Florida Home Care Guide: Agencies, Registries, Medicare & Medicaid (2026)

Florida home care is not one thing. It is three legally distinct provider categories with three different licensure regimes, three different liability models, and three different things you can actually buy. It overlaps with (but is not the same as) Medicare home health, Florida Medicaid SMMC LTC personal care, and the VA's homemaker and home-health-aide benefit. Get the categories wrong and you spend more than you needed to, accept liability you did not realize you were taking on, or hire a worker who is not legally permitted to do what you are paying for. This guide separates the categories, prices each one, walks through who pays for what, and explains the major 2026 legislative change (SB 1068) that Florida families need to know about before signing a single contract.

Key takeaways before you read further

• Florida home care splits into three legally distinct provider types under Chapter 400, Part III, Florida Statutes: licensed Home Health Agencies (HHAs), nurse registries, and homemaker/companion providers. Each has a different licensure path, a different liability model, and a different scope of permitted services.
• Effective July 1, 2026, CS/CS/SB 1068 imposes new written-disclosure, business-naming, license-display, and fee-filing rules on Florida nurse registries. The bill is a direct response to over a decade of complaints about registry transparency.
• Medicare home health is short, skilled, and zero-cost-share, but does not cover daily ADL or custodial care, 24-hour or live-in care, homemaker-only services, or companion services. The typical episode runs a few weeks of nursing visits and therapy after a hospital discharge.
• Florida's SMMC LTC waitlist runs roughly 48,000 to 59,000 applicants in 2024-2025, with priority set by frailty score under §409.979(3), F.S. and Rule 59G-4.193, F.A.C., not by date of application. The front door is the Florida Elder Helpline at 1-800-963-5337.
• Florida is one of the most permissive states on family-caregiver hiring through SMMC LTC's Participant-Directed Option (PDO). Adult children, siblings, parents, friends, neighbors, and (notably) spouses can all be paid, under the federal extraordinary-care standard at 42 CFR §441.301(b)(1)(ii).

The three Florida home care provider types under Chapter 400, Part III

Florida's entire home-care regulatory framework lives in a single statutory chapter and a single part: Chapter 400, Part III, Florida Statutes, §§400.461 to 400.518. The three provider types families can hire from are:

1. Licensed Home Health Agency (HHA). §§400.461 to 400.497, F.S.; implementing rules at Chapter 59A-8, F.A.C. The only type that may legally provide skilled medical services: skilled nursing (RN/LPN), home health aide services, physical therapy, occupational therapy, speech-language pathology, medical social work, and dietitian services. The only type that can be Medicare-certified and bill Medicare or Medicaid for direct services.

2. Nurse Registry. §400.506, F.S.; implementing rules at Chapter 59A-18, F.A.C. A referral agency, not a care provider. The registry vets credentials, runs background checks, matches caregivers to clients, and collects a placement fee, but the caregiver is an independent contractor of the family, not an employee of the registry. Registries cannot bill Medicare or Medicaid; their revenue is the contracting fee paid by the private-pay client.

3. Homemaker and Companion Services Provider. §400.509, F.S.; implementing rules at Rule 59A-8.025, F.A.C. The non-medical layer. AHCA registration, not licensure (§400.509(2) explicitly exempts these providers from licensure but requires registration); biennial fee of $50. Permitted services are statutorily narrow: light housekeeping, meal planning and preparation, shopping assistance, errands, companionship, accompanying clients on outings. Florida law explicitly prohibits homemaker/companion workers from providing any hands-on personal care (no bathing, dressing, transferring, toileting, ambulation assistance, or medication assistance) and any nursing service.

The single sharpest line in Florida home care runs through that third category. The moment a worker physically assists a client with an activity of daily living, even for thirty seconds, even just to steady them on the way to the bathroom, that worker has crossed out of companion territory into personal care, and personal care can only be delivered by a licensed HHA, a nurse registry placing a credentialed CNA or HHA, or by ALF/AFCH staff inside a residential facility. This is the single most-violated rule in Florida home care, and AHCA enforcement records show it as a recurring violation across the 2023-2025 inspection cycle.

The liability question most families do not ask until it is too late

Read this before you sign with a nurse registry. A licensed home health agency takes on the employment relationship: the caregiver is a W-2 employee or contractor of the agency, the agency carries professional liability and workers' compensation insurance, the agency is vicariously liable for caregiver negligence under the standard respondeat superior doctrine, and a $50,000 surety bond is required for HHAs serving ten or more patients under §400.471(2)(c), F.S. A nurse registry takes on essentially none of that. The caregiver is an independent contractor of the family. The family is the de facto employer for liability purposes. The registry's liability is generally limited to negligent screening, negligent referral, or failure to verify credentials, not to whatever the caregiver does once they walk through your door. Registry contracts uniformly include strong indemnification language pushing liability back onto the family. If the caregiver injures the client or steals from the home, the registry is rarely the right defendant.

This is not a reason to avoid registries. They are often the right choice for stable clients who want a direct relationship with their caregiver, more continuity, and a lower hourly rate than agencies typically charge. It is a reason to do three things before you sign:

1. Review your homeowners' policy for in-home worker coverage. Most standard homeowners policies cover injuries to occasional household workers but exclude regular paid in-home caregivers; you may need a rider or a separate workers' compensation policy.
2. Confirm the registry runs Level 2 background screening on every contractor under §408.809, F.S. and Chapter 435, F.S., fingerprint-based and AHCA/FDLE/FBI-checked through the AHCA Care Provider Background Screening Clearinghouse.
3. Get a written services contract specifying scope of services, rates, payment terms, and a clear statement of the independent-contractor relationship.

What the 2026 Legislature just changed: SB 1068

The 2026 Florida Legislature passed CS/CS/SB 1068, the most consequential consumer-facing change to Florida home-care regulation in over a decade. Effective July 1, 2026, the bill amends §400.506 (nurse registries) and §400.509 (homemaker/companion) F.S. to:

• Require nurse registries to provide written client disclosures at intake and annually thereafter.
• Prohibit registries from using business names, advertising, websites, or digital-platform language that implies they directly employ caregivers; the term "nurse registry" must appear in the registered business name.
• Require registries to display license numbers prominently in marketing and on every digital platform.
• Require a written disclaimer regarding the independent-contractor nature of referred caregivers.
• Require registries to file fee schedules with AHCA and disclose them to clients before services initiate.

The bill is a direct legislative response to over a decade of complaints about registry transparency. AHCA must issue implementing rule amendments to Chapter 59A-18, F.A.C., and the first compliance audits are expected in late 2026 and through 2027. If your family is contracting with a registry in 2026 or later, the contract you sign should now include the SB 1068 disclosures.

Medicare home health: what every family needs to know

Medicare home health is one of the most-misunderstood Medicare benefits in the country. Eligibility under 42 USC §1395f(a)(2)(C) and 42 CFR 424.22 requires all five of the following to be true at the same time:

1. Under the care of a physician or qualified practitioner (NP, PA, CNS) with a plan of care signed and reviewed at least every 60 days under 42 CFR 484.18 and 484.60.
2. Homebound, defined under §1835(a) of the Social Security Act and 42 CFR 424.22(a)(1)(ii): leaving home requires considerable and taxing effort, though the beneficiary may leave for medical care, religious services, adult day care, or infrequent special events without losing homebound status.
3. Need intermittent skilled nursing OR PT or SLP (or continuing OT). Intermittent means fewer than 8 hours per day and fewer than 28 hours per week (up to 35 in unusual circumstances).
4. Face-to-face encounter with the certifying clinician within 90 days before or 30 days after the start of care, related to the primary reason for home health (42 CFR 424.22(a)(1)(v)). May occur via telehealth.
5. Care delivered by a Medicare-certified HHA meeting the Conditions of Participation at 42 CFR Part 484.

The biggest misunderstanding about Medicare home health. Medicare home health does NOT cover:

• 24-hour or live-in care.
• Custodial or personal care that is unrelated to a skilled need.
• Homemaker services when not incident to skilled care.
• Companion or sitter services.
• Home-delivered meals as a stand-alone benefit.

Medicare home health is short, targeted, and skilled: the typical episode is a few weeks of nursing visits, PT, and home-health-aide hours after a hospital discharge. It does not solve the long-term, daily ADL problem. That is what SMMC LTC personal care, private-pay home care, and family caregiving are for.

When Medicare home health is the right tool, it is one of the few zero-cost-share benefits in the entire Medicare program. The beneficiary pays $0 for covered visits: no deductible, no coinsurance. (Durable medical equipment furnished under home health carries the standard 20 percent Part B coinsurance.)

How Medicare pays the agency. Since January 1, 2020, Medicare home health has been paid under the Patient-Driven Groupings Model (PDGM) with 30-day payment periods (the certification period remains 60 days, but payment was shortened). PDGM classifies episodes into 432 case-mix groups based on admission source, timing, clinical grouping, functional impairment level, and comorbidity adjustment. The CY 2026 final rule (CMS-1828-F) cuts aggregate Medicare home-health payments by approximately 1.3 percent, about $220 million nationwide compared to CY 2025, combining a -1.023% permanent behavioral adjustment and a -3.0% temporary adjustment, partially offset by the market-basket update. The Home Health Value-Based Purchasing (HHVBP) Expanded Model is in its second payment year for CY 2026, applying agency-level payment adjustments of up to ±5% based on CY 2024 performance.

For families this all matters less than knowing one thing: the rate cuts are putting financial pressure on Florida home health agencies, particularly smaller and rural ones. Some agencies are reducing service areas, raising private-pay rates to subsidize Medicare margins, or exiting the market entirely. If your loved one is on a Medicare home health episode and the agency announces a service-area reduction or referral-only model, that is the regulatory backdrop.

Florida Medicaid: SMMC LTC personal care and the custodial gap

Medicare's refusal to pay for custodial care leaves an enormous gap in the U.S. eldercare system. Florida Medicaid fills part of that gap through the Statewide Medicaid Managed Care Long-Term Care program. Operationally codified at Fla. Admin. Code R. 59G-4.192 with services described in the AHCA-Plan contract Exhibit II-B, SMMC LTC's home-care-relevant services include:

SMMC LTC is not an entitlement. Florida operates approximately 116,200 funded slots and serves roughly 128,000 to 140,000 unique beneficiaries per year through slot turnover. The active SMMC LTC waitlist runs 48,000 to 59,000 applicants. Priority is set by frailty score under §409.979(3), F.S. and Rule 59G-4.193, F.A.C., not by date of application. Eight priority ranks exist; Ranks 7 and 8 (Imminent Risk and APS High Risk Referral) are released first; Ranks 1 and 2 are screened but not placed on the active list. The first practical step for any family thinking about SMMC LTC personal care is calling the Aging and Disability Resource Center to start the CARES screening, even when the family is not certain they are eligible yet.

The Institutional Care Program (ICP) is different. ICP, full-benefit Medicaid for nursing-home residents who have been placed for at least 60 consecutive days, is an entitlement (no waitlist), but it covers no HCBS whatsoever. ICP pays for the nursing home and only the nursing home.

The Participant-Directed Option: paid Florida home care from a family member

One of the most underused features of SMMC LTC is the Participant-Directed Option (PDO), a structure that lets a Medicaid-eligible member directly hire and supervise a paid caregiver, with the SMMC LTC plan paying through a Fiscal/Employer Agent who handles tax withholding, payroll, and workers' compensation. PDO covers Adult Companion, Homemaker, Personal Care/Attendant Care, Intermittent and Skilled Nursing, and In-Home Respite.

PDO-eligible workers must be 18 or older, pass a Level 2 background check under Chapter 435, F.S., and execute a written PDO Direct Service Worker Agreement. The member is the common-law employer; the F/EAs serving Florida plans are GT Independence (Humana, Sunshine Health, Aetna Better Health) and Public Partnerships LLC / PPL (Simply Healthcare, Florida Community Care).

Florida is one of the most permissive states on family-caregiver hiring.

• Most states limit who can be paid under HCBS waivers (adult children, sometimes; spouses, almost never).
• Florida allows adult children, siblings, parents, friends, neighbors, and spouses to be paid PDO caregivers.
• The federal authority is the extraordinary-care standard at 42 CFR §441.301(b)(1)(ii).
• Legal representatives generally cannot be paid for both representation and direct care simultaneously.
• Hourly rates are SMMC-LTC-plan-specific and typically run $13.50 to $17.50 per hour for personal care in 2026.

VA benefits that stack with Florida home care

For Florida veterans and their surviving spouses, three federal benefit streams from the VA can meaningfully reduce out-of-pocket home-care costs.

VA Aid & Attendance (A&A). A pension supplement that pays the difference between a qualifying veteran's countable income and the Maximum Annual Pension Rate (MAPR). 2026 rates effective December 1, 2025 through November 30, 2026:

• Veteran, no dependents: $2,296/month ($27,553/year).
• Veteran, one dependent: ~$2,727/month.
• Surviving spouse, no dependents: $1,556/month ($18,679/year).
• Veteran with Housebound benefit (cannot be combined with A&A): ~$1,886/month.

Net worth limit: $163,699 in 2026. Wartime service requirement: 90 days of active duty with at least one day during a Congressionally designated wartime period.

VA Homemaker and Home Health Aide Care (38 CFR §17.111). This is a direct VA-purchased benefit, not a pension and not Medicare home health. The VA contracts with community home-care agencies to deliver homemaker and home-health-aide services to enrolled veterans with clinical need (ADL impairment, caregiver burden, recent nursing-facility discharge, or high medical-services utilization). Copayments under §17.111: veterans with any compensable service-connected disability (≥10%) pay $0; other veterans pay up to $15/day for outpatient extended care after the first 21 days/year (which are free).

VA Veteran-Directed Care (VDC). The VA's consumer-direction program, parallel to Florida Medicaid's PDO. The veteran receives a flexible budget to hire workers, including in many cases family members. Available at participating VA Medical Centers.

VA Home-Based Primary Care (HBPC). A VA-staffed interdisciplinary medical-home program for veterans with complex chronic conditions. Distinct from contracted homemaker/HHA care; HBPC is for complex medical management (geriatrics, cardiology, palliative care) delivered by VA clinicians in the home.

How Florida home care costs compare in 2025-2026

The crossover insight Florida families need to understand: 24-hour around-the-clock home care always exceeds nursing-home cost in Florida. A live-in single caregiver (where the worker sleeps at the home, with a designated room and board provided) approximates the cost of an ALF base rate. Eight to twelve hours of agency home care per day approximates ALF base plus add-on care fees. This math is the reason most Florida families do not choose 24-hour home care for any length of time. They end up at an ALF, memory-care unit, or skilled nursing facility instead. Home care wins on cost for moderate ADL impairment with intermittent paid help; residential care wins on cost (per dollar) for severe impairment requiring 24-hour supervision.

The hybrid stack: how Florida families actually pay

In practice, the typical Florida family does not pick one payer or one provider. They layer multiple sources, each covering the gap the others leave. The most common configuration for a moderate-impairment older adult living at home:

1. Medicare home health for the skilled nursing visit (post-hospital, wound care, med reconciliation): $0 cost-share, episode-based, ~60-day duration.
2. SMMC LTC personal care for daily ADL assistance: Medicaid-funded if member is enrolled and slot-released.
3. PDO family caregiver for evenings and weekends: paid adult child, sibling, or spouse.
4. Private-pay companion for community outings and social engagement: fills the gap outside Medicaid hours.
5. VA Aid & Attendance as income supplement: funds the private-pay portion if veteran-eligible.

The hybrid stack is almost always cheaper for the family than ALF placement for someone with moderate impairment, and substantially cheaper than nursing-home placement for someone who can stay in the community with this layered support. It does, however, require the family to act as the general contractor, coordinating five different payment streams, multiple workers, and the inevitable scheduling gaps. For families without a primary caregiver who can play that coordinator role, the operational burden of the hybrid stack often outweighs the cost savings, and a residential placement becomes the better choice.

Choosing a Florida home care provider: agency vs. registry vs. companion

When a Licensed HHA is the right call

• The need is for skilled nursing, PT, OT, SLP, or medical social work.
• Medicare or Medicaid is paying or could be paying.
• The family wants an employer-model relationship: agency carries liability, agency manages payroll and workers' comp, agency handles scheduling and substitutes.
• The family is willing to pay the higher hourly rate that agency models carry over registry rates.
• The client's needs change frequently or the family does not have a designated coordinator.

When a Nurse Registry is the right call

• The client is medically stable and needs ongoing personal care.
• The family wants a direct relationship with the caregiver (less staff turnover).
• The family is comfortable with employer responsibilities: workers' comp consideration, tax handling for independent contractors, review of homeowners' insurance.
• A specific caregiver has been identified (the family knows who they want, the registry handles the credentialing and contracting).
• Lower hourly cost matters more than the agency-model accountability.

When a Homemaker/Companion Provider is the right call

• The need is purely non-medical: housekeeping, meal prep, transportation, social engagement.
• The client can perform their own ADLs (or has family or other help for ADL needs).
• Cost minimization is paramount; companion services are the lowest-cost provider type.
• The family understands that the worker may not legally provide hands-on personal care, and there is a separate plan for ADL needs.

When SMMC LTC PDO is the right call

• The client is Medicaid-eligible (or close enough that planning can get them there) and on the LTC waiver.
• A family member or trusted friend wants to be paid for the time they are already providing.
• The flexibility of self-direction (scheduling, choice of worker, ability to fire) outweighs the administrative burden of being the common-law employer.

When VA Homemaker/HHA Care is the right call

• The client is a veteran enrolled in VA health care.
• The veteran has clinical need (ADL impairment or caregiver burden).
• The veteran has a service-connected disability ≥10% (zero copayments) or can absorb the modest copayment otherwise.

Quality oversight: what is available and what is missing

Florida's home-health quality oversight is mixed. The federal Home Health Compare site at Medicare.gov publishes star ratings on Quality of Patient Care (a composite of OASIS-based outcomes including improvement in ambulation, bathing, bed transferring, dyspnea, oral medications, and acute-care hospitalization rate) and on the HHCAHPS Patient Survey (care of patients, communication, specific care issues, overall rating). For any Medicare-certified Florida HHA, this is the highest-quality publicly available quality data.

For nurse registries and homemaker/companion providers, the quality-data picture is much thinner. Florida does not maintain a public Watch List for home health agencies analogous to the §400.0235 Nursing Home Watch List or the FloridaHealthFinder ALF list. AHCA publishes licensure status, complaint history, and inspection findings through the Facility Locator, but a casual user has to know where to look, and nurse registries and homemaker/companion providers are subject to less frequent inspection than HHAs.

Adverse incident reporting under §400.494, F.S. requires HHAs to report to AHCA within 15 days any event resulting in death, brain or spinal damage, permanent disfigurement, surgical procedure performed in error, or sexual abuse. License revocation, suspension, or probation flows through §408.815, F.S. with a 21-day administrative-complaint dispute window and Chapter 120, F.S. appeals.

The single highest-leverage consumer-protection phone number is AHCA's Consumer Complaint Hotline: 1-888-419-3456. Online complaints can be filed through AHCA's Health Care Complaint Form. Whether the provider is an HHA, a nurse registry, a homemaker/companion provider, or any other AHCA-regulated facility, this is the right place to start.

A watch item: the federal 80/20 access rule

The CMS Ensuring Access to Medicaid Services Final Rule (89 Fed. Reg. 40542, May 10, 2024) creates the so-called 80/20 Rule, requiring at least 80% of Medicaid HCBS payments for homemaker, home health aide, and personal care services to flow to direct-care worker compensation.

• Effective for state implementation by 2030, with state reporting required by 2028.
• Florida AHCA has not yet issued implementing guidance as of May 2026; SMMC LTC managed-care plan contracts will need amendment to comply.
• The rule has drawn industry pushback and may face challenge; track for 2026-2027 developments.
• If implemented as written, the rule will materially reshape the SMMC LTC personal-care market in Florida and likely raise direct-care-worker wages while putting margin pressure on plans and provider networks.

Frequently Asked Questions

What is the actual hourly rate I will pay a Florida home health aide in 2026?

About $25 per hour at the state median, with metro variation across Florida and a national median of $27 per hour. At a typical 44 hours per week with 4.33 weeks per month, that is about $4,767 per month. Companion services typically run a few dollars per hour lower; agency rates run a few dollars per hour higher than registry-placed independent-contractor rates.

Can my husband be paid to take care of me through Florida Medicaid?

In Florida, often yes. Florida is among the most permissive states on family-caregiver hiring under the SMMC LTC PDO option, and spouses are explicitly eligible under the federal extraordinary-care standard at 42 CFR §441.301(b)(1)(ii). Most other states do not allow paid spouses; Florida does. Hourly rates run roughly $13.50 to $17.50 in 2026 depending on the SMMC LTC plan. The spouse must be 18+, pass a Level 2 background check, and execute a PDO Direct Service Worker Agreement. The plan's Fiscal/Employer Agent (GT Independence or Public Partnerships, depending on the plan) handles payroll, withholding, and workers' compensation.

How long is the SMMC LTC waitlist?

The active waitlist has run between 48,000 and 59,000 applicants in 2024-2025. Priority is by frailty score, not date of application. Applicants ranked 7 and 8 (Imminent Risk, APS High Risk Referral) are released first. The right step today is calling 1-800-963-5337 (the Florida Elder Helpline) to start a CARES screening, even if you are not sure your loved one will qualify. The screening is free and produces both a frailty score and an entry on the waitlist.

Why is Medicare home health so short?

Medicare home health is designed as a post-acute, skilled benefit. The typical episode is several weeks of nursing and therapy after a hospital discharge, not ongoing custodial care. Once the patient stabilizes and no longer needs intermittent skilled care, they no longer meet the eligibility criteria. Recertification past the first 60-day episode is permitted as long as the homebound and skilled-need criteria continue to be met, but most patients age out of Medicare home health long before they age out of needing daily ADL help.

What is the SB 1068 disclosure I should be looking for in 2026 and beyond?

After July 1, 2026, every Florida nurse registry must give you a written intake disclosure (and an annual update) covering: (a) the registry's license number, (b) a clear disclaimer that referred caregivers are independent contractors, and (c) the registry's fee schedule. The registry's name itself must include the term "nurse registry," and the registry's marketing must not imply that it directly employs caregivers. If you sign a contract with a registry in mid-2026 or later and these disclosures are missing, that is a material AHCA compliance issue and worth a call to 1-888-419-3456.

Where to start

The single most useful phone call for almost every Florida family thinking about home care is the Florida Elder Helpline at 1-800-963-5337. The Helpline routes you to the Aging and Disability Resource Center for your county, which can: schedule a CARES screening (the front door to SMMC LTC personal care, the LTC waiver waitlist, and the Alzheimer's Disease Initiative); refer you to local Area Agency on Aging programs (homemaker, congregate meals, transportation); and connect you to your county's case-management resources. The call is free, the screening is free, and most families learn about benefits and programs they did not know existed.

The framework around Florida home care looks complicated because it is. Three provider types, three payer streams, two federal benefit categories, and a brand-new disclosure regime under SB 1068. There is no single right answer that works for every family. But the framework breaks down into manageable pieces if you are honest about three things: what skilled needs your loved one has (and therefore whether Medicare home health is on the table); how much hands-on personal care they need (and therefore whether you need a licensed HHA or registry caregiver, not just a companion); and how the family can or cannot stack Medicare, Medicaid, VA, and private pay to cover the actual hours of need. Get those three things right and the choice of provider type usually becomes obvious. Get them wrong, particularly the personal-care-vs-companion-services line, and you will find out the hard way, sometimes during a regulatory inspection and sometimes after a fall or theft incident.

Find personalized help navigating Florida home care options at brevy.com.