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Long story short my dad was diagnosed with ESRD (kidney failure) was given Medicaid, approved for SSDI starting in November and automatically enrolled into Medicare because of his illness. We were informed that his Medicaid is being terminated as of tomorrow and all he will be left with is Medicare which doesn’t cover a lot of the services he is being provided with now through Medicaid. We are trying to get his Medicaid situated as we believe he should still be eligible. But that’s another story... my question in regards to this post is if anyone knows if Medicare covers home health care? I am currently his caregiver and I have done a lot of research and from what I see the only way his services will be covered is if he requires skilled services, is home bound, and I don’t remember what else off the back of my hand. He fits under every category except for skilled services. I do everything for him except for bathing and feeding. He is able to do both, barely, on his own. I was speaking with his Medicaid case worker and she stated that from everything she has gathered throughout home visits she believes he fits the criteria for a nursing home so wouldn’t one assume that he’d qualify for home care through Medicare? He is only 43 and a nursing home is way out of the question for him. Not even an option in his mind... Anybody know anything else on this? Is there anyway that Medicare can still help? His Medicare is through United health care. Hope I provided enough info.

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I don’t think he will be eligible for home care (skilled nursing) but I was a home care RN & our agency did provide PT & OT. He will need an order from a doctor, which may be hard to get as he has not recently been hospitalized & therefore not acute to be considered to need home care. 

Examples of skilled care are wound care & dressing changes, new amputees that need assistance adjusting to their home with this new event, Just to take vital signs doesn’t qualify as skilled care as he has his vital signs checked 3x/week on dialysis. Ditto PT & OT - not acute. 

Home PT & OT May not stay in for long if they feel he has reached his maximum potential. But it’s worth a try. My guess is no. 

As far as being home bound, the patient is allowed to go to doctors visits and dialysis treatments, he will be ok with maintaining a home bound status.

I don’t know what skilled services he qualifies for.
I was also a dialysis RN for many years too. 

Home care aids can provide hygiene such as bathing, but once or twice a week and for as long as he has home care (usually 60 days). If the agency has aides- at times we had minimal aides to provide hygiene due to staffing & then were sent to the patients with the greater need.

Maybe hire a private aide for hygiene a few times a week?
Who will go grocery shopping for him?

He should qualify for transportation to and from dialysis too. Usually patients pay a small amt according to his income, but I am thinking he won’t have to pay for this.
As for Hospice or Palliativd care (not sure what PC is at this time), dialysis is considered life sustaining treatment this dialysis patients rarely do dialysis if they choose hospice. Not sure about PC.

Sorry for this change in coverage. It’s really hard navigating the system but again, I would utilize the social worker provided at dialysis. Insist on a one on one meeting, and make her/him committ to a time. Her job is to help your dad. Keep on her!
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Hi garden artist, I will definitely ask his nephrologist about that when we see him. Thank you for your input. No he is not a veteran, or at least I don’t believe so. He was in the army but never served, only basic training.
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Jasr - just a quick comment. Ask the doctor who scripted for dialysis about Palliative Care. It's a step up from hospice, provides at home care for chronic conditions and could provide therapy if scripted for by a doctor.

What PC actually can provide is still apparently not clearly known as I get different responses from different people, but what I wrote above is what a very competent doctor told us.

Is he by any chance a Veteran?
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This is honestly a nightmare for us! We’ve spent most of yesterday and today on phone with nuermous reps from Medicaid and now UHH, no one from Medicaid can provide us with answers as to why Medicaid was terminated, all we get it “maybe his income is too high” that’s it! Re applied yesterday for full coverage or even partial as that is he only thing that was recommended to us, and no one has been in contact with us. On hold now waiting for someone from UHH but you know how long these wait times are. I am hoping we can get everything situated fast as Dad is very dependent on me and cannot be left alone as he takes multiple meds 4x daily, insulin 2x, vitals must be checked 3x daily, cannot cook for himself, dialysis leaves him unable to care for himself. I am praying, hoping for a good outcome. Ugh!
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Call United Health Care NOW. Ask what home services they cover through father's Medicare plan - it won't be 24/7 care by any means. My MIL received physical therapy twice per week, occupational therapy once per week, a brief nurse visit twice per week to check vitals and medication levels, with the visits staggered so that MIL had someone from the outside come by 4 days per week for about 2-4 hours per day for Parkinson's related care once she was certified homebound. The rest? the rest was on my father in law. Medicare covers skilled services, but not most of the activities of daily living and they don't provide daily hours in home care like Medicaid does in most cases. Have you checked into hospice for equipment and respite care if you can't get Medicaid? Even a few hours of help or therapy could be great in your case. HOWEVER, your insurance company will have guidance for you if your worst case scenario of not getting Medicaid re-certified happens.
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