"Home care" and "home health" sound interchangeable, but in Kentucky they're two separately overseen services, and the difference decides who pays. The state's Office of Inspector General licenses a Home Health Agency to deliver skilled, doctor-ordered care that Medicare can cover, and certifies a Personal Services Agency for non-medical daily help that Medicare won't.
This guide draws that line so a family doesn't pay out of pocket for care a program would have covered, or wait on Medicare coverage that was never coming. What matters isn't the agency's name. It's whether the care is skilled or non-medical, and which program pays the bill.
In This Guide
- Key Takeaways
- The Core Difference
- Home Health: The Licensed Home Health Agency
- Home Care: The Certified Personal Services Agency and Who Pays
- Which One Do You Need?
- What It Costs
- Frequently Asked Questions
The Core Difference
The split is skilled versus non-medical, and in Kentucky it runs through two different paths at the same agency. The OIG doesn't put in-home care under one rulebook. It licenses a Home Health Agency to deliver skilled care, and it certifies a Personal Services Agency, on a separate path, to deliver non-medical help.
A Home Health Agency provides skilled, intermittent care: nursing and physical, occupational, or speech therapy that a physician orders because the person has a medical need only a licensed professional can meet. Wound care after surgery, an infusion a patient can't manage alone, therapy to rebuild strength after a stroke or a fall. The care is part-time and intermittent, not round-the-clock.
A Personal Services Agency provides non-medical support: attendant care, companion and sitter services, and homemaking. The person can be medically stable and still need this help every day.
That separation is what decides the money. A Kentucky Home Health Agency has to clear two gates before it operates, a Certificate of Need and a license, and it may then become Medicare-certified, which is the step that lets it bill Medicare for the skilled care it's licensed to deliver. A Personal Services Agency provides care Medicare doesn't pay for at all. So when a Kentucky family hears "home health agency," that's shorthand for the skilled, often Medicare-certified track, and "personal services" points to the non-medical one.
The same person often needs both at once. Someone discharged after a hip replacement might need home health (a nurse and a physical therapist for a few weeks) and also personal care (an aide for bathing and meals for months). Those come on different paths, and they run on separate payment tracks: Medicare pays for the skilled piece, and something else pays for the personal-care piece.
Home Health: The Licensed Home Health Agency
Skilled home health in Kentucky comes from a Home Health Agency licensed by the OIG, often one that has also earned Medicare certification. The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. The Certificate of Need and the state license are the floor; Medicare certification is the additional step that lets the agency bill Medicare for those services.
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 physician certifies that the person needs skilled nursing or therapy on a part-time or intermittent basis, under a plan of care the physician reviews, and the care comes from a Medicare-certified agency.
When those conditions are met, Medicare pays for the covered skilled services: the nursing visits, the therapy, and the home health aide help that's attached to that skilled care. What Medicare home health won't do is staff an aide in the home for general daily help with no skilled-care purpose. That's personal care, and it's the next section.
Home Care: The Certified Personal Services Agency and Who Pays
Non-medical home care in Kentucky comes from a Personal Services Agency (PSA), certified by the OIG to provide attendant care, companion and sitter services, and homemaking. Because it isn't skilled medical care, the payer picture looks nothing like home health.
Who pays for personal care comes down to a few routes:
- Private pay. Many families pay out of pocket, by the hour. This is the default when no one qualifies for a public program and the need is non-medical.
- Kentucky Medicaid. For low-income Kentuckians, non-medical in-home services are funded through Kentucky Medicaid home and community-based waivers, so a person can stay at home rather than enter a facility.
- Long-term care insurance. A private policy, if the person holds one, may reimburse personal-care hours.
One line is worth stating plainly. Medicare does not pay for non-medical personal care. A family expecting Medicare to cover an aide for daily help will find it won't, no matter how much that help is needed. The ways to pay for personal care are private funds, long-term care insurance, or, for eligible low-income Kentuckians, Kentucky Medicaid waivers.
Which One Do You Need?
Start with the need, not the brochure. The table maps the two services across the dimensions that decide what the care is and who pays. The path is your first clue: a Home Health Agency delivers skilled care, while a Personal Services Agency delivers the non-medical help.
| Home Health Agency (Skilled) | Personal Services Agency (Non-Medical) | |
|---|---|---|
| What it is | Skilled, physician-ordered care: nursing and physical, occupational, or speech therapy under a plan of care, on a part-time or intermittent basis | Everyday non-medical help: attendant care, companion and sitter services, and homemaking that keeps someone safe at home |
| Who provides it | An OIG-licensed Home Health Agency that holds a Certificate of Need, often Medicare-certified, and its clinical staff (nurses and therapists) | An OIG-certified Personal Services Agency and its attendants, companions, and homemakers |
| Who pays | Medicare (when homebound + intermittent skilled need) | Private pay, long-term care insurance, or Kentucky Medicaid home and community-based waivers for eligible low-income Kentuckians |
A quick way to place a situation: if a physician 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 a Personal Services Agency, and the question becomes whether to pay privately or qualify through a Kentucky Medicaid waiver. Both can be in play at once, and plenty of Kentucky families arrange both.
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 non-medical side, where families pay out of pocket unless a Kentucky Medicaid waiver covers it.
For non-medical home care in Kentucky, a home health aide ran about $77,792 a year in 2024, according to the CareScout/Genworth Cost of Care Survey, on a basis of 44 hours a week. Homemaker services in Kentucky ran about $73,216 a year on the same basis. These are industry survey medians, not government rates and not a maximum, so what a specific Kentucky agency charges can land above or below them, and the Louisville and Lexington areas tend to run higher than rural parts of the state. A family using fewer hours than the full-week assumption will pay less than the annual figure suggests.
For low-income Kentuckians who qualify, that private cost can be covered instead through Kentucky Medicaid home and community-based waivers.
Frequently Asked Questions
No. Medicare does not pay for non-medical personal care, the help with bathing, dressing, meals, and everyday support that an aide provides. Medicare's home health benefit covers skilled, physician-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, long-term care insurance, or, for eligible low-income Kentuckians, a Kentucky Medicaid waiver.
Home health is skilled medical care a physician orders and a licensed clinician delivers, covered by Medicare when the person is homebound and needs intermittent skilled care. Non-medical home care is everyday help with daily living that Medicare does not cover. In Kentucky, the OIG oversees the two on separate paths: a licensed Home Health Agency for the skilled care, a certified Personal Services Agency for the non-medical help.
A Personal Services Agency (PSA) is certified by the Cabinet for Health and Family Services, Office of Inspector General, to provide non-medical support: attendant care, companion and sitter services, and homemaking. It's a separate path from a Home Health Agency, and the care it provides is the kind Medicare does not pay for. Low-income Kentuckians may have it covered through a Kentucky Medicaid waiver instead.
Yes. A Kentucky Home Health Agency must obtain a Certificate of Need and be licensed before it operates, and it may then earn Medicare certification, the step that lets it bill Medicare for the skilled care it delivers. A Personal Services Agency follows a different path, OIG certification, because it provides non-medical care rather than skilled medical services.
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 personal care (an aide for bathing and meals). The two run on separate payment tracks, Medicare for the skilled care and private pay or a Kentucky Medicaid waiver for the personal care, so arranging one does not arrange or pay for the other.
Learn More
- Assisted Living in Kentucky
- Nursing Homes in Kentucky
- Memory Care in Kentucky
- Medicaid Planning Strategies
- Caregiver Burnout: Signs and Support
Find personalized help arranging in-home care in Kentucky 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.