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Will Social Security Disability Pay for Home Healthcare?

Female Caregiver Assisting Senior Man in Wheelchair

Most people are familiar with the social security retirement benefits that are available to qualifying individuals when they reach age 62. However, there are two other lesser-known social security benefits. They include Social Security Disability Insurance and Supplemental Security Income, commonly referred to as SSDI and SSI. Knowing how these Social Security programs work will help you understand how they can contribute to your home health care needs.

Qualifying for Social Security Disability Insurance

To qualify for Social Security disability insurance, you must meet the following criteria:

  • You must have worked for a specific amount of time in a job that the Social Security Administration has approved of. Naturally, this is a job where you would have paid Social Security taxes.
  • You must be able to show that you have a medical condition that meets the “disability definition” of the Social Security Administration. The health condition must show that because of its severity, you are unable to work and it may be life-threatening. The Social Security Administration has a range of medical conditions that qualify as a disability. They include everything from heart conditions, a debilitating diagnosis such as ALS or cancer, intellectual disorders, and even mental health conditions like schizophrenia.

The Social Security Administration is constantly updating its list of disabilities and what qualifies. Having an experienced attorney on your side can help you understand how these qualifications line up with your health issues.

How Social Security Disability Insurance Is Calculated

The severity of your disability does not impact your SSDI benefits. Your Social Security disability insurance benefits are calculated based on how much income you have earned and how much you have paid into Social Security taxes.

Your benefits are calculated based on your annual index monthly earnings or AIME. This is your average earnings over a period of time. The Social Security Administration uses this number and plugs it into a formula to determine what your primary Insurance Amount or PIA will be. Your PIA is the basic amount that is used to determine your monthly benefits.

SSDI payments vary from Individual to individual because of how long someone has worked, how much they have earned, and how much they have paid in Social Security taxes. Benefits will typically range anywhere from $800 to $1,800 per month.

Other factors can bring down your SSDI payment. These will typically include other government benefits such as public disability benefits, pensions that are based on work not covered by Social Security, and worker’s compensation benefits.

Will Social Security Disability Insurance Pay for Home Health Care?

SSDI does pay for home health care in limited circumstances but in a roundabout way. Individuals who qualify for SSDI can also start receiving Medicare coverage after two years, and Medicare does cover home health care for those who qualify. In this regard, then, being eligible for SSDI can enable you to receive home health care through Medicare after two years.

To be eligible for home health care through Medicare, though, you must meet Medicare’s eligibility criteria. These criteria include:

  • Being homebound as defined by Medicare.
  • In need of skilled nursing care
  • Having approval from a doctor to receive the necessary healthcare services at home
  • Receiving care from a Home Health Agency certified by Medicare

If you meet these eligibility requirements, you can have home health care paid for by Medicare. There are limits, though, on what kinds of services can be provided. Covered services include:

  • Skilled nursing care up to eight hours a day or up to 28 hours a week. Round-the-clock care is not covered by Medicare.
  • Skilled therapy, such as physical therapy, speech therapy or occupational therapy
  • A home health aid for personal care, but only when such care is needed in addition to skilled nursing care or therapy as described above
  • Social services
  • Medical supplies and equipment

Home Health Care Support Through Medicaid

Although Social Security Disability (SSD) is not income-based, Supplemental Security Income (SSI) is, and people who qualify for SSI also qualify for the state medical program, Medicaid (Medi-Cal in California). Medicaid may be able to pay for home healthcare needs, including home health aides and long-term nursing care that Medicare does not cover.

Medicaid waiver programs

Many states offer Medicaid Waiver programs. These are programs designed to keep people out of nursing homes and will instead pay for home health care so that individuals can receive the care they need in the comfort of their own homes. The benefits of Medicaid Waiver programs vary from state to state; however, they will typically cover the following services:

  • In-home health care
  • Personal care and hygiene services including bathing, moving and eating
  • Home care services in which household chores are taken care of, grocery runs are made, and other errands pertaining to the keeping of the household are executed
  • Minor modifications to the home such as the installation of a ramp
  • Payment for needed medical equipment.

In many states, Medicaid may also pay family members for providing care as well. There are different programs available which family members must apply for in order to receive payments.

Seek The Aid of an Experienced Professional

Navigating Social Security Disability Income can be very difficult especially for individuals who do not fully understand the program and how it works. Understanding how Medicaid helps an applicant as far as home health care goes can be equally difficult. Having an attorney by your side who is experienced in Social Security Disability benefits can be of great value to you. Contact one of our experienced attorneys today to explore your options and receive the care you deserve. For help with Social Security (SSI/SSD) in Southern California, call Drake & Drake in Calabasas at 818-914-4055.

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