"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 pay for on its own.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services,U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualifications for coverage of services (eCFR, current). ecfr.gov. Retrieved Aug 3, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-409/subpart-E/section-409.42
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
- Home Care vs. Home Health in Kentucky: 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 Home Care and Home Health Cost in Kentucky
- Frequently Asked Questions
Home Care vs. Home Health in Kentucky: 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services,U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualifications for coverage of services (eCFR, current). ecfr.gov. Retrieved Aug 3, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-409/subpart-E/section-409.42
A Personal Services Agency provides non-medical in-home help with everyday living. The person can be medically stable and still need this help every day.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services
That separation is what decides the money. A Kentucky Home Health Agency applies to the OIG for a license (some facility types also need a certificate of need first), and for Medicare to pay, the care must come from a Medicare-certified agency.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services A Personal Services Agency provides care Medicare doesn't pay for when it's the only care a person needs. 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. The state license is the floor; for Medicare to pay for those services, the agency must also be Medicare-certified.
Medicare's home health benefit covers this care when a beneficiary meets the conditions, and for the covered skilled services the beneficiary generally pays $0.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services,U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualifications for coverage of services (eCFR, current). ecfr.gov. Retrieved Aug 3, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-409/subpart-E/section-409.42 The two that trip families up most:
- Homebound. The person is normally unable to leave home, leaving takes a lot of effort, and either their condition makes leaving inadvisable or they need help to get out, such as a cane, wheelchair, walker, or another person. Homebound doesn't mean never leaving: trips for medical treatment and short, infrequent absences for things like religious services are allowed.Centers for Medicare & Medicaid Services. (n.d.). Home Health Services Coverage - Medicare.gov. medicare.gov. Retrieved Oct 13, 2026, from https://www.medicare.gov/coverage/home-health-services
- Intermittent skilled need. A physician or allowed practitioner sees the person in person and certifies that they need 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. Federal rules read "part-time or intermittent" as combined skilled nursing and home health aide services under 8 hours a day and 28 or fewer hours a week (up to 35 on case-by-case review).U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualifications for coverage of services (eCFR, current). ecfr.gov. Retrieved Aug 3, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-409/subpart-E/section-409.42
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, deliver meals, or provide 24-hour care. That's personal care, and it's the next section.U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualifications for coverage of services (eCFR, current). ecfr.gov. Retrieved Aug 3, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-409/subpart-E/section-409.42
Home Care: The Certified Personal Services Agency and Who Pays
Non-medical home care in Kentucky comes from a Personal Services Agency (PSA), certified (rather than licensed) by the OIG to provide non-medical in-home help.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services 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 Kentuckians who qualify financially for Medicaid and need a nursing-facility level of care, the Home and Community Based (HCB) waiver covers services such as attendant care so a person can stay at home rather than enter a facility. It currently has a waiting list, so apply early.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY
- 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 when that is the only care a person needs.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services A family expecting Medicare to cover an aide for daily help, with no skilled care in the picture, will find it won't. The ways to pay for personal care are private funds, long-term care insurance, or, for eligible Kentuckians, a Kentucky Medicaid waiver.
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services
| 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 with daily living activities, like bathing and dressing, that keeps someone safe at home |
| Who provides it | An OIG-licensed Home Health Agency (Medicare-certified, for Medicare to pay) and its clinical staff (nurses and therapists) | An OIG-certified Personal Services Agency and its non-medical staff |
| Who pays | Medicare (when homebound + part-time or intermittent skilled need) | Private pay, long-term care insurance, or Kentucky Medicaid home and community-based waivers for eligible 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 Home Care and Home Health Cost in Kentucky
Home health, when Medicare covers it, generally costs the beneficiary $0 for the covered skilled services.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services,U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualifications for coverage of services (eCFR, current). ecfr.gov. Retrieved Aug 3, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-409/subpart-E/section-409.42 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 non-medical caregiver ran about $74,360 a year in 2025, according to the CareScout 2025 Cost of Care Survey (released March 2026), on a basis of 44 hours a week, or roughly $6,197 a month.Genworth Financial. (2025). CareScout Releases 2025 Cost of Care Survey Results. investor.genworth.com. Retrieved Aug 3, 2026, from https://investor.genworth.com/news-events/press-releases/detail/1054/carescout-releases-2025-cost-of-care-survey-results The 2025 survey combined the older "homemaker" and "home health aide" lines into a single non-medical caregiver category. 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 CareScout cautions that real costs vary with individual care needs, provider availability, and local market conditions. A family using fewer hours than the full-week assumption will pay less than the annual figure suggests.
For context, here is where non-medical home care sits against the other main long-term care settings in Kentucky, all from the same 2025 survey:Genworth Financial. (2025). CareScout Releases 2025 Cost of Care Survey Results. investor.genworth.com. Retrieved Aug 3, 2026, from https://investor.genworth.com/news-events/press-releases/detail/1054/carescout-releases-2025-cost-of-care-survey-results
| Care setting | Median annual cost (Kentucky) |
|---|---|
| Assisted living | About $63,480 to $66,330 a year, the range between the two medians CareScout published for Kentucky (its only published monthly figure is $5,528) |
| Non-medical caregiver (home care, 44 hrs/week) | About $74,360 a year (roughly $6,197 a month) |
| Nursing home, semi-private room | About $116,618 a year (roughly $9,718 a month) |
| Nursing home, private room | About $135,050 a year (roughly $11,254 a month) |
For eligible Kentuckians, that private cost can be covered instead through Kentucky Medicaid home and community-based waivers.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY
Frequently Asked Questions
Does Medicare pay for home care in Kentucky?
Not on its own. Medicare does not pay for personal care that helps with daily living activities like bathing and dressing when that is the only care a person needs; aide help with those tasks can be covered only while the person also needs skilled home health care.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services,U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualifications for coverage of services (eCFR, current). ecfr.gov. Retrieved Aug 3, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-409/subpart-E/section-409.42 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 on its own, the options are private pay, long-term care insurance, or, for eligible Kentuckians, a Kentucky Medicaid waiver.
What is the difference between home care and home health in Kentucky?
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 when it's the only care needed.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services 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.
What is a Personal Services Agency in Kentucky?
A Personal Services Agency (PSA) is certified by the Cabinet for Health and Family Services, Office of Inspector General, to provide non-medical in-home help; the OIG certifies a PSA rather than licensing it.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services It's a separate path from a Home Health Agency, and the care it provides is the kind Medicare does not pay for when it's the only care needed. Eligible Kentuckians may have it covered through a Kentucky Medicaid waiver instead.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY
Does a Kentucky Home Health Agency need a Certificate of Need?
It may. A Kentucky Home Health Agency applies to the OIG for a license, and the OIG says many of the facility types on its application list must have a certificate of need or fire marshal approval before licensure, so an applicant should contact the office to find out whether those requirements apply. For Medicare to pay for its care, the agency must also be Medicare-certified.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services A Personal Services Agency follows a different path: the OIG certifies it rather than licensing it.
Can someone get both home health and personal care at the same time?
Yes.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Sep 4, 2026, from https://www.medicare.gov/coverage/home-health-services 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.
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