Livable Later

Practical home changes for staying safely at home

Costs, contractors, and paying

Medicaid waivers, Medicare, and other ways people pay

Original Medicare does not buy stairlifts or grab bars. Some Medicaid waivers pay for home changes, with rules and caps that are different in every state.

Livable Later editorial team · Updated November 2, 2026 · About 7 minutes

People pay for home changes with savings, family help, a contractor payment plan, a home-equity loan, a reverse mortgage, a tax deduction if they qualify, or a public program aimed at a narrow group. The public programs are the ones most often described badly in advertisements. This page says what the federal sources actually establish, and where the answer can only come from your state or your plan. It is not financial, tax, or benefits advice. A counselor at the agency, a HUD-approved housing counselor, or a tax professional is the person who can apply the rule to a file.

Figures for USDA Section 504 and VA grants are in those guides and are not repeated here except to point you to them.

Original Medicare and the equipment it does cover

As of November 2026, Medicare.gov describes durable medical equipment as durable, used for a medical reason, typically only useful to someone who is sick or injured, used in the home, and expected to last at least three years. The covered examples on that page include walkers, wheelchairs, hospital beds, and commode chairs. A separate Medicare page covers patient lifts that move a person from a bed to a chair. After the Part B deductible, the person generally pays 20 percent of the Medicare-approved amount if the supplier accepts assignment. The supplier has to be enrolled in Medicare. A doctor or other qualifying practitioner has to order the item.

Stairlifts, grab bars, ramps, widened doors, and curbless showers are not on that list. They are building work, not the DME Medicare describes. A patient lift is not a stairlift. A commode chair is not a remodeled bathroom. If a supplier says Medicare will pay for a stairlift, ask them to show you the coverage page and the written order requirements. Also ask what you owe if the claim is denied. Do not sign an advance payment based on a television ad.

Medicare Advantage plans are allowed to offer supplemental benefits that Original Medicare does not, and some plans have included limited help with home modifications or related supports for enrollees who meet that plan's rules. The dollar limit, the catalog of what counts, and the eligibility test are in the plan's Evidence of Coverage for that year. They change. Call the plan and read the document. "Medicare Advantage" is not a national benefit for bathrooms.

Seat-lift mechanisms are a narrow DME topic of their own, outlined in the chair guide. Even there, the chair as furniture is a different question from the mechanism. Ask before you buy.

Medicaid waivers are state programs under federal rules

Medicaid home and community-based services waivers, especially 1915(c) waivers, can include home accessibility adaptations, also called environmental modifications. CMS's waiver technical guidance describes them as physical adaptations required by the person's service plan to ensure health and safety or to increase independence, such as ramps, grab bars, widened doorways, bathroom changes, or specialized electrical and plumbing for medical equipment. The same guidance has long said that general home improvements are excluded: things of general utility, such as carpeting, a roof, or central air, and adaptations that add square footage. The work has to meet state and local codes.

That is the federal shape. Your state decides whether its waiver includes the service, who is eligible (these waivers are for defined populations, not for every Medicare beneficiary), what the lifetime or annual cap is, whether the person must own the home, whether a landlord must consent, which providers may do the work, and whether a therapist's evaluation is required. Caps differ by state and by waiver. This site will not invent a national Medicaid bathroom allowance, because there is not one. Call the state Medicaid agency or the waiver case manager and ask for the environmental-modification sheet. Get the cap, the excluded items, and the "do not start work first" rule in writing.

Community First Choice, the 1915(k) option, includes certain home and community-based attendant services and, in states that adopted it, can include related supports. Not every state has adopted it. Ask your state. Do not rely on a list of states you found on a forum.

Some Area Agencies on Aging and nonprofits run home-repair or ramp programs with their own rules, sometimes using Older Americans Act funds, sometimes donations. The Eldercare Locator, 1-800-677-1116 and eldercare.acl.gov, is the federal door to the Area Agency on Aging. HUD has also funded an Older Adults Home Modification Program that awards money to organizations, which then serve eligible households. It is not an entitlement you apply for at a HUD counter in every county. Ask the Area Agency whether a funded program is open near you.

The Assistive Technology Act funds a program in every state that can demonstrate devices and sometimes loan them. A reacher or a temporary ramp from a loan closet is not a permanent remodel. It can be the thing you use while you wait. Find the program through the Administration for Community Living's assistive technology pages.

Reverse mortgages and tax deductions, carefully

A Home Equity Conversion Mortgage is a Federal Housing Administration reverse mortgage for homeowners 62 or older. HUD requires counseling from a HUD-approved counselor before you proceed. The loan is repaid when the borrower dies, sells, or no longer lives in the home as a principal residence, and the borrower has to keep up taxes, insurance, and maintenance. Failure to do those things can put the loan in default. Proceeds can be used for home repairs, among other uses. Fees and interest are significant. A non-borrowing spouse's right to stay is a specific set of rules, not a casual assumption. Read HUD's HECM pages and take the counseling. This site is not recommending a reverse mortgage. It is identifying the federal product people are sold, and the counseling rule that exists because the product is easy to misunderstand.

IRS Publication 502 (2025) allows a medical-expense deduction for home improvements whose main purpose is medical care for you, your spouse, or a dependent, but the cost is reduced by any increase in the home's value. If the improvement does not increase value, the whole cost can be included. Publication 502 lists improvements that usually do not increase value and can be included in full, among them entrance ramps, widening doors and halls, bathroom modifications and support bars, lowering kitchen cabinets, moving electrical outlets, porch lifts (elevators generally add value, the publication says), stair changes, grab bars, door hardware, and grading the ground for access. Only reasonable costs count. Extra cost for architectural taste does not. You still have to itemize, you can deduct only the amount of medical expenses that exceeds 7.5 percent of adjusted gross income, and you cannot deduct amounts insurance or a grant already paid. Worksheet A in the publication is the arithmetic. A tax professional and the current year's publication beat any summary, including this one.

Before you spend

  • If you expected Medicare to pay for a stairlift, ramp, or grab bar, reread the DME page. Confirm any Advantage extra benefit in the Evidence of Coverage.
  • If you have Medicaid, ask the waiver case manager whether environmental modifications are a covered service and what the cap is. Do not start work first.
  • Call the Eldercare Locator to find the Area Agency on Aging and any local repair program.
  • Veterans use the VA guide. Rural homeowners who are income-eligible use the USDA guide. Do not assume the programs stack.
  • For a reverse mortgage, complete HUD-approved counseling before you sign. For a tax deduction, use Publication 502 and a tax professional.

A program that says no is useful information. It tells you the project is out of pocket, which means the sequence matters: do the Saturday safety work now, and phase the remodel you can actually pay for. A denied claim after the work is finished is the expensive way to learn the same fact.

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