In California, "home health" and "home care" are two different services with two different payers. Home health is skilled, doctor-ordered medical care that Medicare covers when someone is homebound and needs intermittent skilled care; home care is non-medical help with daily living that families pay for privately or, if they qualify, get through Medi-Cal.
This guide draws the line between the two: what each service is, who is licensed to provide it, and exactly who pays. Getting the terms confused costs families money, because the program that covers one will not touch the other.
In This Guide
- Key Takeaways
- The Core Difference
- Home Health: Skilled, Doctor-Ordered, Medicare-Covered
- Home Care: Non-Medical Help With Daily Living
- Which One Do You Need?
- What It Costs
- Frequently Asked Questions
The Core Difference
The split is medical versus non-medical, and it decides everything downstream: who provides the service, what license they hold, and which program pays.
Home health is skilled care. A doctor orders it because the person has a medical need that requires a licensed professional, a nurse, a physical or occupational or speech therapist, or a medical social worker. Think wound care after surgery, IV medication, injections a patient can't self-administer, or therapy to recover function after a stroke or a fall.
Home care is non-medical. No clinical license is involved in the hands-on work. An aide helps with the activities of daily living: bathing, dressing, getting to the bathroom, preparing meals, light housekeeping, and supervision. The person may be perfectly stable medically and still need this help every day.
The same person often needs both. Someone discharged after hip surgery might get home health (a nurse and a physical therapist for a few weeks) while also needing home care (an aide to help with bathing and meals for months). They run on separate tracks with separate payers, which is why the labels matter.
Home Health: Skilled, Doctor-Ordered, Medicare-Covered
Home health in California is delivered by a Home Health Agency, which the state licenses through CDPH under Title 22 of the California Code of Regulations section 74600. The agency employs the clinical staff, a registered nurse, therapists, and medical social workers, 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. The two that trip families up most:
- Homebound. Leaving home requires considerable and taxing effort, and the person generally needs help or an assistive device to do it. Occasional, short trips out (to a medical appointment, to religious services) don't disqualify someone.
- Intermittent skilled need. A doctor certifies that the person needs skilled nursing or therapy on a part-time or intermittent basis, under a plan of care the doctor reviews. Home health is not round-the-clock care.
When those conditions are met, Medicare pays for the covered services at no cost to the beneficiary. That covered set is the skilled part: the nursing visits, the therapy, and a home health aide's help that is tied to the skilled care. What Medicare home health does not do is staff an aide in the home for general daily help that has no skilled-care purpose. That is home care, and it sits in the next section.
Home Care: Non-Medical Help With Daily Living
Non-medical home care in California comes through one of two channels.
Private Home Care Organizations. These are agencies CDSS licenses to send non-medical aides into the home. California requires the aides to be background-checked and listed on the state's public Home Care Aide Registry, so a family can verify that the person at the door is registered and cleared. Families pay these agencies privately, by the hour.
In-Home Supportive Services (IHSS). IHSS is a Medi-Cal program, administered by the counties, that pays for non-medical in-home help for eligible low-income aged, blind, or disabled Californians. It lets people who would otherwise need a higher level of care stay in their own homes. A recipient can often hire a caregiver of their choosing, including a family member, who is then paid through the program.
Eligibility and the number of authorized hours for IHSS are set at the county level through an in-home assessment, so they vary, and the county IHSS office or Medi-Cal is the place to confirm what a specific person qualifies for. The point for sorting out terminology is this: IHSS funds home care, the non-medical help. It is not home health and does not provide skilled nursing or therapy.
One line is worth stating plainly. Medicare does not pay for non-medical home care. A family expecting Medicare to cover an aide for daily help will find it won't, regardless of how much that help is needed. The routes to paying for home care are private funds or, for those who qualify, IHSS.
Which One Do You Need?
Start with the need, not the brochure. The table below maps the two services across the dimensions that decide who provides the care and who pays.
| Home Health | Home Care (Non-Medical) | |
|---|---|---|
| What it is | Skilled medical care: nursing, physical/occupational/speech therapy, medical social work | Help with daily living: bathing, dressing, meals, housekeeping, supervision |
| Doctor's order required | Yes, under a physician's plan of care | No |
| Who provides it | Home Health Agency licensed by CDPH (Title 22 CCR 74600) | Home Care Organization licensed by CDSS (aides on the Home Care Aide Registry), or IHSS caregivers |
| Who pays | Medicare, when homebound and needing intermittent skilled care, at no cost for covered services | Private pay, or IHSS (Medi-Cal) for eligible low-income Californians |
| Does Medicare pay? | Yes, for covered skilled services | No |
A quick way to place a situation: if a doctor 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 home care, and the question becomes whether to pay privately or apply for IHSS. Many families end up arranging both at once.
What It Costs
Home health, when Medicare covers it, costs the beneficiary nothing for the covered services. The cost question really lives on the home care side, where families pay out of pocket unless IHSS covers it.
For private non-medical home care in California, the median hourly rate was about $38 to $39 an hour in 2024, per the CareScout (Genworth) Cost of Care Survey. CareScout reported roughly $38 an hour for homemaker services and about $39 for a home health aide hired privately, and now groups both as non-medical caregiver work because most agencies charge the same rate. Those are survey medians, not maximums, and they are industry estimates rather than government figures, so the rate a specific agency quotes can land above or below them.
On an annual basis, the same 2024 survey put California's median at about $86,944 a year for homemaker (non-medical) home care and $89,232 a year for a home health aide, both above the national medians. The annual figures assume a steady weekly schedule; many families use fewer hours and pay less. For low-income seniors who qualify, IHSS removes the private cost by funding the care through Medi-Cal instead.
Frequently Asked Questions
No. Medicare does not pay for non-medical home care, the help with bathing, dressing, meals, and housekeeping that an aide provides. Medicare's home health benefit covers skilled, doctor-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 or, for eligible low-income Californians, IHSS through Medi-Cal.
Home health is skilled medical care, nursing, physical, occupational, or speech therapy, and medical social work, ordered by a doctor and delivered by a CDPH-licensed Home Health Agency. Home care is non-medical help with daily living from a CDSS-licensed Home Care Organization or through IHSS. The simplest test is whether a doctor's order and a licensed clinician are involved: if yes, it's home health; if not, it's home care.
IHSS (In-Home Supportive Services) is a county-administered Medi-Cal program that pays for non-medical in-home help for eligible low-income aged, blind, or disabled Californians. It funds home care, not home health. Eligibility and authorized hours are set at the county level through an assessment, so check with the county IHSS office or Medi-Cal. Home health, by contrast, is skilled care covered by Medicare and does not run through IHSS.
CDSS licenses Home Care Organizations and maintains a public Home Care Aide Registry of background-checked, cleared aides. Before hiring, you can confirm that an organization is licensed and that the individual aide is listed on the registry. For skilled home health, look for a Home Health Agency licensed by CDPH under Title 22 CCR section 74600.
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 non-medical home care (an aide for bathing and meals). The two run on separate tracks with separate payers, so arranging one does not arrange or pay for the other.
Learn More
- Nursing Homes in California
- Memory Care in California
- California Medi-Cal IHSS
- Medicare in California
- California Medicaid (Medi-Cal)
Find personalized help arranging care at home in California at brevy.com.
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