Home Care vs Home Health Care in Michigan: What Medicaid Covers

Home care vs home health care comes down to one word: medical. Home care is non-medical help with bathing, dressing, meals and housework, and in Michigan it is paid for by Medicaid through Home Help. Home health care is skilled nursing or therapy ordered by a doctor, usually paid by Medicare for a short period after illness or surgery.

On this page

1. What is the difference between home care and home health care?
2. Home care vs home health care: side-by-side comparison
3. Who provides each type of care in Michigan?
4. What do Medicaid and Medicare cover for home care and home health care?
5. How much do home care and home health care cost in Michigan?
6. Which one does your loved one need?
7. Frequently asked questions

What is the difference between home care and home health care?

The two terms sound alike and are often mixed up, even by hospitals. The difference matters because it decides who provides the care, who pays, and how long it lasts.

Home care

Home care, also called personal care, custodial care or non-medical home care, means help with everyday living. A caregiver assists with activities of daily living such as bathing, dressing, toileting, eating and moving around, plus household tasks like cooking, laundry, shopping and light cleaning. No doctor’s order is needed, and the care can continue for years.

Home health care

Home health care is medical treatment delivered at home under a physician’s plan of care. It includes skilled nursing for wounds, injections and medication management, physical and occupational therapy, and speech therapy. It is provided by a licensed, Medicare-certified home health agency and is meant to be short-term, ending when the patient recovers or stops improving.

Home care vs home health care: side-by-side comparison

Feature	Home care	Home health care
Type of help	Personal care and household tasks	Skilled nursing and therapy
Who provides it	Personal care aide, home health aide, or a paid family caregiver	Registered nurse, licensed practical nurse, physical, occupational or speech therapist
Doctor’s order required	No, but Home Help needs a Medical Needs form	Yes, with a plan of care
How long it lasts	Ongoing, as long as the need exists	Short-term, usually weeks
Michigan Medicaid pays	Yes, through Home Help and MI Choice	Yes, when medically necessary
Medicare pays	No, except briefly alongside skilled care	Yes, if homebound and intermittent
Family member can be paid	Yes, through Home Help	No
Typical private cost	About $28 to $35 per hour	About $150 to $250 per skilled visit

Who provides each type of care in Michigan?

Home care in Michigan comes from three sources. Home care agencies like Supportive Solutions Homecare employ personal care assistants and home health aides who are trained in safe transfers, bathing and dementia care. Independent caregivers, often relatives, can enroll with MDHHS as individual Home Help providers. Private-pay caregivers are hired directly by the family.

Home health care comes only from agencies certified by Medicare and licensed by the State of Michigan. A nurse or therapist visits on a schedule set by the doctor, typically one to three times a week, and the agency bills Medicare or Medicaid per visit.

A home health aide can work in either setting. Inside a home health agency, the aide’s visits are limited to the period of skilled care. Inside a home care agency, the same aide can provide daily help indefinitely.

What do Medicaid and Medicare cover for home care and home health care?

Michigan Medicaid

Medicaid is the main payer for long-term home care in Michigan. The Home Help program, run by the Michigan Department of Health and Human Services, pays a caregiver for a set number of hours each month based on an in-home assessment. The MI Choice Waiver adds services such as respite and adult day care for people who need a nursing-facility level of care. Medicaid also covers skilled home health visits when a doctor orders them.

Medicare

Medicare Part A and Part B cover home health care if the patient is homebound, needs intermittent skilled care, and is under a doctor’s plan of care. The benefit can include a home health aide for personal care, but only while skilled care is active. Medicare does not pay for ongoing custodial home care, and it never pays a family member. Our post on whether Medicaid pays for in-home caregivers goes deeper on the difference.

Other payers

• Long-term care insurance usually covers home care once the policy’s benefit trigger is met.
• Veterans benefits can pay for home care through VA programs.
• Private pay covers anything not funded elsewhere.

How much do home care and home health care cost in Michigan?

For families paying out of pocket, home care agencies in Michigan generally charge about $28 to $35 per hour, with rates a bit higher in the Detroit, Ann Arbor and Grand Rapids markets than in Flint or Lansing. A private skilled nursing visit typically runs roughly $150 to $250, and therapy visits are priced similarly.

The bigger cost question is duration. Home health care ends after a few weeks. Home care can be needed every day for years, which is why Medicaid Home Help matters so much. For a family that qualifies, Medicaid pays for the approved hours, and a relative can be the one earning the hourly pay. Start with our Medicaid eligibility check to see if that door is open.

Which one does your loved one need?

Ask three questions.

1. Is there a medical task a nurse must do? Wound care, IV therapy, injections, or rehab after a stroke or joint replacement point to home health care. Ask the hospital discharge planner for a referral.
2. Is the need about daily living? Help getting bathed, dressed, fed and safely moved around the house is home care. Request a Home Help assessment through the county MDHHS office.
3. Is it both? This is common after a hospital stay. Medicare home health handles the therapy while Medicaid Home Help or an agency aide handles daily care. Our post-surgery care page explains how we coordinate the two.

Supportive Solutions Homecare provides home care, not skilled home health care, in Detroit, Dearborn, Warren, Sterling Heights, Ann Arbor, Flint, Lansing and Grand Rapids. If your loved one needs nursing, we will say so and help you find it. If a family member wants to provide the daily care and get paid, our get paid to care program handles the enrollment.

Frequently asked questions

What is the difference between a home care agency and a home health agency?

A home care agency provides non-medical help with bathing, dressing, meals, housework and companionship, delivered by aides and paid mainly by Medicaid Home Help, long-term care insurance or private funds. A home health agency is Medicare-certified and sends nurses and therapists for doctor-ordered skilled care. Home health is short-term and medical; home care is ongoing and personal.

Does Medicare pay for home care in Michigan?

Not on its own. Medicare covers home health care, meaning skilled nursing or therapy, for a homebound patient under a doctor’s plan of care. It can add part-time aide help only while skilled care is active. Once skilled care ends, Medicare stops paying for personal care. Long-term daily help must come from Medicaid, insurance or private pay.

Does Medicaid pay for home health care?

Yes. Michigan Medicaid covers skilled home health visits when a physician certifies they are medically necessary, and it covers ongoing personal care through the Home Help program. Someone with both Medicare and Medicaid usually has Medicare billed first for skilled visits, with Medicaid picking up personal care hours and any remaining costs.

Can a family member be paid for home care but not home health care?

Correct. Under Michigan’s Home Help program, a relative, friend or neighbor can enroll as an individual provider and be paid for personal care and household tasks. Skilled home health care must be delivered by licensed nurses and therapists working for a certified agency, so family members cannot bill for it, even if they are nurses themselves.

Which type of care do I need after surgery?

Usually both. Medicare home health typically covers a nurse or therapist for wound checks and rehab for a few weeks after discharge. Help with bathing, meals and getting around the house is home care, which Medicaid Home Help can cover if your loved one qualifies, or which an agency can provide privately during recovery.