Florida Home Care: Agencies, Registries, 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. One change families may have read about did not happen: SB 1068, a 2026 bill that would have required nurse registries to give clients written disclosures, died in the Senate Health Policy committee on March 13, 2026.1

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

Florida licenses home care under one part of one statutory chapter: Chapter 400, Part III, Florida Statutes, §§400.461 to 400.53.1 The three provider types families can hire from are:

1. Licensed Home Health Agency (HHA). An HHA provides one or more home health services, which Florida law defines to include nursing care; physical, occupational, respiratory, or speech therapy; home health aide services; and dietetics and nutrition counseling. §400.464(1) requires a license or registration to operate one. Skilled care is not the HHA's alone, though: a licensed nurse or therapist referred by a licensed nurse registry can provide it too.1 A licensed HHA may apply to enroll in Medicare and Medicaid once its state license is issued.1

2. Nurse Registry. §400.506, F.S. A referral agency, not a care provider: AHCA licenses it to offer contracts for nurses, home health aides, certified nursing assistants, homemakers, and companions to work in a client's home.1 By statute the caregiver is "deemed an independent contractor and not an employee of the nurse registry," and the registry may not monitor, supervise, manage, or train them.1

3. Homemaker and Companion Services Provider. §400.509, F.S. The non-medical layer. AHCA registration, not licensure (§400.509 exempts these providers from licensure under Part III but requires them to register with the agency), with a registration fee of $50 per biennium.1 These providers do housekeeping, cooking, errands, and companionship, and they cannot provide personal care or nursing under state law.1 §400.462 says a companion or homemaker "may not provide hands-on personal care to a client," and the registration exemption holds only while the provider does not provide a home health service.1

The sharpest line in Florida home care runs through that third category. Florida law bars companions and homemakers from giving hands-on personal care, so a worker hired as a companion is not the one to help with bathing, dressing, or using the bathroom. Hands-on care at home can come from a licensed HHA, a caregiver referred by a nurse registry, or an aide or CNA working alone in their individual capacity, whom Florida exempts from agency licensure; a family that hires that last way is not dealing with a licensed or registered business.1

The liability question to settle before you hire

This is not a reason to avoid registries. A registry can suit a medically stable client who wants a direct relationship with one caregiver. It is a reason to do three things before you sign:

1. Review your homeowners' policy and ask your insurer how it treats a paid caregiver who works in your home regularly, and whether you need added coverage.
2. Ask the registry to confirm Level 2 background screening. Florida requires Level 2 screening under Chapter 435, F.S., conducted through AHCA, for anyone seeking work with a licensee or provider who will give clients personal care directly (§408.809, F.S.), and fingerprints must be submitted electronically.1
3. Get a written services contract specifying scope of services, rates, payment terms, and a clear statement of the independent-contractor relationship.

SB 1068: the registry bill that did not pass

The 2026 Florida Legislature considered SB 1068, a nurse-registry transparency bill. It would have required registries to give clients a written disclosure at intake and every year, and it would have restricted registry business names and advertising. It did not become law: its final Senate action reads "Died in Health Policy," dated March 13, 2026.1

So SB 1068 added no registry disclosure rules. A registry contract signed today carries what current law and the contract itself say, and current law already deems a referred caregiver an independent contractor rather than the registry's employee, and requires the registry to tell you so at referral. That is why the three steps above are worth doing before you sign.1

Medicare home health: what every family needs to know

Medicare home health is easy to misread. Under 42 CFR 424.22, a beneficiary must meet all five of the following at the same time:1

1. Under the care of a physician or allowed practitioner who establishes and periodically reviews a plan of care. Nurse practitioners, clinical nurse specialists, and physician assistants can certify, and eligibility is recertified every 60 days.5
2. Homebound: leaving home needs help such as a cane, walker, wheelchair, or another person, or is not recommended because of the condition, and the person normally cannot leave home without a lot of effort. The beneficiary may still leave for medical treatment, religious services, adult day care, or short, infrequent non-medical absences.1
3. Need intermittent skilled nursing OR PT or SLP (or continuing OT). Intermittent means skilled nursing and aide services combined of less than 8 hours a day and 28 or fewer hours a week (up to 35 in reviewed cases).1
4. Face-to-face encounter no more than 90 days before or within 30 days after the start of care, related to the primary reason for home health. It may occur by telehealth, subject to Medicare's telehealth rules.1
5. Care delivered by a Medicare-certified HHA.1

Medicare home health is built around a skilled need: someone who needs more than part-time or intermittent skilled care does not qualify, and personal care alone is not covered.1 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, the cost is simple: "You pay nothing for covered home health services." Medicare-covered medical equipment supplied with home health carries the 20% Part B coinsurance after the Part B deductible.1

How Medicare pays the agency. Since 2020, Medicare home health has been paid under the Patient-Driven Groupings Model (PDGM) with 30-day payment periods; eligibility is still recertified every 60 days. PDGM sorts each period by admission source, timing, clinical grouping, functional impairment level, and comorbidity adjustment.5 The CY 2026 Home Health PPS final rule (CMS-1828-F) is estimated to cut aggregate Medicare home-health payments by about 1.3 percent, roughly $220 million nationwide compared to CY 2025.1

For families this all matters less than knowing one thing: the 30-day period is a billing unit, not a limit on care. A patient told that a 30-day period has ended has not, by that fact alone, reached the end of the benefit; whether care continues turns on whether they still meet the eligibility rules, rechecked every 60 days.5

Florida Medicaid: SMMC LTC personal care and the custodial gap

Medicare does not pay for custodial care when that is the only care needed.1 Florida Medicaid covers some of it through the Statewide Medicaid Managed Care Long-Term Care program, which delivers care through contracted managed care plans and is operationalized at Fla. Admin. Code R. 59G-4.192.6 Every plan must cover at least 26 services, and a plan may cover more. Those that bear on care at home include:6

Being on this list is not an entitlement to each item: services are available based on medical necessity, or when they are needed to delay or prevent nursing facility placement.6

SMMC LTC is not an open entitlement. Florida makes enrollment offers only "[s]ubject to the availability of funds," so people seeking home care through the program usually wait on a statewide pre-enrollment list (Rule 59G-4.193, F.A.C. still calls it the wait list). The Department of Elderly Affairs releases people from that list by priority score under §409.979(3), F.S.; when capacity is limited among people with identical scores, the one placed on the list earliest goes first. The rule sorts scores into eight ranks. Ranks 1 and 2 are low priority, and a low rank means you are not placed on the list at all, though you can ask for a rescreening after a significant change in circumstances. Ranks 3 through 8 go on the list, including Rank 7 (Imminent Risk) and Rank 8 (Adult Protective Services High Risk Referral).2 The first practical step for any family thinking about SMMC LTC personal care is calling the Elder Helpline to reach the local Aging and Disability Resource Center and start the process, even when the family is not certain they are eligible yet; the CARES level-of-care assessment is free.3

The Institutional Care Program (ICP) is different. ICP is the separate Medicaid pathway for people already living in a licensed nursing facility, and the wait-list rule does not apply to it. It is a route into nursing-home care, not home care. The bridge between the two: a nursing-home resident who has lived in a Florida-licensed skilled nursing facility for at least 60 consecutive days and wants to move back to the community can bypass the screening and wait list to enroll in SMMC LTC.2

Both SMMC LTC and ICP use the same income test. In 2026 an applicant's gross monthly income, after allowable deductions, may not exceed 300% of the SSI federal benefit rate, which is $2,982 a month; an applicant over that cap may still qualify by setting up a qualified income trust (a Miller trust). An SMMC LTC home-care applicant's countable resources may not exceed $2,000, or $5,000 for an applicant whose income falls within the MEDS-AD limit. On spousal-impoverishment protection, Florida's rule text and its eligibility manual part ways. The rule says those policies are not applied to HCBS waiver programs (the Familial Dysautonomia and Model waivers excepted), but DCF's current eligibility manual applies the Community Spouse Resource Allowance to SMMC LTC, and federal law through September 30, 2027 extends spousal-impoverishment protection to people eligible for home-and-community-based waiver services. The sources do not settle which text controls, but DCF is the agency that decides eligibility, so a married SMMC LTC applicant should not conclude from the rule alone that the allowance is off the table because the care is at home. Florida sets the allowance at the federal maximum standard or court-ordered support, whichever is larger, so $162,660 in 2026 is the floor for the at-home spouse, not the ceiling.7

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

SMMC LTC's Participant-Directed Option (PDO) lets an enrolled member who lives in their own home or a family home hire and direct their own caregiver. Under the July 2026 SMMC LTC contract, the plan must offer PDO to every enrollee whose plan of care includes adult companion care, attendant nursing care, homemaker services, intermittent and skilled nursing, or personal care. Florida's current LTC waiver, approved effective April 1, 2025, names the same five services, and in-home respite is not a PDO service under either one.4

The minimum qualifications are lighter than families expect: for adult companion, homemaker, and personal care the contract lists "None," while attendant nursing and intermittent and skilled nursing must come from an RN or LPN licensed under Chapter 464, F.S. The plan pays for Level 2 background screening of the worker and makes the clearance decision under Chapters 435 and 408.809, F.S., and every worker signs a Participant/Direct Service Worker Agreement stating the services, hourly rate, schedule, and relationship to the member. The member holds employer authority. The managed care plan itself is the Fiscal/Employer Agent, or it may subcontract that job after giving enrollees at least 30 days' notice.4

VA benefits that stack with Florida home care

For Florida veterans (and, for Aid & Attendance, surviving spouses), four VA programs bear on home care.

VA Aid & Attendance (A&A). A monthly payment added to a VA pension for a veteran who gets the pension and meets at least one aid-and-attendance requirement.8 For rates effective December 1, 2025 through November 30, 2026, the A&A Maximum Annual Pension Rate (MAPR) is $29,093 a year for a veteran with no dependents and $18,697 a year for a surviving spouse with no dependents, with a net-worth limit of $163,699.1 A veteran who started active duty before September 8, 1980 needs at least 90 days of active duty with at least one day during wartime; later entrants generally need 24 months or their full called period, again with at least one wartime day.8

VA Homemaker and Home Health Aide Care. This is a direct VA benefit, not a pension and not Medicare home health. The aides work for organizations under contract with VA and help with daily activities such as bathing, dressing, eating, and moving around. All enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria, and the service is available where they live.9 VA says a copay for this service may be charged based on your service-connected disability status. It is not one of the services 38 CFR §17.111 lists and prices: that regulation's $15-a-day rate, after 21 free days in any 12-month period, applies to adult day health care, noninstitutional geriatric evaluation, and noninstitutional respite care, and many veterans are exempt from it, including those with a compensable service-connected disability.1

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 their own personal care aides, which VA says might include a family member or neighbor. It is only available in certain locations.10

VA Home-Based Primary Care (HBPC). VA health care delivered at home by a team, including primary care visits, care management, social work, rehabilitation, and pharmacy, for veterans with ongoing illnesses who have trouble getting to clinic visits. Distinct from contracted homemaker/aide care, and a copay may apply.11

How Florida home care costs compare

CareScout collected these rates from July through November 2025. Florida's in-home and assisted-living medians run below the national medians, and its nursing-home median runs above.12

The crossover Florida families need to understand: at the $32 hourly median, 44 hours a week of paid in-home help already costs more than the assisted-living median, and paying for all 168 hours in a week would run far past the nursing-home median.12 That math makes round-the-clock paid home care hard to sustain for long. On these medians, paid home care is the cheaper option only while the paid hours stay part-time.

The hybrid stack: how Florida families actually pay

A family does not have to pick one payer or one provider. Sources can be layered, each covering the gap the others leave, and when there is a skilled need, Medicare home health, where you pay nothing for covered visits, can be one of them.1 One way the layers can fit together for a moderately impaired older adult living at home:

1. Medicare home health for the skilled nursing visit (post-hospital, wound care, med reconciliation): nothing to pay for covered visits, with eligibility rechecked every 60 days.
2. SMMC LTC personal care for daily ADL assistance: Medicaid-funded once the member is released from the wait list and enrolled.
3. PDO family caregiver for evenings and weekends: a paid family member, friend, or neighbor.
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.

Because each public program covers part of the hours, layering can keep the family's own share of the bill below what paying privately for every hour would cost. 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 can outweigh the cost savings, and a residential placement can be the better choice.

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

How to check a provider and report a problem

For any Medicare-certified Florida HHA, Medicare's Care Compare tool is the federal place to look the agency up.

For any of the three provider types, confirm its standing with AHCA first: AHCA licenses home health agencies and nurse registries, and every homemaker or companion provider must register with it.1 Medicaid.gov lists AHCA's toll-free number as 1-888-419-3456.13 If you suspect a caregiver of abuse, neglect, or exploitation, report it to the Florida Abuse Hotline at 1-800-962-2873, which DCF says takes reports 24 hours a day, 7 days a week; if someone is in immediate danger, call 911.13

A watch item: the federal 80/20 access rule

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 connects you to your local Aging and Disability Resource Center; Florida's 11 Area Agencies on Aging operate as ADRCs, and the Department of Elder Affairs determines level-of-care eligibility for SMMC LTC through its CARES program.3 The ADRCs give information about state and federal benefits and local programs, and they are where you apply for services.13 The call is toll-free, the CARES assessment is free, and the call can turn up benefits and programs a family 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 no new registry disclosure law, since SB 1068 died in committee.1 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.

Learn More

Find personalized help navigating Florida home care options 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.