Home Care vs. Home Health in Washington, DC (2026): Who Pays for Each

In Washington, DC, home health is skilled nursing or therapy delivered at home, while home care is everyday help with bathing, dressing and eating, and the real difference for a family is who pays. Medicare won't pay for that everyday help at home when it's the only care someone needs, though Medicare does cover skilled nursing and therapy care through its home health benefit for people who are eligible. DC Medicaid can pay for everyday help at home through a personal care aide (PCA) benefit in its regular State Plan, which the DC Office of Administrative Hearings says covers up to 8 hours a day, with more available under the Elderly and Persons with Physical Disabilities (EPD) Waiver. And in the District's own licensing law, a "home care agency" is one that provides skilled nursing, which is close to the reverse of how most families use the phrase.1,2,3

In This Guide

• Home Care vs. Home Health in Washington, DC at a Glance
• What Medicare Will and Won't Pay For at Home
• How DC Licenses Home Care Agencies
• What In-Home Care Costs in Washington, DC
• How DC Medicaid Pays for a Personal Care Aide
• Home Care or Home Health in DC: Which Does Your Parent Need?
• Frequently Asked Questions
• Learn More

Home Care vs. Home Health in Washington, DC at a Glance

Home care and home health in Washington, DC differ on what the worker does, which DC rules apply, and which payer to check first. Private-pay costs run on different weekly schedules for each kind of care, so they are compared in the cost section below rather than side by side here.3,2,1,6,5

What Medicare Will and Won't Pay For at Home

Medicare does not pay for long-term custodial care, meaning ongoing help with activities of daily living, when that help is the only care a person needs.4 Medicare.gov puts it plainly: "Medicare doesn't pay for long-term care." Federal Medicare regulations exclude custodial care from coverage except for hospice palliation, and the exclusion is written against the service, not the setting.1 So Medicare's custodial care exclusion applies to an aide who only helps a parent bathe and dress at home in Northeast DC just as it applies to an aide working in an assisted living facility.

A Medigap policy won't pay for custodial care at home either. Medicare.gov states that Medicare and most health insurance, including Medigap, do not pay for long-term care services.1

Skilled care is a different question. Medicare does cover skilled care, meaning nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel, in a Medicare-certified skilled nursing facility or through Medicare's home health benefit.1 Our guide to who qualifies for Medicare home health care walks through who is eligible for that home health benefit. At hospital discharge, Medicare.gov's advice for someone without a 3-day qualifying inpatient hospital stay who needs care after discharge is to "ask if you can get care in other settings (like home health care)."4

When Medicare won't pay for long-term care, Medicare.gov points to Medicaid for people who meet their state's eligibility rules, or to private long-term care insurance.4,1 In the District, the Medicaid route for everyday help at home is the personal care aide benefit covered below.

How DC Licenses Home Care Agencies

DC's licensing law uses the words differently from most families. Under D.C. Code § 44-501, part of the Health-Care and Community Residence Facility, Hospice and Home Care Licensure Act, a "home care agency" is an agency, other than a hospice, that directly provides skilled nursing services and at least one other therapeutic service to a person who is sick or has a disability, at home or in a community residence facility.3 D.C. Code § 44-501's definition of a therapeutic service includes physical, speech or occupational therapy, medical social services, and personal care services.

So a DC-licensed home care agency is, by definition, a skilled-nursing provider that may also provide personal care services. The licensing rules that follow:

• A license is required. D.C. Code § 44-502 makes it unlawful to operate a covered facility or agency in the District without a license, and a DC facility or agency license expires one year from issue or last renewal unless renewed.3
• DC Health is the licensing agency. DC Health lists home health agencies among the health care facilities it licenses and certifies for compliance with state and federal health and safety standards. DC's home care agency regulations are 22-B DCMR Chapter 39.3
• Dementia training applies. D.C. Code § 7-744.02's dementia training requirement covers home care agencies whose program participants have Alzheimer's disease or related dementia.3

An agency that sends only companions or homemakers, with no skilled nursing, doesn't meet the D.C. Code § 44-501 definition of a home care agency. This guide could not confirm whether some other DC license or registration covers that kind of agency, so ask any non-medical agency which DC license it holds and check the answer with DC Health.

Questions worth asking any DC agency before you sign:

• Is the agency licensed by DC Health as a home care agency, and when does the license renew?
• For skilled care Medicare is expected to pay for, will Medicare actually cover this agency's visits?
• For personal care DC Medicaid is expected to pay for, is the agency set up to bill DC Medicaid for PCA services?
• If your parent has dementia, how does the agency meet DC's dementia training requirement?

What In-Home Care Costs in Washington, DC

For home care paid out of pocket, the most recent survey figure is CareScout's 2025 Cost of Care Survey, whose Washington, DC results were released March 2, 2026. CareScout's 2025 DC annual median for in-home care from a non-medical caregiver was $86,944, based on 44 hours a week for 52 weeks, unchanged from 2024. CareScout's 2025 national median for in-home care from a non-medical caregiver was $80,080.5

The 2025 CareScout Cost of Care Survey also reports a separate DC line for a private duty nurse at home: $3,900 a year, based on 1 hour a week for 52 weeks, against a $4,680 national median.5

Two things to know before you use these figures in a budget:

• They are annual medians on stated schedules. CareScout publishes its DC cost figures as annual amounts on stated weekly hours: 44 hours for a non-medical caregiver and 1 hour for a private duty nurse. A DC family using fewer hours than CareScout's 44-hour week would pay less than CareScout's annual DC median for a non-medical caregiver, and an agency's own rate can land above or below the median.5
• The region is wider than the District. CareScout collects rates at the metropolitan-area level; its 2025 DC region also takes in Arlington and Alexandria, and CareScout says its regions can include counties from nearby states.5

How DC Medicaid Pays for a Personal Care Aide

DC Medicaid covers personal care aide services in two places: the District's regular Medicaid State Plan, and the Elderly and Persons with Physical Disabilities (EPD) Waiver. DC Medicaid PCA services assist a beneficiary with activities of daily living such as eating, dressing, bathing, using the bathroom and moving around.2

The DC Office of Administrative Hearings (OAH) explains on its in-home health services page that two agencies make two separate decisions:2

1. Financial eligibility. The DC Department of Human Services (DHS) decides financial eligibility for Medicaid and the EPD Waiver based on the person's income and resources.
2. Level of care. The DC Department of Health Care Finance (DHCF) decides whether the person meets the level of care for in-home services, based on a face-to-face assessment completed by the District's long-term care services contractor, Liberty Healthcare.

Based on the Liberty Healthcare assessment score, DHCF may approve a DC Medicaid beneficiary for up to 8 hours of PCA services a day under the DC Medicaid State Plan. If the assessment score reaches the level of care required for a nursing facility, DHCF may qualify the beneficiary for DC Medicaid's EPD Waiver instead, which has a higher income cap and allows more than 8 hours of PCA services a day.2 The PCA hours a DC Medicaid beneficiary actually gets follow from DHCF's determination on the assessment, not from the 8-hour ceiling.

DC Medicaid State Plan PCA services run through home health agencies. DHCF's Transmittal 17-29 (2017) requires personal care aides to enroll in DC Medicaid so home health agencies can claim Medicaid reimbursement for PCA services, and DHCF's 2017 rule on the long-term care assessment process has the home health agency's supervisory nurse re-evaluate each State Plan PCA recipient's need for continued services at least once every twelve months, or sooner after a significant change in health.2

Why the State Plan route matters: the Medicaid and CHIP Payment and Access Commission (MACPAC) describes nursing facility and home health services as Medicaid's only two mandatory long-term care benefits, with services such as personal care attendants optional. MACPAC explains that once a state puts an optional service in its state plan, the service must be provided to everyone eligible through the pathways that grant the traditional benefit package, while waivers can be limited to specific groups and can cap enrollment.6,2

DC Medicaid's EPD Waiver is the route for someone whose needs reach nursing-home level. The EPD Waiver lets DC residents who would otherwise need nursing-home care receive services at home or in an assisted living community; the EPD Waiver serves people 65 or older, or 18 to 64 with a physical disability, and its services include case management, PCA services, personal emergency response services, Services MyWay and assisted living.7 Eligibility and enrollment are covered in how DC Medicaid pays for care at home through the EPD Waiver. If DHCF denies, cuts or ends PCA hours, DC Medicaid appeals and fair hearings explains how to challenge the decision.

Home Care or Home Health in DC: Which Does Your Parent Need?

Start from the need, then check the payer:

• Nursing or therapy after a hospital stay or a new diagnosis. That's the skilled side. Medicare covers skilled nursing and therapy care through its home health benefit for people who are eligible, so check who qualifies for Medicare home health care first, and ask the discharge planner which DC agencies can take the referral.1
• Help with bathing, dressing, meals or getting around, and no skilled need. That's home care. The usual ways DC families pay for home care are private pay, long-term care insurance if your parent holds a policy, DC Medicaid's PCA benefit, and VA benefits for a veteran.4,2
• Daily help that is growing past 8 hours. Ask DHCF whether a new assessment could reach nursing-facility level of care, which is the threshold for the EPD Waiver.2

Learn More

Find personalized help sorting out home care and home health for a parent in Washington, DC 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.