Home Health Services |
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Your neurologist may prescribe skilled nursing services or physical, occupational, or speech-language therapy. Such intermittent and short-term services—if deemed medically necessary—should be covered by Medicare, Medicaid, and private insurance.
Personal caregiving services of a non-medical nature are addressed on the home care page. Veterans: Ask at the VA about your home care benefits. |
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Who pays?
If you have insurance, you should be covered for medically necessary home health services.
Medicare should cover the bulk of these home health services, as long as you:
Medicare should cover the bulk of these home health services, as long as you:
- Have a formal ALS diagnosis
- Qualify for Medicare
- Are certified as homebound by a doctor
- Are under the care of a doctor who established your care plan, reviews it regularly, and prescribes specific short-term or intermittent services that are deemed safe, effective, and specific treatments for your condition
- Use Medicare-certified home health agencies
Medicaid should cover costs for qualifying low-income patients, though covered home health services will vary by state.
Private insurance may also pay for some of the costs. Plans tend to follow Medicare guidelines for covering medically-necessary home health services. Individual policies will vary.
Which services are covered under Medicare?
Medicare will cover the following services if they are prescribed by your doctor:
- Intermittent and short-term skilled nursing services
- Physical therapy (promoting mobility and functionality, reducing pain, preventing falls)
- Occupational therapy (promoting independence through activities of daily living)
- Speech-language therapy (evaluating and treating voice, speech, language, and swallowing difficulties)
- Home assessments that include a safety evaluation and training for caregivers on how to use a feeding tube, how to safely move their loved one in and out of the wheelchair, etc.
- Social services like counseling
- Some personal care services like bathing, toileting, and dressing—but only if these services facilitate skilled nursing care that is already in the home
What is not covered?
Medicare will not pay for:
- Long-term or 24/7 personal care at home
- Non-medical caregiving services such as dressing and bathing (unless skilled nursing care is already in the home)
- Services that are not prescribed by your doctor
- Services performed by providers who are not certified by Medicare
How can I find a good home health agency?
Your ALS clinic neurologist will recommend a home health agency that is certified by Medicare and has experience working with ALS patients. If you do not attend an ALS clinic, your primary care physician can refer you to their preferred home health agency.
What should the nurse or therapist do?
You should be very happy with the quality of service you receive. If not, you have every right to advocate for yourself. You can begin by bringing up your concerns with the agency, individual, or your ALS Clinic team. If you still feel unsatisfied or uncomfortable—for any reason—you have the right to change, whether that means requesting another person from the agency or finding a new agency altogether. You should feel very comfortable with the people who are spending time in your home.
