To be or not to be homebound: the limits of states' discretion in Medicaid's coverage for home health services.

Medicaid's coverage for home health services is a critical source of support for individuals with chronic needs. Generally, the Medicaid services available to individuals striving to stay in the community, such as personal care services or a package of home and community-based services delivered through a waiver or state plan benefit, are completely at state option to provide. The home health benefit, however, has the unique status in the Medicaid program of being a mandatory community-based service that is long-term in nature. Furthermore, while many Medicaid recipients are also enrolled in Medicare (the "dual eligibles") and thereby may receive Medicare coverage for home health care services, Medicaid's home health eligibility requirements are less restrictive than Medicare's, which may provide these individuals with greater access to the service.