Home Health Eligibility | Medicare Homebound Guidelines

Who is eligible for home health?

Most patients, including Medicare beneficiaries, are eligible for home health services when the patient is under the care of a physician who has certified that the patient is homebound and in need of one of the following services:

• Intermittent skilled nursing care; and/or
• Physical, Occupational, or Speech Therapy when:
  
  1. your condition is expected to improve in a reasonable and generally-predictable period of time;
  2. you need a skilled therapist to safely and effectively make a maintenance program for your condition; or
  3. you need a skilled therapist to safely and effectively do maintenance therapy for your condition.

When is a patient homebound?

A patient is homebound when the patient is generally confined to their home due to an illness or injury. Homebound patients may still leave their home, but leaving the home must require supportive devices, such as a wheelchair, or the assistance of another person. Homebound patients typically leave the home only for: (1) medical treatment; (2) adult day care; or (3) short infrequent absences, such as attending religious services. Patients who are covered by private insurance may not need to be homebound to receive home health services.

Who is not eligible for home health services?

• Medicare Beneficiaries who are not homebound; and
• Patients who need more than part-time or intermittent nursing care.

​You may qualify for home health if:

• you have been recently diagnosed with an illness;
• your doctor recently changed your medications;
• your medical condition recently changed for the worse;
• you need any type of therapy;
• leaving home is difficult for you due to your illness;
• you would rather receive medical care in your home;
• you have been in the hospital recently; or
• you fear falling in your home.

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