As more states expand access to home- and community-based services, Medicaid home-based care (HBHC) is becoming a central component of long-term care delivery. For home care providers, that means new opportunities—but also new responsibilities.
Whether you’re already delivering Medicaid services or exploring expansion, understanding what qualifies as HBHC, what services fall under Medicaid waivers, and how to position your agency operationally is key to providing compliant, high-quality care.
Medicaid Home-Based Health Care (HBHC) refers to care services delivered in an individual’s home setting, rather than in a facility. These services are designed to help Medicaid-eligible individuals—primarily seniors and adults with disabilities—avoid institutionalization and receive care in the least restrictive environment.
For providers, HBHC typically falls under Home and Community-Based Services (HCBS) waiver programs, managed care contracts, or fee-for-service Medicaid depending on the state.
Agencies delivering these services must meet a variety of requirements—from caregiver credentialing and EVV (Electronic Visit Verification) to Medicaid-compliant billing and documentation workflows.
Home and Community-Based Services (HCBS) are a vital part of Medicaid programs, designed to support individuals with disabilities, aging adults, and families in maintaining independence and quality of life within their own homes and communities. Rather than relying on expensive institutional care, HCBS programs provide a wide range of services—such as personal care, homemaker assistance, and respite care—that help individuals live safely and comfortably at home. These services are often made available through Medicaid waivers, allowing states to offer flexible support tailored to the unique needs of each person. By focusing on community-based care, HCBS programs help reduce costs, promote dignity, and provide essential help to those who need it most.
Eligibility for Home and Community-Based Services is determined by a combination of factors, including income, age, and disability status, and can vary depending on your state and the specific Medicaid program. In most cases, individuals must complete an application and undergo an assessment to review both their financial situation and their need for care at home. Medicaid waivers play a key role in providing access to these services, offering additional support for those who qualify. To learn more about eligibility requirements and the enrollment process, it’s important to contact your state Medicaid agency or local community resource center. They can provide up-to-date information, answer questions, and help you find the right programs and services for your needs.
Getting started with Medicaid Home-Based Health Care (HBHC) begins with finding a provider in your community who participates in Medicaid programs. Start by reaching out to your state Medicaid agency or a local resource center to obtain a list of approved providers and learn about the benefits available to you. Once you have this information, schedule an appointment with your doctor or care provider to discuss your health needs and develop a care plan tailored to your situation. Be sure to ask questions about the types of services offered, what documentation you’ll need to provide, and how to make the most of your coverage. Taking these steps will help ensure you receive the care and support you need to live safely and comfortably at home.
This broad waiver program allows eligible individuals to receive a combination of medical and non-medical care at home. Eligibility for this waiver often requires a face-to-face assessment to determine the individual's care needs. Services may include skilled nursing, physical therapy, personal care assistance, meal support, and transportation.
Providers contracted under these waivers typically must submit documentation that aligns with state service codes, units of care, and billing requirements.
In consumer-directed models, the care recipient selects and oversees their own caregivers. While families have control over who provides care, agencies may still play a role in payroll administration, caregiver training, or documentation support—especially in fiscal intermediary or administrative roles.
For clients with high-acuity needs, PDN is often approved through Medicaid. Providers offering PDN must coordinate with physicians, ensure skilled staff availability, and manage complex billing scenarios involving prior authorizations and detailed care notes.
Tasks like light cleaning, meal prep, and errands may be authorized through state Medicaid programs. These non-medical services still require proper scheduling, caregiver tracking, and billing accuracy to remain in compliance.
Some clients qualify for additional layers of care coordination or daily living assistance. These wraparound services often require a more nuanced understanding of state program guidelines and unit-based billing structures.
Medicaid HBHC can be a meaningful source of revenue and impact—but it comes with complexity.
As a provider, here are a few operational areas to review:
Some resources and support services for providers, such as consultations with your state Medicaid agency, are free. If you have a question about compliance, billing, or recent policy changes, don’t hesitate to reach out for clarification.
If you’re offering—or considering offering—HBHC services under Medicaid, it’s essential that your agency is operationally ready to manage the regulatory and billing demands.
Medicaid home-based care presents a growing opportunity for home care providers—but success requires more than just service delivery. From waiver program navigation to backend billing and documentation, agencies must ensure they’re equipped to manage every piece of the puzzle.
Whether you’re expanding into Medicaid HBHC for the first time or scaling an existing program, aligning your operations to state requirements and staying updated on policy changes can make the difference between sustainable growth and compliance headaches.