"Home care" and "home health" sound interchangeable, but in Louisiana they're two separately licensed services, and which one you need decides who pays. The state licenses a Home Health Agency to deliver skilled, doctor-ordered care that Medicare can cover, and separately licenses Personal Care Attendant and other home and community-based providers 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. The label that 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: Personal Care Attendant and HCBS
- Which One Do You Need?
- What It Costs
- Frequently Asked Questions
The Core Difference
The split is skilled versus non-medical, and in Louisiana it's written into two different licenses. The Louisiana Department of Health Health Standards Section doesn't lump in-home care under one rulebook. It licenses a Home Health Agency to deliver skilled care, and it licenses Personal Care Attendant and other HCBS providers, under a separate set of rules, to deliver non-medical help.
A Home Health Agency provides skilled, physician-ordered care: skilled nursing plus at least one of physical therapy, speech therapy, occupational therapy, medical social services, or home health aide service, ordered because the person has a medical need only a licensed professional can meet. Wound care after surgery, IV medication, injections a patient can't manage alone, therapy to rebuild strength after a stroke or a fall. The care is intermittent, not round-the-clock.
A Personal Care Attendant or other HCBS provider delivers non-medical support: help with activities of daily living and the everyday tasks that keep someone safe at home. The person can be medically stable and still need this help every day. Before Louisiana will license one of these providers, it must clear the state's Facility Need Review, a step the skilled home-health track runs separately from.
That separation is what decides the money. A Home Health Agency may also become Medicare-certified, which is the step that lets it bill Medicare for the skilled care it's licensed to deliver. A PCA or HCBS provider delivers care Medicare doesn't pay for at all. So when a Louisiana family hears "home health agency," that's shorthand for the skilled, often Medicare-certified track, and "personal care" 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 from different providers, 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 Louisiana comes from a Home Health Agency licensed by the Department of Health's Health Standards Section, 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. To hold the license, an agency must offer skilled nursing plus at least one of physical therapy, speech therapy, occupational therapy, medical social services, or home health aide service. The state license is 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 will not 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: Personal Care Attendant and HCBS
Non-medical home care in Louisiana comes from a Personal Care Attendant or other home and community-based service provider, separately licensed by the Health Standards Section to provide help with daily living and everyday support. One licensing detail sets this track apart: before a PCA or HCBS provider can be licensed, it must clear the state's Facility Need Review. Because the care 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.
- Louisiana Medicaid waivers. For low-income Louisianans, Louisiana Medicaid funds non-medical in-home care through its 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 Louisianans, a Louisiana 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 license is your first clue: a Home Health Agency delivers skilled care, while a PCA or HCBS provider delivers the non-medical help.
| Home Health Agency (Skilled) | Personal Care Attendant / HCBS (Non-Medical) | |
|---|---|---|
| What it is | Skilled, physician-ordered care: skilled nursing plus at least one of physical, speech, or occupational therapy, medical social services, or home health aide service, on an intermittent basis | Everyday non-medical help with activities of daily living (bathing, dressing, eating, mobility) and the support that keeps someone safe at home |
| Who provides it | An LDH-licensed Home Health Agency, often Medicare-certified, and its clinical staff (nurses and therapists) | A separately LDH-licensed PCA or HCBS provider, which must clear Facility Need Review, and its attendants |
| Who pays | Medicare (when homebound + intermittent skilled need) | Private pay, long-term care insurance, or a Louisiana Medicaid home and community-based waiver for eligible low-income Louisianans |
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 PCA or HCBS provider, and the question becomes whether to pay privately or qualify through a Louisiana Medicaid waiver. Both can be in play at once, and plenty of Louisiana 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 Louisiana Medicaid waiver covers it.
For non-medical home care in Louisiana, a home health aide ran about $50,336 a year in 2024, according to the CareScout/Genworth Cost of Care Survey, on a basis of 44 hours a week. That sits below the national median for the same survey, making Louisiana one of the more affordable states for in-home care. These are industry survey medians, not government rates and not a maximum, so what a specific Louisiana agency charges can land above or below them, and the New Orleans and Baton Rouge 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 Louisianans who qualify, that private cost can be covered instead through a Louisiana Medicaid home and community-based waiver.
Frequently Asked Questions
No. Medicare does not pay for non-medical personal care, the help with bathing, dressing, meals, and everyday support that an attendant 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 Louisianans, a Louisiana 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 Louisiana, the Department of Health licenses the two separately: a Home Health Agency for the skilled care, and a Personal Care Attendant or HCBS provider for the non-medical help.
A Personal Care Attendant (PCA) is one of the home and community-based service providers the Louisiana Department of Health Health Standards Section licenses to deliver non-medical support: help with activities of daily living and similar everyday tasks. It's a separate license class from a Home Health Agency, the provider must clear the state's Facility Need Review before licensure, and the care it provides is the kind Medicare does not pay for. Low-income Louisianans may have it covered through a Louisiana Medicaid waiver instead.
Yes. For eligible low-income Louisianans, Louisiana Medicaid funds non-medical in-home care through its home and community-based waivers, so a person can stay at home rather than enter a facility. Eligibility and enrollment run through the state, which is where a family begins.
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 attendant for bathing and meals). The two run on separate payment tracks, Medicare for the skilled care and private pay or a Louisiana Medicaid waiver for the personal care, so arranging one does not arrange or pay for the other.
Learn More
- Assisted Living in Louisiana
- Nursing Homes in Louisiana
- Memory Care in Louisiana
- Medicaid Planning Strategies
- Caregiver Burnout: Signs and Support
Find personalized help arranging in-home care in Louisiana 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.