My husband's in a NH on Medicaid. Is it possible to get that Medicaid approval for home care, and for how long?

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As mentioned, HCBS would be the Medicaid program to check into. While generally available in all states, it is not necessarily available in all communities within a state. It is limited by geography and by number of patients, so you need to call your state Medicaid department to inquire about its availability in your area.
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So you want to move hubby from a NH back to your home? He is already approved for Medicaid and he has Medicare too, correct?

I'd suggest that I would schedule a care-plan meeting at the NH. You can do this either through the social worker or the DON (director of nursing). At the care-plan meeting (this is required every 90 days or so @ NH) there should be his floor nurse, a social worker, dietary and activities person. If you go thru the DON to schedule this, she may come into the meeting also (BTW the DON is the goddess ruler at the NH so be aware of that). You want to tell them that you are considering his going back home and want to see if it is feasible and what equipment and home health care he will need to have so that he can be at optimum care at home.

You also want to ask if he is at the point of being a hospice patient - as some of the home health costs could be paid by Medicare if he is on hospice. MediCARE pays for hospice, not MedicAID.

I bet the NH is going to suggest he is best off at a full service facility if he has alot of issues or is physically large man or has significant cognitive issues (mid stage dementia's). It is not that they want to keep him there but that so often it is the emotion of the family that makes the decision to move them without a reality check on the feasibility of the move and taking care of him for possibly years. You want to have other family that is going to be helping in his caregiving be at the care-plan meeting too. So they can hear directly from his medical chart what is going on with him.

Realize that if he is in a facility & on Medicaid, Medicaid is paying 100% for everything and all approval and acceptance of costs is done & final with no billing statement for you to do a co-pay on or deal with. So the physical therapist has a equipped room at the NH to do their job and a CNA takes him from his bed down to the room and then back again to lunch that a dietitian made according to whatever diet he needs. If you are doing this at home, it is not going to be the same as there is no PT room, or staff making food, etc. It could be alot more work than you ever anticipated. You probably could have bills with co-pays from the PT or other providers to have to deal. You will have to deal with his medications, this could be easy or it could be complicated if he is not willing to take his meds on schedule or if the med's require skille (like wound cleaning or injections).

Most programs require a recertification in order to be continued. For hospice its 2 90 day periods and then every 60 days. For home health services, it depends on the service. PT usually has a set # of hours it is provided in a calendar year. He will have to be evaluated to continue getting a service. In the NH, there is a big fat medical chart that gets done so recertification is easy to do. But at home, not so. So have to be prepared that he may not be recertified for home health care & then it's private pay for the service to continue.

All this is why it is good to have everybody at the care plan meeting @ the NH so that everybody is fully aware of what is needed for care and discuss if it can all work at home for the possible months or years to provide. Good luck.
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If you have decided to bring him home, there's a program under Medicaid called 'Home and Community Based Services' (HCBS). This allows Medicaid to pay for a lot of things at home like: personal care services; respite care services; adult day health services; homemaker/home health aide services; rehabilitation; etc.) Since he's already qualified under Medicaid for full care at a nursing home, it may be an easy transition for you. My husband (stage 6 dementia) has been in a nursing home/rehab center for 5 days after a hospital stay - and I'm also determined to bring him home. We live in Texas and I've just applied for this type of Medicaid for him. The nursing home he's in for rehab are really good people and the facility is actually pretty decent, but they do not have the staff to give him the type of attention I feel he needs. I may learn the hard way, but if 'push comes to shove' and I can't keep him at home any more, I have the last resort of putting him in a nursing home. I may be kidding myself - but with help, I think I can do it. So, hang in there. There's hope for the financial and manpower piece of caring for your husband at home under the HCBS program.
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