Doctor’s Forms When Applying for State Home Aide Programs

Art: Robin Mead

If you are applying for a home aide program through Medicaid, in some states, they will have a form for your doctor or nurse to fill out. In other states, there will be no specific form, but they may contact your doctor and request and read your recent medical records.

We cannot stress this enough: You need to talk to your doctor about your home aide application. Your doctor is not a mind-reader. Please tell your doctor that you are applying for a home aide and that they will be sent a form. It may help if you explain to your doctor that the form is going to ask about help in each area of personal care (bathing, dressing, feeding, mobility, toilet). Explain to your doctor the help you need in each personal care area.

If possible, make a doctor’s appointment the same week you have your assessment interview, or at least call or write your doctor so you can let them know.

If there is a form, you may be able to request a copy to personally bring to your doctor. If you can sit with your doctor while it is being filled out, your doctor can ask you questions in the moment. It is much, much, much more likely that the form will be accurate if you are there while it is being filled out.


Some states ask on the form if you need an “institutional level of care” or “nursing home level of care.” The doctor must check yes to this question, or your entire application will be automatically disqualified.

Some doctors are afraid to check yes to this question, because they are worried their patient will be forced into an institution. If this happens, you can explain to your doctor that the program you are applying for is designed to keep people out of institutions, checking yes to this will not place you in an institution, it will provide you with home care so you can stay in your home.

Reader’s Tips

These tips come from parents in California. But a lot of them would be helpful for any disabled person working with their doctor to get homecare forms: Tips For Doctor’s Forms

Can’t Get to a Doctor?

If you are homebound  or bedridden, and unable to get to a doctor, you can ask the person running the program if they have any ideas for any way they can arrange for a doctor or nurse to visit your home to screen you. Also check out How to Get a Doctor or Nurse to Come to Your House.

Thanks for Reading

🌷 This page is part of the free online guide: The Sleepy Girl Guide to State Home Aides

🌷 Art on this page by Robin Mead and Elizabeth D’Angelo.

🌷 Page Updated: 8/1/19

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