Finding the right care for a loved one is often difficult and time-consuming. Figuring out how to pay for it can feel even more daunting. When it comes to how to pay for a home health aide in Westchester, there is no one-size-fits-all answer, and it depends on each person's circumstances and goals for care.
Medicare Does Not Pay for Long-Term Home Care
Many families are surprised to learn that Medicare does not pay for a long-term home health aide. Medicare covers short-term, part-time skilled care at home, such as visiting nurses and physical, occupational, or speech therapy; it also covers limited aide help while those skilled services are under way. To qualify, the person must be homebound and have a doctor's order. Once skilled care is no longer needed, coverage ends, even if the person still needs help with bathing, dressing, or meals.
For that reason, families should plan how they will pay for an aide before Medicare services end.
Paying for Home Care with Medicaid
Medicaid is the main program in New York that pays for a long-term home health aide. It can cover both skilled and custodial care, from a few hours a week up to live-in care, based on an assessment of the person's needs.
To qualify, a person must be financially eligible for Medicaid and need hands-on help with daily activities. An independent assessor evaluates whether they need help with at least three activities of daily living, such as bathing, dressing, or toileting; for someone with dementia or another cognitive impairment, the threshold is two.
Qualifying for Medicaid home care can take several months, so families who need care urgently should have a backup plan in place.
Paying Privately for Home Care
Paying privately is another option. In the New York area, a home health aide costs about $34 an hour, according to the 2024 Genworth and CareScout Cost of Care Survey.
Long-term care insurance can help cover that cost. A policy usually starts paying once the person needs help with at least two activities of daily living or has a severe cognitive impairment; most policies also have a waiting period, often 90 days, before benefits begin.
Families also draw on Social Security, pensions, savings, investments, and retirement accounts. A homeowner age 62 or older may consider a reverse mortgage, which turns home equity into tax-free cash; nothing is due until the home is sold, the owner moves out permanently, or the owner passes away.
For veterans, the VA Aid and Attendance pension can help pay for home care. It is available to eligible wartime veterans and their surviving spouses.
Protecting Assets While Qualifying for Medicaid
Paying privately for home care adds up quickly, especially when a person needs long-term or indefinite help at home. Around-the-clock care can reach $15,000 to $20,000 a month or more, which few families can sustain without a plan. Spending down all of one's savings before qualifying for help is not the only option.
One option is to transfer assets so that a person can qualify for Medicaid. Under current New York rules, transferring assets does not delay Medicaid home care, although a 30-month lookback for home care has been enacted and may take effect in the future. Common approaches include gifts to family members, placing assets in an irrevocable trust, or transferring the home to one's children while the parents continue to live there. Nursing home Medicaid still has a five-year lookback, so any transfer should be planned with that possibility in mind.
Each of these choices carries tax, family, and financial consequences. The right one depends on the person's health, the family's situation, and the type of assets involved.
How Robert Legal Group Can Help
Too often, families wait until a crisis to start planning. Starting early keeps more options open. Drawing on half a century of legal experience, our attorneys and care coordinators will work with you to understand your options for paying for care and build a customized plan tailored to you or your loved one.
Frequently asked questions
Can Medicaid pay a family member to care for my loved one?
Yes, in many cases. New York's Consumer Directed Personal Assistance Program (CDPAP) lets a person on Medicaid hire a relative, such as an adult child, as their paid aide. A spouse cannot be paid through the program.
How much does home care cost in Westchester?
A home health aide in the New York area costs about $34 an hour, based on the 2024 Cost of Care Survey. A few hours a week is manageable for many families; around-the-clock care can reach $15,000 to $20,000 a month or more.
When should we start planning to pay for home care?
As early as possible, ideally before care is urgently needed. A Medicaid application can take several months, and planning ahead keeps more options open for protecting savings and the home.
Getting Help With the Decision
Deciding how to pay for home care is easier with someone who knows the options and has guided other Westchester families through them. Robert Legal Group can review your loved one's situation, explain which programs fit, and help you build a plan before a crisis forces the decision.
The information in this post is general and for educational purposes only. It is not legal advice, and reading it does not create an attorney-client relationship. Every situation is different; please contact an attorney about your specific circumstances. This blog post is published by Robert Legal Group, PLLC, 145 Palisade Street, Suite 200, Dobbs Ferry, NY 10522, (212) 547-8862, www.robertlegalgroup.com.