In Alabama, home health is skilled care Medicare can cover, while non-medical home care is everyday help Medicare does not pay for when that is the only care a person needs. Home health, the doctor-ordered nursing and therapy a certified agency delivers, falls under the Alabama Department of Public Health's Bureau of Health Provider Standards, whose Division of Health Care Facilities certifies agencies for Medicare and Medicaid participation. Alabama home health agencies are not required to be licensed by the Alabama State Board of Health, but they may apply for that certification.

This guide draws that line so a family doesn't pay out of pocket for care a program would have covered, or hire an agency it never checked. The label on the door isn't the thing that matters. What matters is whether the care is skilled or non-medical, who oversees it, and which program pays.

In This Guide

Home Care vs. Home Health in Alabama: The Core Difference

The split is skilled versus non-medical, and in Alabama that line also decides who oversees the provider and which program pays. Home health is skilled, intermittent care: nursing and physical, occupational, or speech therapy a physician orders because the person has a medical need only a licensed professional can meet. Wound care after surgery, IV medication, injections a patient can't give alone, therapy to rebuild strength after a stroke or a fall. The care is part-time and intermittent, not around the clock.

Non-medical home care is everyday support: help with bathing, dressing, meals, and housekeeping, plus the daily tasks that keep someone safe at home. The person can be medically stable and still need this help every day.

Alabama treats the two tracks differently in one specific way. Home health falls under the Alabama Department of Public Health's Bureau of Health Provider Standards, the state's regulatory agency for licensing and certifying health care facilities, and its Division of Health Care Facilities certifies agencies for Medicare and Medicaid participation. Alabama home health agencies are not required to be licensed by the Alabama State Board of Health, but they may apply for certification in the Medicare and Medicaid programs. What Alabama asks of a purely non-medical home care agency is a question no source we cite answers, so this guide leaves it open rather than guessing, and the burden of vetting sits with the family either way.

The split also tracks the money. Medicare can pay for the skilled, certified home health track. It does not pay for non-medical personal care at all. So when an Alabama family hears "home health agency," that's shorthand for the skilled, state-overseen, often Medicare-certified track, and "home care" or "personal care" points to the non-medical one. The same person often needs both at once: someone home after a hip replacement might need a nurse and a physical therapist for a few weeks and an aide for bathing and meals for months. They come from different sources and run on separate payment tracks.

Home Health: ADPH Oversight and What Medicare Covers

Skilled home health in Alabama comes from an agency that falls under the Alabama Department of Public Health's Bureau of Health Provider Standards, the state's regulatory agency responsible for licensing and certifying health care facilities. Certification is voluntary rather than a precondition of operating: Alabama home health agencies are not required to be licensed by the Alabama State Board of Health, but they may apply for certification in the Medicare and Medicaid programs, and the bureau's Division of Health Care Facilities is what certifies them for participation. That certification is the step that lets an agency serve Medicare and Medicaid patients and bill those programs for the skilled care it delivers, so a family counting on Medicare to pay should ask whether the agency is Medicare certified. The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered.

Medicare's home health benefit covers this care when a beneficiary meets the conditions., Two of those conditions most often determine eligibility:

  • Homebound. Leaving home takes considerable, taxing effort, and the person generally needs help or a device to do it. Short trips out, to a medical appointment or to church, don't disqualify someone.
  • Intermittent skilled need. A physician certifies that the person needs skilled nursing or therapy on a part-time or intermittent basis, under a plan of care the physician reviews, delivered by a Medicare-certified agency.

When those conditions are met, Medicare pays for the covered skilled services: the nursing visits, the therapy, and the home health aide help attached to that skilled care. What Medicare home health will not do is staff an aide in the home for general daily help with no skilled-care purpose. That's home care, and it's the next section.

Home Care: Non-Medical Help and Who Pays

Non-medical home care in Alabama is help with bathing, dressing, meals, housekeeping, and the everyday support that keeps someone at home. Because it isn't skilled medical care, the payer picture looks nothing like home health.

One thing this guide cannot tell you is what state credential, if any, Alabama requires of an agency that provides only non-medical help. No source we cite answers that, and we would rather leave the question open than fill it with a plausible guess about someone's care. Ask each agency directly what it holds, and confirm the answer with the Alabama Department of Public Health before you rely on it. On the home health side, by contrast, Medicare or Medicaid certification is a check a family can ask about and verify, since the state's Division of Health Care Facilities grants it. Either way the vetting falls to the family. Reasonable checks: ask for references, ask how aides are screened and trained, and ask whether the agency is an enrolled Medicaid provider, which is its own form of accountability.

Who pays for non-medical home care comes down to a few routes:

  • Private pay. Many families pay out of pocket, by the hour. This is the default when no one qualifies for a public program and the need is non-medical.
  • Medicaid Elderly and Disabled Waiver. For low-income Alabamians, non-medical in-home services are funded through the Medicaid Elderly and Disabled (E&D) Waiver, run by the Alabama Department of Senior Services.
  • Long-term care insurance. A private policy, if the person holds one, may reimburse personal-care hours.

The payment rule here is direct. Medicare does not pay for non-medical personal care. A family expecting Medicare to cover an aide for daily help will find it won't. The ways to pay for home care are private funds, long-term care insurance, or, for eligible low-income Alabamians, the Medicaid E&D Waiver.

Home Care vs. Home Health in Alabama: Which Do You Need?

Start with the need, not the brochure. The table maps the two services across what decides the care and who pays. The first clue is whether a physician has ordered skilled care: that points to a home health agency, while ongoing non-medical help points to home care.

Home Health (Skilled) Non-Medical Home Care
What it is Skilled, physician-ordered care: nursing plus physical, occupational, or speech therapy under a plan of care, part-time or intermittent Everyday non-medical help with bathing, dressing, meals, and housekeeping, and the support that keeps someone safe at home
Who oversees it ADPH's Bureau of Health Provider Standards; agencies aren't required to be licensed by the State Board of Health but may apply for Medicare and Medicaid certification No state requirement that any source we cite establishes, so families vet on references, training, and Medicaid standing
Who pays Medicare (when homebound and needing intermittent skilled care under a physician's plan); Medicaid for certified care Private pay, long-term care insurance, or the Medicaid E&D Waiver for eligible low-income Alabamians; Medicare does not pay

A quick way to place a situation: if a physician has ordered skilled care and the person is homebound, you're looking at home health, and Medicare is the payer to check first. If the need is ongoing help with everyday tasks and there's no skilled medical component, you're looking at non-medical home care, and the question becomes whether to pay privately or qualify through the E&D Waiver. Both can be in play at once, and plenty of Alabama families arrange both.

What It Costs

Home health, when Medicare covers it, costs the beneficiary nothing for the covered skilled services., The cost question really lives on the non-medical side, where families pay out of pocket unless the E&D Waiver covers it.

For non-medical home care in Alabama, a non-medical caregiver ran about $61,776 a year in the CareScout 2025 Cost of Care Survey (released March 2026), on a basis of 44 hours a week. Beginning with the 2025 survey, CareScout merged its former homemaker and home-health-aide categories into this single non-medical caregiver line, so a separate "homemaker" figure no longer applies. That puts Alabama well below the national non-medical caregiver median of about $80,080 a year for in-home help. These are industry survey medians, not government rates and not a maximum, so what a specific Alabama agency charges can land above or below them, and the Birmingham and Huntsville areas tend to run higher than rural parts of the state. A family using fewer hours than the full-week assumption will pay less than the annual figure suggests.

For low-income Alabamians who qualify, that private cost can be covered instead through the Medicaid Elderly and Disabled Waiver.

Your next step Your next step depends on which track you need. If a physician has ordered skilled care, ask the ordering doctor or the discharging hospital for a Medicare-certified home health agency and confirm the homebound and intermittent-skilled conditions on Medicare's home health page. If the need is ongoing non-medical help, contact the Alabama Department of Senior Services to ask about the Medicaid Elderly and Disabled Waiver and to find your local Aging and Disability Resource Center; if you're paying privately, ask each agency for references, its aide screening and training, and whether it is an enrolled Medicaid provider.

Frequently Asked Questions

Does Medicare pay for home care in Alabama?

No. Medicare does not pay for non-medical personal care, the help with bathing, dressing, meals, and everyday support an aide provides. Medicare's home health benefit covers skilled, physician-ordered care (nursing and therapy) for people who are homebound and need it on an intermittent basis. For non-medical home care, the options are private pay, long-term care insurance, or, for eligible low-income Alabamians, the Medicaid Elderly and Disabled Waiver.

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

Home health is skilled medical care a physician orders and a licensed clinician delivers, covered by Medicare when the person is homebound and needs intermittent skilled care. Non-medical home care is everyday help with daily living that Medicare does not cover. In Alabama, home health falls under the Department of Public Health's Bureau of Health Provider Standards, whose Division of Health Care Facilities certifies agencies for Medicare and Medicaid participation; that certification is something an agency applies for, not a license the state requires it to hold.

Is non-medical home care licensed in Alabama?

This guide can't tell you, and we won't guess. The Alabama Department of Public Health source we rely on speaks to skilled home health agencies, and no source we cite establishes what an agency providing only bathing, meals, and housekeeping must hold. Ask any agency you're considering what state credential it has and confirm the answer with ADPH before you rely on it. A family's own vetting matters either way: ask for references, ask how aides are screened and trained, and check whether the agency is an enrolled Medicaid provider. Skilled home health, by contrast, falls under ADPH's Bureau of Health Provider Standards, which certifies agencies for Medicare and Medicaid participation.

What does an Alabama home health agency need to operate?

Less than most families assume. Alabama home health agencies are not required to be licensed by the Alabama State Board of Health, but they may apply for certification in the Medicare and Medicaid programs. Certification is voluntary rather than a precondition of operating, and it is what lets an agency take part in Medicare and Medicaid and bill those programs for the skilled care it delivers. Oversight sits with the Department of Public Health's Bureau of Health Provider Standards, whose Division of Health Care Facilities certifies facilities for Medicare and Medicaid participation.

Can someone get both home health and home care at the same time?

Yes, and many do. A person recovering from surgery might receive Medicare-covered home health (a nurse and a therapist for a set period) while also needing ongoing home care (an aide for bathing and meals). The two run on separate payment tracks, Medicare for the skilled care and private pay or the Medicaid E&D Waiver for the non-medical care, so arranging one does not arrange or pay for the other.

Learn More

Care TypesHome Care vs. Home Health by State: What's the Difference and Who PaysHome care is non-medical help; home health is skilled, doctor-ordered care. See what each costs, who pays (Medicare vs. Medicaid), and your state's guide. Care TypesAssisted Living in AlabamaAssisted living in Alabama runs about $4,425/month, well below the national median. Alabama's two license types (ALF vs SCALF), costs, and who pays. Care TypesNursing Homes in AlabamaNursing homes in Alabama in 2026: a semi-private room runs about $100,010 a year, well below the national median. How to check quality and how Medicaid pays. Care TypesMemory Care in AlabamaMemory care in Alabama means a Specialty Care Assisted Living Facility (SCALF). See what the license requires, what it costs, and how to vet a place. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house. CaregiverCaregiver Burnout: Signs and SupportHow to recognize caregiver burnout, why it happens, and what actually helps, from respite care to evidence-based programs like REACH II and Powerful Tools.

Find personalized help sorting out home health and home care in Alabama at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.