Respite Care in Medicaid

Caring for a loved one is rewarding, but it takes time and energy. You want to always be there for them, but it’s important to have a backup plan. What would happen if you needed a break or you couldn’t take care of your loved one in an emergency?

For times where you can’t take care of your loved one, you should consider “respite care.”  Respite care is a temporary break for you – the family caregiver. While someone else cares for your loved one you can get away, take a rest, or take care of yourself. For those of you who are caring for someone who is on Medicaid, respite care can be a Medicaid Home and Community-Based Services (HCBS) benefit.

There are other types of respite care too, but we’re focused on the kind of respite care that Medicaid covers. Keep reading to find out how the Medicaid respite care benefit works. Learn how it’s different from other types of respite care, and how to apply.

What Is Medicaid Respite Care?

In most states, Medicaid has a benefit you can apply for to get a temporary caregiver for your loved one while you take a break. This is called respite care.

If your application is approved, you won’t pay for your loved one’s replacement care. This lets you recharge or handle other things. Respite care is something that is planned in advance. Medicaid will cover the cost, but there might be a waiting list. Most of the time your loved one can stay at home and get the care they need.

Medicaid respite care is different from other kinds of respite care. Other types of respite care include care from private insurance, other state or local programs, or Veterans Affairs. You may need to pay for some of these respite options by yourself, as they aren’t covered by Medicaid. Non-profit groups or volunteers might give you respite care for free or for a low cost, but they’re not the same thing as Medicaid respite care.

To make sure your respite care costs are covered, work with your loved one’s Medicaid case manager to apply for respite care before you need it.

Who Can Get Respite Care?

Respite care is a Home and Community-Based Services benefit. Because HCBS programs are part of Medicaid, your loved one will most likely need to be eligible for Medicaid. To get Medicaid services, your loved one must have a medical need for care and must not be able to pay for their own healthcare.

How Long Can I Get Respite Care?

Every state has its own rules for how long Medicaid respite care can last. Some states decide how long respite care is allowed based on each person’s needs. Other states set time limits that apply to everyone.

Planning Ahead

You should always have a backup plan prepared for your loved one’s care in case of an emergency. This way, they can keep getting what they need. Make a detailed care plan that includes:

• Contact information for Medicaid and your loved one’s case manager.
• A list of emergency contacts and backup caregivers.
• Other community resources, volunteer groups, and nonprofits that can help in an emergency.

If you know you’ll need a break from caregiving, apply for respite care ahead of time. Some states might have waitlists, so planning early helps make sure your loved one gets in-home care when you both need it. Get in touch with your local Medicaid office or visit their website to start the process.