In Florida, "home health" and "home care" are two different services, regulated separately by the state, and only one of them is the kind of care Medicare pays for. Home health is skilled, doctor-ordered care from a licensed Home Health Agency that Medicare covers when someone is homebound and needs intermittent skilled care; non-medical home care is help with housekeeping and companionship that families pay for privately or through Medicaid.
This guide draws the line between the two. Both are overseen by the Florida Agency for Health Care Administration (AHCA), but under different rules, by different provider types, with different payers. Getting the labels straight is how families avoid paying out of pocket for care a program would have covered, or waiting on coverage that was never going to come.
In This Guide
- Key Takeaways
- The Core Difference
- Home Health: The AHCA-Licensed Home Health Agency
- Home Care: Homemaker and Companion Providers
- Which One Do You Need?
- What It Costs
- Frequently Asked Questions
The Core Difference
The split is medical versus non-medical, and in Florida it decides three things at once: who provides the care, what kind of AHCA oversight that provider holds, 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 home health aide working under that clinical plan. Wound care after surgery, IV medication, injections a patient can't manage alone, therapy to rebuild function after a stroke or a fall. These are skilled needs.
Home care is non-medical. No clinical license is involved in the work. In Florida, a Homemaker and Companion Services provider handles light housekeeping, cooking, running errands, transportation, and companionship. The person can be medically stable and still want this help every day.
One Florida rule surprises families often enough that it is worth stating plainly. Personal care, the hands-on help with bathing, dressing, and toileting, is not what a homemaker and companion provider does. By Florida law those providers cannot give personal care or nursing. Personal care sits with a home health aide working under a licensed Home Health Agency, or it's funded through Medicaid. So a family that hires a companion expecting help with a bath has hired the wrong service. The section below on which one you need walks through how to place a real situation.
Home Health: The AHCA-Licensed Home Health Agency
Skilled home health in Florida is delivered by a Home Health Agency (HHA) that AHCA licenses. A licensed HHA can enroll as a Medicare and Medicaid provider, and it employs or contracts the clinical staff, registered nurses, therapists, and home health aides, who carry out the plan of care a physician has ordered. This is the agency type that bills Medicare.
Medicare's home health benefit covers this care when a beneficiary meets the conditions. The two that trip families up most:
- Homebound. Leaving home takes considerable, taxing effort, and the person generally needs help or an assistive device to do it. Short, occasional trips out, to a medical appointment or 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 skilled services: the nursing visits, the therapy, and the home health aide help that is tied 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 purpose. That's home care, and it's the next section.
A separate AHCA category, the Nurse Registry, also exists in Florida. A nurse registry refers independent caregivers, including nurses and aides, to clients rather than employing them directly. It's regulated by AHCA under its own rules and is a distinct path from both a licensed HHA and a homemaker and companion provider. For most families weighing the home health versus home care question, the choice is between those first two, but it helps to know the registry option is there.
Home Care: Homemaker and Companion Providers
Non-medical home care in Florida comes from Homemaker and Companion Services providers, who register with AHCA. Registration is a lighter form of oversight than the licensure a Home Health Agency carries, which fits the lighter scope of the work: housekeeping, cooking, errands, transportation, and companionship. There's no doctor's order behind it and no clinical staff doing the hands-on work.
The line Florida draws here is firm. A homemaker and companion provider cannot provide personal care or nursing. That means no bathing, no dressing, no help with toileting or transfers, no medication administration. Those tasks belong to a home health aide under a licensed HHA, or they're funded through Medicaid. A family that needs hands-on personal help, not just housekeeping and company, is shopping for the wrong category if it's only looking at homemaker and companion services.
One line is worth stating plainly. Medicare does not pay for non-medical home care. A family expecting Medicare to cover a companion or homemaker for daily help will find it won't, no matter how much that help is needed. The ways to pay for non-medical home care are private funds, private insurance, or Medicaid.
For low-income older Floridians, Medicaid funds in-home care through the Statewide Medicaid Managed Care Long-Term Care program, usually shortened to SMMC-LTC. A person who qualifies is enrolled in a managed care plan that arranges and pays for long-term care services at home, which can include personal care and homemaker help, as an alternative to a nursing home. The financial and clinical eligibility rules, and the wait involved, have their own mechanics; our Florida Medicaid Long-Term Care Waiver guide covers them. The point here is simply that SMMC-LTC, not Medicare, is the public program that pays for non-medical home care in Florida.
Which One Do You Need?
Start with the need, not the brochure. The table maps the two services across the dimensions that decide who provides the care and who pays.
| Home Health (Home Health Agency) | Home Care (Homemaker and Companion) | |
|---|---|---|
| What it is | Skilled medical care: nursing, physical/occupational/speech therapy, home health aide services | Non-medical help: housekeeping, cooking, errands, transportation, companionship (no personal care or nursing) |
| Who provides it | A Home Health Agency licensed by AHCA, with clinical staff under a doctor's plan of care | A Homemaker and Companion Services provider registered with AHCA |
| Regulated by | AHCA, by licensure; can enroll in Medicare and Medicaid | AHCA, by registration |
| Who pays | Medicare (when homebound + intermittent skilled need), Medicaid, or private insurance | Private pay; Medicaid via SMMC-LTC for those who qualify. Medicare does not pay |
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 from a licensed HHA, and Medicare is the payer to check first. If the need is help with bathing, dressing, or other hands-on personal care, that's also a home health aide under an HHA, or it's covered through Medicaid, never a homemaker and companion provider. And if the need is purely housekeeping, errands, meals, and company, with no hands-on or medical component, a homemaker and companion provider fits, paid privately or through SMMC-LTC. Many families end up arranging more than one of these at once.
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 home care side, where families pay out of pocket unless Medicaid covers it.
For in-home care in Florida, the statewide median ran about $68,640 a year for a home health aide in 2024, according to the Genworth/CareScout Cost of Care Survey, which is roughly $5,720 a month at a full-week schedule. Homemaker services ran at about the same statewide median that year. These are approximate industry survey medians, not government rates and not maximums, so what a specific agency charges can land above or below them, and high-cost metros like Miami, Naples, and the Florida Keys run materially higher than rural counties. Many families also use fewer hours than a full week and pay less.
For Floridians who qualify for Medicaid, that private cost can be covered instead through SMMC-LTC, which arranges and pays for long-term care at home for enrollees who meet the program's financial and clinical rules.
Frequently Asked Questions
No. Medicare does not pay for non-medical home care, the housekeeping, errands, meals, and companionship a homemaker and companion provider supplies. Medicare's home health benefit covers skilled, doctor-ordered care (nursing and therapy) from a licensed Home Health Agency for people who are homebound and need it on an intermittent basis. For non-medical home care, the options are private pay or, for those who qualify, Medicaid through the SMMC-LTC program.
Home health is skilled medical care a doctor orders and a licensed clinician delivers, from a Home Health Agency licensed by AHCA, and Medicare covers it when the person is homebound and needs intermittent skilled care. Non-medical home care is help with housekeeping, errands, and companionship from a Homemaker and Companion Services provider registered with AHCA, and Medicare does not cover it. 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.
No. Under Florida law, Homemaker and Companion Services providers cannot give personal care, which includes bathing, dressing, toileting, and transfers, or any nursing. That hands-on personal care has to come from a home health aide working under a licensed Home Health Agency, or be funded through Medicaid. If the help your parent needs is mostly with the body rather than the household, a homemaker and companion provider is the wrong category.
For low-income older Floridians who qualify, Medicaid funds in-home long-term care through the Statewide Medicaid Managed Care Long-Term Care program (SMMC-LTC). A person enrolled in an SMMC-LTC managed care plan can receive personal care and homemaker services at home as an alternative to a nursing home. Eligibility has its own financial and clinical tests and often a wait; see our Florida Medicaid Long-Term Care Waiver guide for the mechanics.
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 (a homemaker for meals and housekeeping). The two run on separate tracks with separate payers, so arranging one does not arrange or pay for the other.
Learn More
- Home Care in Florida
- Nursing Homes in Florida
- Florida Medicaid Long-Term Care Waiver
- Florida Medicaid (the full guide)
Find personalized help arranging care at home in Florida 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.