Two agencies call you back. One says it provides “home health care.” The other says it provides “home care.” Both send someone to the house. Both talk about helping your mother bathe, dress, and stay safe. The hourly rates are not far apart.
Then the first agency bills Medicare and you pay nothing. The second agency asks for your credit card.
The difference between those two phrases is not marketing. It is written into federal law, and it decides who pays. This page explains the distinction the way the rulebook draws it, then shows you how to find out what your own state covers.
The short answer
| Home health care | Home care (personal care) | |
|---|---|---|
| What it is | Skilled medical care — nursing, physical therapy, occupational therapy, speech-language pathology, medical social services | Non-medical help with daily living — bathing, dressing, toileting, meals, light housekeeping, companionship |
| Who provides it | A licensed nurse or therapist, working for an agency that meets Medicare’s participation requirements | A trained aide or attendant, usually working for a state-licensed agency, a registry, or hired directly |
| Ordered by | A physician or other allowed practitioner, as part of a written plan of care | A care plan, family decision, or — under Medicaid — a physician’s treatment plan or a state-approved service plan |
| Does Medicare pay? | Yes, if you meet the conditions. You pay nothing for covered services | No — not when this is the only care you need |
| Does Medicaid pay? | Yes. Home health is a mandatory Medicaid benefit every state must cover | Only if your state chose to. Personal care is an optional Medicaid benefit |
That last row is the one nobody puts on a brochure, and it is the single most important line on this page. Keep reading and we will show you the citation.
Why the wording matters more than it looks
“Home health” and “home care” sound like two ways of saying the same thing. In federal Medicaid law they are two different benefit categories, authorized under two different sections of the Social Security Act, with two different levels of obligation on your state.
Medicaid.gov publishes a list of mandatory and optional state plan benefits. States are required to provide all mandatory benefits under federal law. States may provide optional benefits if they choose to add them through the state plan process.
On the mandatory list: Home health services (1905(a)(7), 42 CFR 440.70 and 42 CFR 441.15).
On the optional list: Personal care (1905(a)(24), 42 CFR 440.167).
So when a home care agency tells you “Medicaid might cover this, it depends on your state,” they are being accurate — and they are describing a legal fact about their own service line, not a paperwork hurdle. When a home health agency tells you the same thing, they are being vague, because their service is one your state is required to cover.
This is also the reason the two phrases get blurred in marketing copy. Many of the largest companies in this space run both a home health division and a personal care division. Whichever one you end up buying, the revenue lands in the same place. They have no particular reason to draw a sharp line for you. The government does.
What Medicare pays for — and the exact conditions
Medicare covers home health under Part A and Part B. Per Medicare.gov, covered home health services include:
- Medically necessary part-time or intermittent skilled nursing care — wound care for pressure sores or a surgical wound, patient and caregiver education, intravenous or nutrition therapy, injections, and monitoring serious illness and unstable health status
- Physical therapy, occupational therapy, and speech-language pathology services (if you meet certain conditions)
- Medical social services
- Part-time or intermittent home health aide care — help with walking, bathing or grooming, changing bed linens, feeding
- Injectable osteoporosis drugs for women who meet certain criteria
- Durable medical equipment
- Medical supplies for use at home
Note the fourth bullet carefully. Aide care — the hands-on help that most families are actually looking for — is only covered if you’re also getting skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time. The aide rides along with the skilled care. When the skilled need ends, the aide ends with it.
The eligibility gate
To qualify, you must need part-time or intermittent skilled services and you must be “homebound,” which Medicare defines as meeting both of these conditions:
- Leaving your home isn’t recommended because of your condition, or you have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.
- You’re normally unable to leave your home and leaving takes a lot of effort.
Two clarifications that families get wrong in both directions. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services — homebound does not mean housebound. And you can still get home health care if you attend adult day care.
There is also a ceiling on the other end: you won’t qualify for home health services if you need more than part-time or intermittent skilled care. Too little skilled need and you don’t qualify. Too much and you don’t qualify either. The benefit is built for the middle.
How much, and what it costs
- If you qualify, you can get unlimited home health visits.
- In most cases, “part-time or intermittent” means you may be able to get skilled nursing care and home health aide services up to 8 hours a day (combined), for a maximum of 28 hours a week.
- You may be able to get more frequent care for a short time — less than 8 hours a day and up to 35 hours a week — if your provider decides it’s necessary.
- You pay nothing for covered home health services.
- After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for Medicare-covered medical equipment.
A health care provider must assess you face-to-face before certifying that you need home health services, a provider must order your care, and a Medicare-certified home health agency must provide it. If an agency is not Medicare-certified, the question of Medicare coverage never arises, no matter how good the care is.
What Medicare will not pay for, in its own words
Medicare doesn’t pay for:
- 24-hour-a-day care at your home
- Home meal delivery
- Homemaker services (like shopping and cleaning) unrelated to your care plan
- Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need
If an agency is about to give you something Medicare won’t pay for, it should hand you a notice called an Advance Beneficiary Notice (ABN) before providing the item or service. An ABN arriving in your hands is not a formality. It is the agency telling you, in writing, that this bill is coming to you.
If your Medicare benefits come through a Medicare Advantage plan rather than Original Medicare, the rules above are the federal floor, not the whole picture — plans can and do administer the benefit differently. We cover that separately in does Medicare Advantage cover home health care.
What Medicaid pays for — and three rules that are the opposite of Medicare’s
Most articles on this topic describe Medicaid as “like Medicare, but for low-income people.” For home health specifically, that is wrong in three concrete ways, and each one works in the family’s favor.
1. Medicaid home health has no homebound requirement
42 CFR 440.70(c)(1) states it plainly: “Home health services cannot be limited to services furnished to beneficiaries who are homebound.”
The same regulation adds that nothing in the section prohibits a beneficiary from receiving home health services in any setting in which normal life activities take place, other than a hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities, or any setting where Medicaid could pay for inpatient services that include room and board.
If someone has told you your mother can’t get Medicaid home health because she still gets out to church and the grocery store, that is Medicare’s rule being misapplied to Medicaid.
2. Medicaid home health is not contingent on needing a nurse
42 CFR 440.70(b) lists nursing service, home health aide service, and medical supplies/equipment/appliances as required components, therapy as optional, and then says: “Coverage of home health services cannot be contingent upon the beneficiary needing nursing or therapy services.”
This is the exact inverse of the Medicare aide rule. Under Medicare, the aide only comes if skilled care is already in the house. Under Medicaid, the state may not condition the benefit on a nursing or therapy need.
3. Medicaid equipment coverage is broader than Medicare’s DME list
This is the provision that matters most to anyone trying to make a house work for someone who is aging in place. Under 42 CFR 440.70(b)(3), covered items are “medical supplies, equipment, and appliances suitable for use in any setting in which normal life activities take place” — and the regulation goes on to say:
“State Medicaid coverage of equipment and appliances is not restricted to the items covered as durable medical equipment in the Medicare program.”
And, at (b)(3)(v):
“States can have a list of preapproved medical equipment supplies and appliances for administrative ease but States are prohibited from having absolute exclusions of coverage on medical equipment, supplies, or appliances. States must have processes and criteria for requesting medical equipment that is made available to individuals to request items not on the State’s list… When denying a request, a State must inform the beneficiary of the right to a fair hearing.”
Three things follow from that paragraph. Your state cannot flatly rule out an entire category of equipment. Your state must have a route for requesting something that isn’t on its preapproved list. And a denial comes with fair hearing rights.
This is why “Medicare doesn’t cover it” and “nobody covers it” are different sentences — a distinction we walk through in detail for two specific items, in does Medicare cover stair lifts and does Medicare cover walk-in tubs.
A beneficiary’s need for medical supplies, equipment, and appliances must be reviewed by a physician or other licensed practitioner annually, and for equipment the required face-to-face encounter must occur no more than 6 months prior to the start of services. For home health services generally, the face-to-face encounter must be related to the primary reason the beneficiary requires the services and must occur within the 90 days before or within the 30 days after the start of services.
One thing Medicaid and Medicare do share: 42 CFR 440.70(d) defines a “home health agency” as one that meets requirements for participation in Medicare. The certification standard is the same on both sides.
Personal care under Medicaid: the optional benefit
If what your family needs is help with bathing, dressing, toileting, and meals — with no skilled nursing component at all — you are asking about personal care services, and whether they are covered depends on choices your state made.
42 CFR 440.167 defines personal care services as services furnished to someone who is not an inpatient or resident of a hospital, nursing facility, ICF/IID, or institution for mental disease, that are:
- Authorized for the individual by a physician in accordance with a plan of treatment or (at the option of the State) otherwise authorized in accordance with a service plan approved by the State;
- Provided by an individual who is qualified to provide such services and who is not a member of the individual’s family; and
- Furnished in a home, and at the State’s option, in another location.
That second condition is widely misread. The regulation defines “family member” narrowly — “family member means a legally responsible relative.” And the whole section opens with a carve-out: “Unless defined differently by a State agency for purposes of a waiver granted under part 441, subpart G.” In other words, whether an adult child can be paid to care for a parent is a state-by-state and program-by-program question, not a flat federal no.
Beyond the state plan personal care benefit, the optional benefits list also includes three other routes states can use to cover in-home support: state plan home and community based services (1915(i)), self-directed personal assistance services (1915(j)), and the Community First Choice Option (1915(k)).
HCBS waivers: where the two paths converge — and where the modification money is
The most common way personal care actually reaches an older adult at home is a 1915(c) home and community-based services waiver. Nearly all states and DC offer services through HCBS waivers, and about 257 HCBS waiver programs are active nationwide.
Per Medicaid.gov, standard waiver services “include but are not limited to: case management (i.e. supports and service coordination), homemaker, home health aide, personal care, adult day health services, habilitation (both day and residential), and respite care.” States can also propose “other” types of services that help divert or transition people from institutional settings into their homes and community.
Three features of waivers shape what families experience:
- A level-of-care test. Eligible individuals must demonstrate the need for a level of care that would meet the state’s eligibility requirements for services in an institutional setting. You have to be sick enough to qualify for a nursing home in order to get the help that keeps you out of one.
- Cost neutrality. State waiver programs must demonstrate that providing waiver services won’t cost more than providing those services in an institution.
- Capped slots. States choose the maximum number of people that will be served under an HCBS waiver program. This is why waiting lists exist, and why the wait varies enormously between states.
Waivers are also, in most states, where the money for physical changes to the house lives — grab bars, ramps, roll-in showers, widened doorways, stair lifts. The same waiver that authorizes an aide to come three mornings a week is often the one that will pay to make the bathroom safe. We maintain a state-by-state table of what each program will pay toward those changes: Medicaid home modification limits by state, with the underlying rules explained in does Medicaid pay for home modifications.
How to tell which one you are being sold
Before you sign anything, four questions settle it:
- “Is your agency Medicare-certified?” If the answer is no, Medicare will not pay, full stop. If the answer is yes, ask whether the service they are quoting you is the certified service or a private-pay service the same company also sells.
- “Is there a physician’s order and a written plan of care?” Skilled home health runs on an order and a plan reviewed on a schedule — every 60 days under the Medicaid regulation. Private-duty personal care typically does not.
- “Am I receiving skilled nursing or therapy right now?” If yes, a home health aide may be covered alongside it under Medicare. If no, aide time is personal care, and Medicare is out.
- “Which Medicaid program is this billed under?” State plan personal care, a 1915(c) waiver, Community First Choice, and private pay have different rules, different waiting lists, and different limits. “Medicaid pays for it” is not an answer.
Which one does your family actually need?
| If the situation is… | You’re probably looking at… |
|---|---|
| Discharged from hospital with a wound, new catheter, IV therapy, or a rehab plan | Home health — order it through the discharging provider before you leave |
| Recovering from a stroke, fall, or joint replacement and needs PT/OT | Home health |
| Steady chronic condition, no new medical need, but can’t safely bathe or dress alone | Personal care — check your state’s Medicaid options |
| Safe physically, but can’t be left alone because of memory loss | Neither, exactly — see home care vs. memory care |
| Needs someone in the house around the clock | Not a Medicare benefit; Medicare doesn’t pay for 24-hour-a-day care at home |
| Doing fine with help, but the house itself is the hazard | A home modification, not a service — start with aging in place home modifications |
The honest summary
Home health care is a medical service, ordered by a clinician, delivered by a licensed professional, and paid for by Medicare when you’re homebound and need part-time or intermittent skilled care. Home care is help with living, paid for out of pocket unless your state’s Medicaid program has chosen to cover it — and every state has made that choice differently.
Most families discover this distinction at the worst possible moment: at a hospital discharge desk, or three weeks into a bill they didn’t expect. Knowing which word you are using, and which program it maps to, is worth more than any comparison of hourly rates.
What to do next in your state
The federal rules above are the same everywhere. What varies — and varies a lot — is what your state chose to cover, what its waiver waiting list looks like, and how much it will put toward making the house workable.
We maintain a state-by-state comparison of published home modification funding limits, the agency that administers each program, and the source document behind each figure. Tell us your state below and we’ll send you that state’s current published limits, the agency to apply to, the source documents, and a note if we find the rules have changed. We are not an agency, we don’t sell care, and we don’t pass your information to anyone.
You can also start from the overview: home modification grants.
Sources
All figures and quoted rules on this page come from primary federal sources:
- Medicare.gov — Home health services coverage
- Medicaid.gov — Mandatory & Optional Medicaid Benefits
- Medicaid.gov — Home & Community-Based Services 1915(c)
- eCFR — 42 CFR 440.70, Home health services
- eCFR — 42 CFR 440.167, Personal care services
Rules verified against the sources above on August 22, 2026. Title 42 of the eCFR was last amended August 13, 2026. This page explains federal rules and is not legal or medical advice; your state’s program terms control.