Home Care Agency Blueprint
How is starting a home health agency different from non-medical home care?
Non-medical home care and Medicare-certified home health are different businesses. Home health is skilled, ordered care delivered under federal Conditions of Participation when you seek Medicare certification; non-medical home care is personal care and companionship that your state may license or register, without that Medicare home health path. Decide which lane fits your clinical capacity, capital and payer goals before you spend on a license path. This site is a planning aid, not approval odds, not a state table, and not a promise you will be certified.
Written under the direction of founder Scott McKenzie. Updated .
The short answer
Medicare.gov says Medicare covers home health services such as part-time or intermittent skilled nursing and therapy when a doctor or other allowed provider orders them and a Medicare-certified home health agency provides them. It also says Medicare does not pay for custodial or personal care when that is the only care someone needs. That gap is the line between the two businesses: a certified home health agency delivers skilled, ordered care under federal rules, while a non-medical home care agency delivers personal care and companionship under whatever rules your state sets.
| Topic | Non-medical home care | Medicare-certified home health |
|---|---|---|
| Typical services | Personal care, companionship and homemaking. | Skilled nursing, therapy and medical social services, with home health aide care as part of a skilled plan. |
| Who directs care | The client or family arranges the services they want. | A doctor or other allowed provider orders the care under a plan of care. |
| Main payer path | Clients and families, long-term care insurance, and possibly a state Medicaid program. | Medicare, through its home health payment system, plus other payers you choose to work with. |
| Federal rules | No Medicare home health Conditions of Participation, because the agency is not Medicare-certified. | Medicare Conditions of Participation in 42 CFR Part 484, checked by survey. |
| State rules | Your state may license or register it, or may not. Check your state. | Your state may license it; federal rules say licensure applies as required by the state. Check your state. |
Three paths to the answer
What differs clinically
Skilled, ordered care under a plan of care, compared with personal care and companionship.
What differs for Medicare certification
State rules, Medicare enrollment and a survey against the Conditions of Participation, at a planning level.
How to decide which lane
A free decision guide that sorts your plans item by item, with counts and no recommendation.
Use the free decision guide
Home care vs home health decision guide
Twenty-five planning items in six groups, from service lane to capital, each tied to a source, your state or your own planning.
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Open the decision guide →Conditions of Participation map
The topics in 42 CFR Part 484 that a certified home health agency works under, as a map rather than a manual.
FreeSourced
Read the map →Go deeper
Staffing and clinical capacity
The roles the federal rules name, from administrator and clinical manager to home health aides.
Common mixups
Where founders confuse personal care, Medicaid and Medicare home health.
Questions, answered
Nurse owners, running both lanes, hospice, CoPs and OASIS.
How we built this guide
Our sources, method and conflict of interest.
If non-medical home care is your lane, starthomecareagency.com covers how to start one and homecarelicenseguide.com helps you research your state’s non-medical licensing. For Medicaid personal care or waiver enrollment, see becomemedicaidprovider.com. For cash-to-open planning, see homecarestartupcost.com; for private-pay billing, homecarebillingguide.com; for written policies, homecarepolicyprocedures.com; for caregiver training, homecaretrainingprograms.com. All are also published by Home Care Agency Blueprint.
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
What is the first thing to decide?
Which lane you are planning for: non-medical home care, Medicare-certified home health, or both. The decision guide on this site helps you sort that item by item.
Is this site a list of each state’s home health rules?
No. We do not publish state tables. Check your state licensing or survey agency for current rules.
Who publishes this site?
Home Care Agency Blueprint, which sells courses and coaching to people starting home care agencies. We say so on every page so you can weigh our perspective.
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