Paying for a walk-in tub in California: Medicare, Medi-Cal, VA and tax rules

This page sorts the main funding routes into what is generally not available, what may be available to some people, and what is worth asking about. We are not a government agency and we cannot decide eligibility. Every program below has its own rules, and those rules change. Use the official links at the bottom to confirm details, and talk to the agency before you sign a contract.

Medicare

Original Medicare (Part A and Part B) covers durable medical equipment, or DME, when it is prescribed for use in the home. Medicare.gov describes DME as equipment that is durable, used for a medical reason, typically useful only to someone who is sick or injured, used in the home, and expected to last at least three years. A walk-in tub becomes part of the house and is generally treated as a home modification rather than DME, so Original Medicare generally does not pay for it.

Two things are still worth checking:

• Medicare Advantage plans (Part C) may offer supplemental benefits beyond Original Medicare. Some plans include home-safety items or allowances. Coverage varies widely by plan, so call the number on the member card and ask about the specific item.
• Related covered items. Some bathroom-related equipment, such as a commode chair, can be covered when medically necessary and prescribed. A home evaluation by a therapist may also be covered in some situations.

Medi-Cal: three routes to ask about

Medi-Cal does not list walk-in tubs as a standard benefit. There are, however, programs within Medi-Cal that can pay for home modifications when they are needed to keep someone safely at home. Each has limited eligibility.

Community Supports through a Medi-Cal managed care plan

Under CalAIM, California's Medi-Cal managed care plans may offer optional "Community Supports." One of the services on the state's approved list is Environmental Accessibility Adaptations, also called home modifications. The Department of Health Care Services (DHCS) describes these as physical changes to a home that are necessary to ensure the health, welfare and safety of the member, or to help them function with greater independence. They are aimed at members at risk of moving into a nursing facility. Not every plan offers every Community Support in every county, and renters need the owner's written consent. Call your plan's member services line and ask whether it offers home modifications and how to be assessed.

The HCBA Waiver

The Home and Community-Based Alternatives (HCBA) Waiver serves full-scope Medi-Cal members who need a nursing-facility level of care but want to live at home. DHCS lists environmental accessibility adaptations among the waiver's services. Enrollment is handled through waiver agencies assigned by county, and there may be a waitlist.

MSSP

The Multipurpose Senior Services Program (MSSP) is a Medi-Cal waiver administered by the California Department of Aging. It provides care management and supportive services to older adults who are Medi-Cal eligible and certifiable for nursing-facility placement. CDA lists minor home repair among the services local MSSP sites may arrange. It is not designed to fund a full bathroom remodel, but a care manager can help a family find the right resource.

Veterans: the VA HISA benefit

The Home Improvements and Structural Alterations (HISA) benefit helps veterans make medically necessary changes to their primary home. According to VA's Prosthetic and Sensory Aids Service, HISA provides up to $6,800 for a service-connected condition (or for any condition when the veteran is rated 50 percent or more service-connected) and up to $2,000 for a non-service-connected condition. It is a lifetime benefit: once used, it does not reset.

VA lists roll-in and walk-in showers among examples of eligible work. VA's published exclusions include the purchase or installation of spa, hot tub and Jacuzzi-type tubs. That means a walk-in tub, especially one with jets, may not qualify, and a walk-in or roll-in shower may be the more straightforward HISA project. Your VA medical center's Prosthetic and Sensory Aids Service makes the decision.

1. Talk to your VA provider about the need. A prescription for the change is part of the process.
2. Apply with VA Form 10-0103, usually through the medical center's prosthetics office.
3. Get estimates. Aging Safely Baths & More can provide a written estimate for your application.
4. Wait for approval before work starts.

Veterans with certain severe service-connected disabilities may also qualify for larger VA housing grants, the Specially Adapted Housing and Special Home Adaptation grants. A County Veterans Service Office can help you sort out which applies, at no charge.

California aging programs

California's Area Agencies on Aging receive state and federal funding for services that help older adults stay at home. What is offered depends on the county and the year. The California Department of Aging's Dignity at Home Fall Prevention Program, for example, has funded local agencies to provide home safety assessments, equipment and home modifications to adults aged 60 and over or people with disabilities whose household income is within program limits and who are at risk of falling. A full walk-in tub is beyond what most of these programs fund, but grab bars, shower seats and hand showers often are. Call 1-800-510-2020 to reach your county's agency, or see our aging resources guide.

Taxes: the medical expense deduction

IRS Publication 502 explains that some home improvements made mainly for medical care can count as medical expenses. For improvements that increase the value of the home, only the cost above the increase in value counts. The publication also lists improvements made to accommodate a disability that generally do not increase home value, and bathroom modifications appear in that discussion. Medical expenses are only deductible to the extent they exceed 7.5 percent of adjusted gross income, and only if you itemize. Keep the contract, receipts and any doctor's recommendation. The rules are detailed, so please consult a tax professional before relying on a deduction.

Other ways families pay

• Family contributions. Adult children sometimes share the cost, especially when the change helps a parent stay at home.
• Long-term care insurance. Some policies include home modification benefits. Read the policy or call the insurer.
• Choosing a simpler option. A low-threshold walk-in shower, or grab bars and a transfer bench, can address much of the risk at a lower cost.