Levels of Care & Covered Services
Individuals must meet both the financial and clinical level of care requirements in order to qualify for Medicaid LTSS.
Highest Level of Care
People who have serious needs that meet the criteria for the Highest Level of Care have the option of:
- Nursing facility care
- Home and community-based care
High Level of Care
People who have LTSS needs for the High Level of Care are eligible for home and community-based services, but NOT for nursing home care. Covered Home and Community-based care includes:
- Homemaker/CAN services
- Environmental modifications
- Special medical equipment
- Meals on Wheels
- Personal Emergency Response System
- Case management
- Senior companion
- Assisted living
- Personal case services
- Self-directed care
- Respite
- Minor home modifications
For additional information about the scope of certain covered services, see the following fact sheets:
Special Medical Equipment
Minor Environmental Modifications
Approved Modifications
The approved list of minor environmental modifications are:
- abduction wedge
- adaptive kitchen utensils
- bath/shower chair
- gait belt
- wander device
- hip kit
- offset hinges
- raised toilet seat
- shampoo tray
- threshold ramps
- transfer bench
- adaptive eating utensils
- aids for personal care
- dressing aids
- grab bars
- hip abduction pillow cover
- pivot disc to transfer
- reacher
- safety transfer belt
- standing pole
- tract glove
- versa frame (toilet safety frame)
- hand held shower unit/diverter valve
- Repairs or modifications to the items on this list
These items are for core and preventative services. All items require prior authorization. Items that do not appear on the above approved items list may be considered for coverage, and determination will be based on the individual's unique circumstances as they apply to the current service definitions, policies, and regulations.