MassHealth Home Health Services
NOTE: Glossary words are highlighted. Click on any glossary word to see its definition.
What are MassHealth home services?
Home health services include nursing care; home health aide care; and occupational, physical, and speech/language therapy. MassHealth pays home health agencies to provide these services for eligible MassHealth members. To be covered by MassHealth, home health care services must be medically necessary and part of a doctor’s plan of care.
The rules about home health services are in the Home Health Agency Manual (130 CMR 403) (requires Adobe Reader) on the Health and Human Services web site.
Am I eligible?
To be eligible for MassHealth home health services:
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Your MassHealth coverage type must include home health services. Home health services are included in:
- MassHealth Standard
- CommonHealth
- MassHealth Family Assistance (Direct Care, and Premium Assistance for HIV members)
MassHealth members with Prenatal, Limited, or Essential do not get home health services.
Members with Premium Assistance or Buy-In are covered only if their private insurance plan includes these services.
Members with MassHealth Basic (Managed Care) get limited coverage for home health services.
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You must be living in a private or group home or other non-institutional setting. This can be a temporary residence such as a homeless shelter.
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You must be under the care of a doctor. This can be your own doctor, or a doctor working for a home health agency. Your doctor can be a medical doctor, a dentist, or a podiatrist.
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The home health services must be part of your doctor’s plan of care. Your doctor must review and sign your plan every 60 days.
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The home health services must be medically necessary. If a family member or other caregiver is providing the services you need, then MassHealth will not pay for a home health agency to provide the services.
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The home health services you need cannot cost more than care in an institution.
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Your doctor and home health agency must agree that you can live safely at home with home health care services. MassHealth members age 60 or older must have a referral from their Aging Service Access Point (ASAP).
What benefits will I get?
Home health services must be part-time or intermittent, not full-time for a long period of time. MassHealth limits the number of hours of service and the number of visits you can get. Some services require prior authorization.
MassHealth will pay for home nursing services, home health aide services, and home therapy services for eligible MassHealth members:
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Nursing services
Nursing services are services that can only be performed safely and effectively by a registered or licensed nurse. The need for skilled nursing services depends on the patient’s condition and individual needs.
Note: MassHealth Basic only pays for home skilled nursing services if a person has been in the hospital and needs short-term care at home related to the hospitalization.
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Home health aide services
Home health aide services are health-related services that help keep a patient healthy or help treat an injury or illness. Home health aide services include:
- personal care services
- medication assistance
- changing of dressings
- therapy support services
- care of prosthetic and orthotic devices
In addition to these services, home health aides can provide incidental services while at your home. For example, a home health aide can prepare a meal or take out the trash. However, the main purpose of the visit must be health-related.
MassHealth Basic does not cover home health aide services.
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Physical, occupational, and speech/language therapy
Therapy must be prescribed by a doctor. The therapy must be needed for treatment of a specific illness, injury, or condition. The doctor must review the need for therapy every 60 days.
How do I apply?
To get MassHealth home health services, you must be an eligible member of MassHealth. If you are not a member, you must apply for MassHealth. For information on how to apply, see MassHealth: How do I apply?
If you are already an eligible member of MassHealth, you do not have to apply separately for home health services. Ask your doctor to prescribe home health services if you need them. The home health agency will get approval from MassHealth to provide the services.
MassHealth members age 22 or older who need home nursing care are screened by the home health agency. The agency will get a referral from the local Aging Services Access Point (ASAP) for members who are 60 or older.
Members under 22 who need home nursing care are referred to a MassHealth case manager.
MassHealth Home Health Services section last updated on 4/19/10
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