{
 "name": "medfrail.com home-care rows: care at home instead of a nursing home",
 "version": "2026-10-27",
 "note": "Each row is one fact a person or agent can rely on, with the primary source it was read from and the day. The state Medicaid agency decides who qualifies; these rows only say what the rule and the agency page say. Page: https://www.medfrail.com/home-care",
 "programs": [
  {
   "id": "pace",
   "name": "PACE (Programs of All-Inclusive Care for the Elderly)",
   "area": "Some states and areas only",
   "rows": [
    {
     "fact": "Be 55 years of age or older.",
     "source": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-E/part-460/subpart-I#p-460.150(b)(1)",
     "cite": "42 CFR 460.150(b)(1)",
     "checked": "2026-10-27"
    },
    {
     "fact": "The State administering agency determines the person needs the nursing-facility level of care under the State Medicaid plan.",
     "source": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-E/part-460/subpart-I#p-460.150(b)(2)",
     "cite": "42 CFR 460.150(b)(2)",
     "checked": "2026-10-27"
    },
    {
     "fact": "Reside in the service area of the PACE organization.",
     "source": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-E/part-460/subpart-I#p-460.150(b)(3)",
     "cite": "42 CFR 460.150(b)(3)",
     "checked": "2026-10-27"
    },
    {
     "fact": "At the time of enrollment, able to live in a community setting without jeopardizing health or safety.",
     "source": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-E/part-460/subpart-I#p-460.150(c)(1)",
     "cite": "42 CFR 460.150(c)(1)",
     "checked": "2026-10-27"
    },
    {
     "fact": "Medicare or Medicaid is not required to enroll; a person may have either, both or neither.",
     "source": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-E/part-460/subpart-I#p-460.150(d)",
     "cite": "42 CFR 460.150(d)",
     "checked": "2026-10-27"
    },
    {
     "fact": "The PACE organization becomes the participant's sole service provider; it guarantees access to services, not to a specific provider.",
     "source": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-E/part-460/subpart-I#p-460.152(a)(1)(ii)",
     "cite": "42 CFR 460.152(a)(1)(ii)",
     "checked": "2026-10-27"
    },
    {
     "fact": "If enrollment is denied because health or safety would be jeopardized in the community, the PACE organization must give the reason in writing and refer the person to alternative services.",
     "source": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-E/part-460/subpart-I#p-460.152(b)",
     "cite": "42 CFR 460.152(b)",
     "checked": "2026-10-27"
    },
    {
     "fact": "With Medicaid, no monthly premium for PACE.",
     "source": "https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/other-medicare-health-plans/PACE",
     "cite": "Medicare.gov, PACE",
     "checked": "2026-10-27"
    }
   ],
   "how_to_ask": "Search PACE plans at https://www.medicare.gov/plan-compare/#/pace or ask the state Medicaid agency."
  },
  {
   "id": "hcbs-1915c",
   "name": "Home and community-based services (HCBS) 1915(c) waivers",
   "area": "Each state runs its own",
   "rows": [
    {
     "fact": "States may offer long-term care services at home or in the community instead of an institution, within federal guidelines.",
     "source": "https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c",
     "cite": "Medicaid.gov, HCBS 1915(c)",
     "checked": "2026-10-27"
    },
    {
     "fact": "A person must need a level of care that would otherwise be provided in an institution.",
     "source": "https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c",
     "cite": "Medicaid.gov, HCBS 1915(c)",
     "checked": "2026-10-27"
    },
    {
     "fact": "A state may target a waiver to a group, such as by age or diagnosis.",
     "source": "https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c",
     "cite": "Medicaid.gov, HCBS 1915(c)",
     "checked": "2026-10-27"
    },
    {
     "fact": "States choose the maximum number of people a waiver will serve.",
     "source": "https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c",
     "cite": "Medicaid.gov, HCBS 1915(c)",
     "checked": "2026-10-27"
    }
   ],
   "how_to_ask": "Ask the state Medicaid agency: https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip",
   "unknowns": [
    "Per-state waiver names, slots and waiting lists are not in this file yet; the state agency is the source."
   ]
  },
  {
   "id": "child-disability",
   "name": "A child with a disability who needs institutional-level care at home: the 42 CFR 435.225 option (TEFRA / Katie Beckett), Colorado's CwCHN waiver, and SSI for children",
   "area": "435.225 is a state option; CwCHN is Colorado; SSI is federal",
   "rows": [
    {
     "fact": "The agency may provide Medicaid to children 18 or younger who qualify under section 1614(a) of the Act (SSI disability), who would be eligible for Medicaid if they were in a medical institution, and who are receiving at home the medical care that would be provided in a medical institution.",
     "source": "https://www.ecfr.gov/current/title-42/section-435.225",
     "cite": "42 CFR 435.225(a)",
     "checked": "2026-10-27",
     "unknowns": [
      "Which states elect this option (Medicaid.gov refused automated reads on 2026-10-27).",
      "How each state counts parental income for this group: the rule's text is 'would be eligible ... if they were in a medical institution'; the page tells families to ask."
     ]
    },
    {
     "fact": "The state must find that the child requires hospital, SNF or ICF level of care; that it is appropriate to provide that care outside an institution; and that the estimated Medicaid cost at home is no higher than in an institution.",
     "source": "https://www.ecfr.gov/current/title-42/section-435.225",
     "cite": "42 CFR 435.225(b)",
     "checked": "2026-10-27"
    },
    {
     "fact": "Colorado's Children with Complex Health Needs Waiver (CwCHN) has expanded eligibility to include the former CHCBS and CLLI waivers. Children must be under 19, meet nursing facility or hospital level of care, and meet the SSA disability definition and/or receive SSI.",
     "source": "https://hcpf.colorado.gov/chcbs",
     "cite": "Colorado HCPF, CwCHN waiver page, 'Who Qualifies?'",
     "checked": "2026-10-27"
    },
    {
     "fact": "CwCHN financial: the child's income must be less than three times the current federal SSI limit per month and countable resources less than $2,000. 'Parental income is not considered for the child's eligibility.'",
     "source": "https://hcpf.colorado.gov/chcbs",
     "cite": "Colorado HCPF, CwCHN waiver page, 'Financial'",
     "checked": "2026-10-27",
     "unknowns": [
      "The current federal SSI amount was not read (ssa.gov 403)."
     ]
    },
    {
     "fact": "CwCHN how to apply: already enrolled in Health First Colorado, contact the local Case Management Agency; not enrolled, apply for Health First Colorado. Member Contact Center 1-800-221-3943. Waivers may have waitlists.",
     "source": "https://hcpf.colorado.gov/chcbs",
     "cite": "Colorado HCPF, CwCHN waiver page, 'How to Apply'",
     "checked": "2026-10-27"
    },
    {
     "fact": "A child under 18 is disabled for SSI with a medically determinable impairment causing marked and severe functional limitations that can be expected to cause death or has lasted or can be expected to last at least 12 months.",
     "source": "https://www.ecfr.gov/current/title-20/section-416.906",
     "cite": "20 CFR 416.906",
     "checked": "2026-10-27"
    },
    {
     "fact": "For a child living with parents, SSA deems parental income to the child through the month the child reaches 18; when the parent and child no longer live in the same household, SSA does not deem that parent's income beginning the month after one leaves.",
     "source": "https://www.ecfr.gov/current/title-20/section-416.1165",
     "cite": "20 CFR 416.1165 (intro), (g)(4)",
     "checked": "2026-10-27",
     "unknowns": [
      "SSI amounts and income limits not read (ssa.gov 403); the page says check with Social Security."
     ]
    }
   ]
  }
 ],
 "anywhere": {
  "name": "Eldercare Locator",
  "phone": "1-800-677-1116",
  "source": "https://eldercare.acl.gov/",
  "checked": "2026-10-27"
 }
}