Home health eligibility · Missouri
Do you qualify for home health?
You qualify for home health when you have a physician’s order and plan of care, a skilled need that requires a nurse or licensed therapist, coverage we accept, and a home within our Missouri service area.
Home health is a clinical benefit, not a service you can simply buy into. Four things have to line up.
What are the requirements for home health care?
1. A physician’s order and a plan of care
Home health begins with an order from your physician or another authorized practitioner, who signs a plan of care setting out what is to be done and how often. Nothing starts without it, and the plan is reviewed and re-signed at intervals while care continues.
2. What counts as a skilled need?
The care has to be something that legally requires a nurse or a licensed therapist — wound care, IV therapy, injections, rehabilitation, swallowing assessment. Help with bathing and meals is real and important, but on its own it is not a skilled need, and it is the most common reason a home health referral is declined.
If daily personal care is the actual need, the Consumer Directed Services program is usually the better route. CDS eligibility →
3. Coverage
We accept MO HealthNet, private insurance, and private pay. Each payer sets its own rules about what is covered, how often, and for how long. We do not currently accept Medicare as payment for home health, even though the agency is Medicare-certified — if Medicare is your only home health coverage, say so on the first call.
4. A home we can reach
St. Louis City, St. Louis County, and Missouri communities within roughly 40 miles of our office on Woodson Road. Missouri only.
What will not disqualify you from home health?
- Living with family. Having capable relatives at home does not remove a skilled need.
- Already having a CDS attendant. The two services can run at the same time and often should.
- Being able to leave the house sometimes. Even where a payer applies a homebound rule, it does not mean confined to bed — leaving for medical appointments, religious services and short outings is generally contemplated.
- Age. Home health is not only for older adults.
What if you are not sure you qualify?
Call us and describe what is actually happening. We will tell you honestly whether it sounds like a skilled need, whether home health is the right benefit, or whether something else fits better — including saying so when the answer is no.
Need skilled care at home?
Call us, or text us. Home health starts with an order from your physician — we can talk you through how to get one.
Frequently asked questions
What conditions qualify for home health?
Home health turns on the care you need, not a diagnosis list. You qualify when the care legally requires a nurse or a licensed therapist, such as wound care, IV therapy, injections, rehabilitation or a swallowing assessment. Help with bathing and meals matters, but on its own it is not a skilled need, and that is the most common reason a referral is declined.
Can I use Medicare for home health with Communicare Elite?
No. The agency is Medicare-certified, but we do not currently accept Medicare as payment for home health. We accept MO HealthNet, private insurance and private pay. If Medicare is your only home health coverage, say so on the first call so we can talk it through honestly before anything is arranged.
Do you have to be homebound to get home health?
Not in the sense most people fear. Some payers apply a homebound rule, but even there it does not mean confined to bed. Leaving the house for medical appointments, religious services and short outings is generally contemplated. The four requirements that matter are a physician’s order, a skilled need, coverage we accept and a home within our Missouri service area.
Can I get home health if I already have a CDS attendant?
Yes. Having a Consumer Directed Services attendant does not disqualify you, and the two services can run at the same time. They often should: the attendant covers daily personal care, while home health brings the nurse or therapist for the skilled need your physician orders. Living with capable family does not remove a skilled need either.