Home changes for aging in place, and what Medicare, Medi-Cal and local programs may cover

The short answer

• Start with low-cost fixes that prevent falls: clear walkways, brighter light, non-slip mats, handrails on both sides of stairs, and grab bars by the toilet and tub.
• Ask a clinician about occupational therapy if daily tasks at home are getting harder. Medicare Part B covers it when medically necessary.
• Original Medicare pays for some prescribed equipment, such as walkers, hospital beds and some commodes, but not for grab bars, bath seats, raised toilet seats, stair lifts or building work such as ramps.
• In California, a Medi-Cal plan may pay up to $7,500 over a lifetime for home modifications, if the plan offers the benefit and the member is at risk of needing a nursing home.
• Veterans may get a VA grant of up to $6,800 or $2,000 over a lifetime. Renters have a right to make reasonable disability-related changes, usually at their own cost.
• In Fresno and Madera counties, the Fresno-Madera Area Agency on Aging, (559) 214-0299, can point you to local help.

This is general information, not medical, legal or tax advice; confirm with each program before you pay.

Start with a falls check

More than 1 in 4 older adults reports a fall each year, according to the Centers for Disease Control and Prevention (CDC). The checklist below draws on CDC's free "Check for Safety" checklist.

Medicines that cause dizziness, poor vision, foot problems and weak legs also raise the risk, so ask a clinician for a falls check. See Fall Prevention at Home: A Room-by-Room Safety Guide, Medications that may increase fall risk and Choosing and Using a Cane or Walker Safely.

Room-by-room checklist

Walk through the home with the person who lives there, and watch them do everyday tasks. Tick what is done, then price the larger changes.

Entrances and outdoor steps

• Bright light at each door and over outdoor steps.
• Loose or uneven steps repaired.
• Sturdy handrails on both sides of the steps, running their full length.

Larger changes: a permanent ramp, a no-step entrance, regrading for a level path, or a porch lift.

Bathroom

• A non-slip mat or self-stick strips in the tub or shower.
• Grab bars inside and beside the tub or shower, and beside the toilet, installed to hold a person's full weight.
• A night-light on the path from the bed to the bathroom.
• A shower chair, hand-held shower or raised toilet seat, if bending or standing is hard.

Larger changes: a roll-in shower, a wider door, a lowered sink, or plumbing or wiring for medical equipment.

Bedroom

• A lamp within easy reach of the bed.
• Night-lights, or lights that switch on in the dark, along the way to the bathroom.
• A clear path around the bed.

Larger changes: a hospital bed or bedside commode, if a clinician prescribes one.

Kitchen

• Everyday items on lower shelves, about waist height.
• A sturdy step stool with a grab bar for anything higher. Never stand on a chair.

Larger changes: lowered counters or cabinets, and outlets or switches moved within reach.

Stairs inside the home

• Nothing left on the stairs.
• Handrails on both sides, the full length, with loose rails fixed.
• A light and switch at the top and bottom, and burned-out bulbs replaced right away.
• Carpet fastened firmly to every step, or replaced with non-slip treads.

Larger changes: a stair lift, or moving the bedroom and bathroom to the main floor.

Lighting and floors throughout

• Furniture moved so walking paths are clear.
• Throw rugs removed, or held down with double-sided tape or a non-slip backing.
• Cords run along the wall, not across walkways. An electrician can add an outlet.
• Bright light in hallways, with switches near each doorway.

Smoke and carbon monoxide alarms

• Smoke alarms on every level and just outside each sleeping area.
• Press each smoke alarm's test button monthly. Never take out the battery; a chirp means it is low.
• Battery-operated or battery-backup carbon monoxide (CO) alarms near each sleeping area, replaced as the maker directs or every 5 years.

Larger changes: smoke alarms with flashing strobe lights for a person who is deaf or hard of hearing.

Get a professional home evaluation

An occupational therapist (OT) helps people do daily tasks such as bathing, dressing and using the toilet more safely, and can suggest equipment that fits the person and the home. Medicare Part B covers medically necessary outpatient occupational therapy when a doctor, nurse practitioner, clinical nurse specialist or physician assistant certifies the need. You pay the Part B deductible, then 20% of the Medicare-approved amount. Medicare says there is no yearly dollar limit on medically necessary outpatient therapy.

Tell the therapist which tasks are hard at home. Medi-Cal plans usually require a therapy report before approving home modifications. For building work, get more than one written bid and ask whether a permit is needed.

What Original Medicare pays for, and what it does not

Part B covers durable medical equipment (DME) that is medically necessary and prescribed for use in your home. The supplier must be enrolled in Medicare. If it "accepts assignment," you pay 20% of the approved amount after the deductible; if not, you may pay the full price up front. Medicare's national equipment list (NCD 280.1, current version effective June 9, 2025) treats common items this way:

Medicare Advantage plans may offer extras

Medicare Advantage plans are private plans that replace Original Medicare. Under a 2018 federal policy change, they may offer "home and bathroom safety devices and modifications" as an extra benefit, such as shower stools, hand-held showers, stair and bathroom rails, grab bars, raised toilet seats, portable ramps, night-lights and stair treads, sometimes with a home safety inspection. Structural changes, such as permanent ramps or wider doorways, are not allowed. Each plan decides whether to offer this, so check its Evidence of Coverage, or see Medicare open enrollment for 2027. For free Medicare counseling (HICAP), call 1-800-434-0222, or in Fresno County, Valley Caregiver Resource Center, (559) 224-9117.

Medi-Cal routes in California

Home modifications through your Medi-Cal plan

Through its CalAIM initiative, Medi-Cal lets managed care plans offer "Community Supports," including Environmental Accessibility Adaptations (home modifications). Under the state's Community Supports Policy Guide (Volume 1, updated April 2025):

• Who: plan members at risk of going into a nursing facility.
• What: ramps, grab bars, wider doorways, stair lifts, accessible bathrooms and roll-in showers, wiring or plumbing for medical equipment, and an emergency response system for people often alone.
• Not covered: changes of general use to the household, added square footage (unless needed to finish an adaptation) and decorative work.
• Limit: $7,500 over a lifetime, with exceptions if the person moves or their condition changes a lot.
• Steps: an order from the member's primary care physician, usually a physical or occupational therapy evaluation, a home visit, and two bids where possible.
• Renters: the owner must agree in writing, and the changes are permanent.

The benefit is optional for plans. Call the member services number on your plan card and ask, "Do you offer Environmental Accessibility Adaptations, and how do I get a referral?" For background, see Medi-Cal in plain language.

Home and Community-Based Alternatives (HCBA) Waiver

The HCBA Waiver provides care management by a nurse and social worker team, plus services such as caregiver training and personal care, for Medi-Cal members at risk of nursing facility care. It has been full since July 12, 2023; new applicants go on a waitlist. In June 2026 the state reported 11,229 people enrolled and 7,174 waiting. Apply through your county's waiver agency, or call the state HCBA line at (833) 388-4551.

Assisted Living Waiver

This waiver is for people ready to move, not for changing the current home. It serves adults 21 and older with full-scope Medi-Cal, no share of cost and nursing-home-level care needs, in licensed assisted living or public subsidized housing; the person pays room and board. It runs in 15 counties, including Fresno, through February 28, 2029. In March 2026 the state reported 14,831 people enrolled and 15,910 waiting. Apply through a Care Coordination Agency.

In-Home Supportive Services (IHSS)

IHSS pays for in-home help for people on Medi-Cal who are aged, blind or disabled, so they can stay at home. A county social worker authorizes hours, and the person hires the provider. It pays for help with daily tasks, not for building work. Apply to your county IHSS office, and see IHSS in California: how a family member can be paid to provide care.

Veterans: VA home improvement grants

The Department of Veterans Affairs (VA) Home Improvements and Structural Alterations (HISA) grant helps pay for medically needed changes to a veteran's primary home, owned or rented. Federal rules (38 CFR 17.3105) set lifetime amounts of $6,800 for a service-connected disability (or any disability, with a service-connected rating of 50% or more) and $2,000 for other disabilities. A VA page updated April 24, 2026, says it can help with entrances, permanent ramps, roll-in showers, lowered sinks and counters, and wiring or plumbing for medical equipment. It does not cover removable equipment such as portable ramps, porch lifts or stair glides, or routine repairs. Ask your VA clinician for a referral.

Local help: the Area Agency on Aging

For Fresno and Madera counties, the California Department of Aging lists the Fresno-Madera Area Agency on Aging, 2520 W. Shaw Lane, Suite 101A, Fresno, (559) 214-0299, which is also the local Multipurpose Senior Services Program (MSSP) site, and Central California Legal Services, (559) 570-1200. Elsewhere in California, call 1-800-510-2020 to reach your local agency, or use the department's "Find Services in My County" page; outside California, call the Eldercare Locator at 1-800-677-1116.

Ask the agency about nonprofit, volunteer, city or county home repair programs; many have income or age rules and waitlists, so ask early.

Taxes: when home changes count as a medical expense

IRS Publication 502 (for 2025 returns) lets you count medically needed home changes as medical expenses if you itemize, but only total medical costs above 7.5% of your adjusted gross income (AGI) are deductible.

• Changes that do not raise the home's value can count in full, at a reasonable cost. The IRS lists ramps, wider doorways, railings and grab bars, lowered cabinets, moved outlets, porch lifts and other lifts, modified stairways and modified smoke detectors.
• If a change raises the home's value, as a home elevator generally does, only the cost above that increase counts.

Renters: your right to make changes

Under the federal Fair Housing Act and California's Fair Employment and Housing Act, a landlord must allow a tenant with a disability to make reasonable changes, such as grab bars, a ramp or wider doorways, needed to use the home.

• Who pays: usually the tenant; in some subsidized or public housing, the landlord.
• What the landlord may ask: a description of the work, permits, proper workmanship, and reliable proof of the need if it is not obvious, but not your diagnosis.
• Moving out: you may have to restore the inside of the unit if that is reasonable. The landlord cannot charge a higher security deposit because you asked.

Ask in writing to keep a record. If refused, contact the California Civil Rights Department at 800-884-1684 or the U.S. Department of Housing and Urban Development (HUD); HUD complaints must be filed within one year.

Who might pay: a summary

Before you pay for anything

• Get a prescription or written order for medical equipment.
• Ask the supplier whether it is enrolled in Medicare and accepts assignment.
• Ask your plan, in writing, whether the item is covered, and get approval before work starts.
• If you rent, ask the landlord in writing.
• Keep receipts for a possible medical deduction.

For talking these choices through with relatives, see Talking with family about caregiving. If someone relies on powered medical equipment, see Medical Baseline: lower utility rates if someone at home relies on medical equipment.

Sources

1. Check for Safety: A Home Fall Prevention Checklist for Older Adults — Centers for Disease Control and Prevention, STEADI, 2017; catalog record, accessed October 26, 2026.
2. STEADI patient resources: At a glance — Centers for Disease Control and Prevention, last reviewed September 8, 2026.
3. Fire Safe Seniors: Smoke Alarms — U.S. Fire Administration, FEMA, accessed October 26, 2026.
4. About Carbon Monoxide Poisoning — Centers for Disease Control and Prevention, last reviewed January 12, 2026.
5. Occupational therapy services — Medicare.gov, Centers for Medicare & Medicaid Services, accessed October 26, 2026.
6. Walkers — Medicare.gov, Centers for Medicare & Medicaid Services, accessed October 26, 2026.
7. National Coverage Determination 280.1: Durable Medical Equipment Reference List — Centers for Medicare & Medicaid Services, version 4, effective June 9, 2025.
8. Reinterpretation of "Primarily Health Related" for Supplemental Benefits — Centers for Medicare & Medicaid Services, Center for Medicare, memo of April 27, 2018 (HHS guidance portal copy).
9. Community Supports Policy Guide, Volume 1 — California Department of Health Care Services, updated April 2025, accessed October 26, 2026.
10. Home and Community-Based Alternatives Waiver — California Department of Health Care Services, Vietnamese-language version of the program page, accessed October 26, 2026.
11. HCBA Monthly Dashboard, June 2026 — California Department of Health Care Services.
12. Assisted Living Waiver — California Department of Health Care Services, accessed October 26, 2026.
13. ALW Enrollment and Waitlist — California Department of Health Care Services, enrollment through March 2026.
14. In-Home Supportive Services (IHSS) Program — California Department of Social Services, accessed October 26, 2026.
15. Home Improvements/Structural Alterations (HISA) — U.S. Department of Veterans Affairs, last updated April 24, 2026.
16. Find Services in My County: Fresno — California Department of Aging, accessed October 26, 2026.
17. Publication 502 (2025), Medical and Dental Expenses — Internal Revenue Service, released February 5, 2026.
18. Joint Statement: Reasonable Modifications Under the Fair Housing Act — U.S. Department of Housing and Urban Development and U.S. Department of Justice, March 5, 2008.
19. Housing and Reasonable Modifications for People with Disabilities — California Civil Rights Department, March 2025.
20. 38 CFR 17.3105, HISA benefit lifetime limits — Electronic Code of Federal Regulations, text as of October 1, 2026, accessed October 26, 2026.
21. Contact Us: California Aging and Adult Information Line — California Department of Aging, accessed October 26, 2026.
22. Smoke alarms and alert devices for people who are deaf or hard of hearing — U.S. Fire Administration, FEMA, accessed October 26, 2026.
23. Medicare & You 2027 — Centers for Medicare & Medicaid Services, official handbook (lists California HICAP, 1-800-434-0222), accessed October 26, 2026.