Home or Nursing Home Care

Health plans offer limited coverage for home care and nursing home care.

Topics on this page

• How to get the care
• Home health care
• Nursing home care
• Medicare
• Long-term care

How to get the care

• You need a referral from your doctor and pre-approval from your plan.
• Usually this care must follow a hospital stay.
• The number of days you can get care is limited.
• You may pay a large co-pay or co-insurance.
• The nursing home or home health care provider must be in your health plan’s network.

Home health care

• This includes physical, occupational, and speech therapy. It also includes medication management, nutrition services, wound care, dialysis care, and ostomy care.
• You must be unable to leave your home and your plan must agree that your home is the best place for you to receive care.
• If you have a low income, In-Home Support Services (IHSS) may pay for a home care worker or family member to care for you at home. Call your county Social Services office.

Nursing home care

• This is care in a skilled nursing facility (SNF) under the direction of a doctor and registered nurses.
• You must need skilled nursing care, not just help with daily activities like dressing and eating.
• To choose a nursing home, visit several nursing homes in your plan’s network. Compare the location, cleanliness, noise level, food, and safety of each place. The California Registry   or the JointCommission   helps people find a nursing home.

Medicare

• Medicare   or the Joint Commission   plans have special rules.
• If you have Medicare and feel that your nursing home is sending you home too soon, or your home health care is ending too soon, call Lumetra   or the Joint Commission   at 1-800-841-1602.

Long-term care

Most health plans do not cover long-term care. This is care people need because they can no longer feed themselves, bathe, or care for their other daily needs.

• California Advocates for Nursing Home Reform   or the Joint Commission   and California Registry   or the Joint Commission   provide information on long-term care.
• If you have a low income, you can apply for Medi-Cal. Medi-Cal pays for long-term care. Call HICAP   or the Joint Commission   at 1-800-434-0222 for more information.

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