Home care vs home health: common mixups
By Scott McKenzie, founder of Home Care Agency Blueprint · Updated
Most mixups come from treating non-medical home care and Medicare home health as one business with two names. Here are ones worth checking for, each with its source, a pointer to your state, or marked as our own planning.
Mixups to check for
Calling personal care “home health”
Personal care and companionship are not Medicare home health. Using the label loosely can confuse clients and referral partners about what you provide.
Assuming Medicare will cover custodial-only care
Medicare.gov says Medicare does not pay for custodial or personal care when that is the only care needed.
Skipping state rules because Medicare is federal
Federal rules say a home health agency must be licensed, certified or registered as applicable under the state licensing authority. Check your state.
Source: Check your state; eCFR, 42 CFR Part 484
Copying non-medical policies for a certified agency
A certified home health agency works under the federal Conditions of Participation. Non-medical templates were not written for them.
Source: eCFR, 42 CFR Part 484
Underestimating the survey and documentation work
Certification involves a survey against the Conditions of Participation, and the conditions cover assessments, care plans, clinical records and a quality program.
Source: CMS, Home health agency certification; eCFR, 42 CFR Part 484
Confusing Medicaid personal care with Medicare home health
A state Medicaid personal care or waiver program is a separate state path. Check the program’s rules; becomemedicaidprovider.com, also published by Home Care Agency Blueprint, covers enrollment.
Check your state Medicaid or waiver program
Treating aides and caregivers as interchangeable
Home health aides at a certified agency must meet federal training and competency rules. Non-medical caregivers are trained to your state’s rules.
Source: eCFR, 42 CFR Part 484; Check your state
Planning without a clinical manager
The Conditions of Participation call for a clinical manager from a list of licensed professions to oversee patient care and personnel.
Source: eCFR, 42 CFR Part 484
Relying on an old article about your state
States can change how they license home health agencies. Check your current state rules and the current federal process before you plan around them.
Check your state
Treating hospice as the same as home health
CMS lists hospices and home health agencies as separate provider types with their own certification pages. Research hospice separately.
A planning aid, not a promise. Nothing on this site can tell you which agency to open, whether you would be licensed, or whether you would be certified. It maps the differences and points you to Medicare.gov, CMS and your state so you can check them for your own plans.
Your state sets its own rules. Whether and how your state licenses non-medical home care, home health agencies or both is a state question, and the rules can change. This site does not list state rules. Check your state licensing or survey agency; homecarelicenseguide.com, also published by Home Care Agency Blueprint, helps you research non-medical licensing. Not legal, licensing, Medicare or financial advice.
What to do next
Frequently asked questions
What is the most common mixup?
We do not have data on that, so we will not guess. The ones listed here are worth checking because each can be cleared up with the right source.
Want to talk through your options?
A free 15-minute clarity call with Home Care Agency Blueprint. It helps people start home care agencies, so expect that perspective. You do not need to have chosen a lane first.
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