaid with some caveats:

  • Individuals enrolled in the Program for the All-inclusive Care of the Elderly (PACE) must access home health services through PACE.
  • Individuals who have elected hospice care must access home health services through the hospice benefit. However, children under age 21 who are receiving concurrent curative treatment with hospice care may receive home health services related to the curative treatment.
  • Individuals enrolled in a Medicaid managed care plan must access home health services through their managed care plan.