The short answer
CHAMPVA covers home health care when the patient is homebound and needs intermittent skilled nursing, ordered by a physician and provided by an RN, LPN, or LVN. It doesn't cover housekeeping, homemaker, attendant, sitter, or companion services, or custodial care. Home health doesn't need preauthorization. You pay your deductible and 25%.
When is home health covered?
The CHAMPVA Guidebook covers home health when all of these are true:
- The patient is homebound.
- The care is intermittent, meaning visits, not round-the-clock.
- It's skilled care and medically necessary.
- A physician orders it, and an RN, LPN, or LVN provides it.
Example: a nurse visits three times a week to care for a surgical wound for someone who can't leave home. That fits.
What isn't covered?
38 CFR 17.272 excludes:
- housekeeping and homemaker services, like cleaning and cooking,
- attendant services, including a sitter or companion, and
- custodial care, meaning routine help with daily activities when skilled care isn't the reason.
The Guidebook also excludes care from an immediate family member or someone who lives in the household. CHAMPVA won't pay a relative to provide care.
That's true even when the help is truly needed. A doctor's order doesn't turn a sitter into covered skilled care.
Skilled vs. nonmedical help
| Skilled home health | Homemaker, aide, sitter, companion | |
|---|---|---|
| Purpose | Treat a medical need | Household help, supervision, company, routine personal help |
| Covered? | Yes, if all criteria are met | No |
| Who provides it | RN, LPN, or LVN | Nonmedical helper |
The agency's job title for the worker doesn't decide it. What matters is the actual service.
Does it need preauthorization?
No. Home health isn't on CHAMPVA's preauthorization list. Claims still have to meet the rules above.
What will you pay?
When CHAMPVA is your only coverage: your yearly deductible, then 25% of the allowable amount. If other insurance pays first, you usually owe nothing. Your family's yearly total stops at $3,000. More here: CHAMPVA cost share.
Before home health starts
- Confirm the patient is homebound.
- Get a physician's order that names the skilled need.
- Confirm an RN, LPN, or LVN will provide the skilled care.
- If the agency also offers nonmedical help, ask it to bill those separately.
- Ask if they accept CHAMPVA assignment.
- Tell them about other insurance.
- Keep the order and visit notes.
Where can families find other help?
If what you need is ongoing personal care or supervision, CHAMPVA isn't the program for it. Some options to look into:
- If you care for a Veteran, VA's caregiver programs may help. More here: CHAMPVA for Primary Family Caregivers.
- If the patient has Medicaid, many states offer home care services.
- For skilled care in a facility, see CHAMPVA skilled nursing facility coverage.
- At end of life, hospice covers more in-home support. More here: CHAMPVA hospice care.