Home care vs home health decision guide
By Scott McKenzie, founder of Home Care Agency Blueprint · Updated
Work through twenty-five planning items in six groups, from the services you want to offer to capital and operations. Each item names its source, tells you to check your state, or is marked as your own planning. It shows counts only; it does not tell you which agency to open, or judge whether you would be certified.
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Mark each item Fits home care, Fits home health, Need both researched, Does not apply or Not sure yet. Blank items stay Not checked. Rows marked Check your state depend on your state’s rules.
A. Service lane
1. The services you plan to offer: personal care, companionship and homemaking, or skilled nursing and therapy. Medicare.gov lists skilled nursing, therapy services and medical social services among the home health services Medicare covers.
Source: Medicare.gov, Home health services
2. Whether hands-on help such as bathing or grooming would sit inside a skilled plan of care. Medicare.gov says Medicare covers home health aide care only when the person is also getting skilled nursing or therapy at the same time.
Source: Medicare.gov, Home health services
3. Whether your services would be custodial or personal care on its own. Medicare.gov says Medicare does not pay for custodial or personal care that helps with daily living activities when that is the only care needed.
Source: Medicare.gov, Home health services
4. Clinical tasks you hope to offer, such as wound care or injections, and whether your state allows any of them under a non-medical home care license. Check your state.
Source: Check your state; Medicare.gov, Home health services
B. Who orders and oversees care
5. Who directs the care. For Medicare home health, Medicare.gov says a doctor or other allowed health care provider must see the person, confirm the need and order the care.
Source: Medicare.gov, Home health services
6. Whether you can deliver care under an individualized plan of care that follows physician or allowed practitioner orders, as the federal Conditions of Participation describe.
Source: eCFR, 42 CFR Part 484
7. Who would oversee patient care and personnel. The Conditions of Participation call for a clinical manager, a role limited to listed licensed professionals such as a registered nurse.
Source: eCFR, 42 CFR Part 484
8. Whether your planned clients or their families would arrange and direct the care themselves, without practitioner orders.
Your own planning
C. Payer path
9. Whether you plan to be paid mainly by clients and families, or by long-term care insurance they hold.
Your own planning
10. Whether you plan to serve state Medicaid personal care or waiver clients. That is a state program path, not Medicare home health; becomemedicaidprovider.com, also published by Home Care Agency Blueprint, covers enrollment.
Check your state Medicaid or waiver program
11. Whether you plan to bill Medicare for home health. CMS pays certified home health agencies under a separate home health prospective payment system.
Source: CMS, Home Health PPS
12. Whether you would work with Medicare Advantage or other health plans. Medicare.gov tells people in those plans to check with their plan about home health benefits.
Source: Medicare.gov, Home health services
D. Regulatory path
These rows are prompts, not a state list. Your state may license non-medical home care, home health agencies, both or neither, and its rules can change; confirm each with your state. homecarelicenseguide.com, also published by Home Care Agency Blueprint, helps you research non-medical licensing.
13. Your state’s rules for non-medical home care or personal care: a license, a registration, or neither. Check your state; homecarelicenseguide.com, also published by Home Care Agency Blueprint, helps you find its licensing agency.
Check your state
14. Your state’s rules for home health agencies. Federal rules say an agency must be licensed, certified or registered, as applicable, under the state licensing authority. Check your current state rules; do not assume another state works the same way.
Source: Check your state; eCFR, 42 CFR Part 484
15. Whether you want Medicare certification. CMS describes certification of home health agencies and a survey that checks compliance with the Conditions of Participation.
Source: CMS, Home health agency certification
16. Medicare provider enrollment, which CMS lists among its home health agency resources. Confirm the current steps with CMS before you plan around them.
Source: CMS, Home Health Agency Information Center
17. Whether you would run both lanes, and whether that would mean separate entities, licenses, policies or staff. Ask counsel and check your state.
Check your state; Your own planning
E. Staffing and clinical capacity
18. Who would serve as administrator. The Conditions of Participation set qualifications for the administrator and expect the administrator or a pre-designated person to be available during operating hours.
Source: eCFR, 42 CFR Part 484
19. Access to skilled professionals, such as registered nurses and therapists, who meet the federal personnel qualifications and practice under your policies.
Source: eCFR, 42 CFR Part 484
20. Home health aides who have completed the training and competency evaluation the Conditions of Participation describe, with supervision and in-service training.
Source: eCFR, 42 CFR Part 484
21. Caregivers for non-medical home care, trained to what your state requires. homecaretrainingprograms.com, also published by Home Care Agency Blueprint, covers a caregiver training matrix.
Check your state
F. Capital and operations
22. Your plan for being surveyed against the Conditions of Participation. CMS says surveys determine whether a citation of non-compliance is appropriate.
Source: CMS, Home health agency certification
23. OASIS assessment data and the home health quality reporting program, which certified home health agencies take part in. Confirm current requirements in CMS materials.
Source: CMS, OASIS data sets; CMS, Home Health Quality Reporting Program
24. A quality assessment and performance improvement program, emergency preparedness, infection control and clinical records, which are among the Conditions of Participation.
Source: eCFR, 42 CFR Part 484
25. A cash runway and capital plan for each lane, built from your own quotes. This site publishes no cost figures; homecarestartupcost.com, also published by Home Care Agency Blueprint, covers cash-to-open planning.
Your own planning
Planning aid only. Not legal, licensing or Medicare advice. Counts, not a recommendation; check your state and CMS.
How to use the decision guide
Mark an item Fits home care or Fits home health when your plan for that item clearly points to one lane. Use Need both researched when it could go either way, and Not sure yet when you have not looked into it. Items you leave blank are shown as Not checked. Mark an item Does not apply only when it truly does not affect your plans.
- Mark each item Fits home care, Fits home health, Need both researched, Does not apply or Not sure yet.
- For every row marked Check your state, confirm the current rules with your state licensing or survey agency.
- Use the source line under each item to read what Medicare.gov, CMS or the eCFR says, and ask counsel about anything that affects your legal structure.
- Research the items marked Need both researched or Not sure yet before you spend on either license path.
- Print the guide or download a CSV, and work through it again when your plans change.
What the decision guide does not do
It does not add up to a recommendation, a readiness level, or a view on whether you would be licensed or certified. It does not list your state’s rules or any costs. The counts only show how your own answers are spread across the two lanes, and which items you still need to research.
Where your entries are stored
Your entries are saved only in this browser on this device so you can come back to them. They are never sent to us. Printing and CSV download happen on your device, CSV cells are protected against spreadsheet formulas, and Reset erases only this guide’s saved entries.
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.
Frequently asked questions
Why does the guide not tell me which lane to choose?
Choosing depends on your clinical team, capital, state rules and goals, and we cannot judge those for you. The guide shows counts and lists what you still need to research instead.
Why are there no costs in the guide?
We do not publish cost figures. Build your own from real quotes; homecarestartupcost.com, also published by Home Care Agency Blueprint, covers cash-to-open planning.
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.
Book a free 15-minute clarity call