These two terms sound interchangeable, but they aren't. Home health is short-term, skilled medical care. Home care (sometimes called non-medical home care or personal care) is longer-term help with daily life. Medicare pays for home health but not home care. Medicaid can pay for both through separate programs. They often work alongside each other for the same person.
This guide explains the 2026 Michigan landscape of both services, who qualifies, who pays, what it costs, and how to tell if you need one, the other, or both.
The Simplest Explanation
| Service | What it is | Typical duration | Main payer |
|---|---|---|---|
| Home health | Skilled nursing, physical/OT/speech therapy, home health aide under nurse supervision | Short-term (weeks to a few months) | Medicare; Medicaid for extended cases |
| Home care | Help with ADLs, meal prep, housekeeping, companionship | Long-term (ongoing) | Medicaid (Home Help, MI Choice); VA; private pay |
A useful decision test: If you just had a hospitalization or need a procedure done that requires a nurse at home, that's home health. If you need help bathing or taking medications every day for the foreseeable future, that's home care.
Home Health in Michigan
Home health is licensed and regulated by LARA Bureau of Community and Health Systems. Agencies must be Medicare-certified to bill Medicare and Medicaid-enrolled to bill Medicaid.
What Home Health Covers
- Skilled nursing (wound care, injections, IV therapy, catheter care, patient education)
- Physical therapy (gait training, strength rebuilding post-surgery or post-stroke)
- Occupational therapy (ADL retraining, adaptive equipment training)
- Speech-language pathology (post-stroke speech and swallow rehab)
- Medical social work (linking patients to community resources)
- Home health aide services, but only under RN supervision and typically short-term
All home health services must be ordered by a physician, provided to a homebound patient, and limited to medically necessary skilled needs with measurable goals.
Medicare's Home Health Rules
Medicare Part A or B (depending on circumstances) pays for home health when:
- A doctor certifies the patient needs intermittent skilled care.
- The patient is homebound: meaning leaving home requires considerable effort or assistance, though brief absences for medical appointments, religious services, adult day care, or family events don't disqualify.
- The care is intermittent (not 24/7) and time-limited (not custodial long-term care).
- The provider is a Medicare-certified home health agency.
Medicare pays 100% of the approved costs: no deductible, no coinsurance for the services themselves. If the home health aide portion exceeds 28 hours per week, that's generally when Medicare stops covering.
Medicare does NOT pay for:
- 24-hour home care.
- Custodial personal care when that's the only need.
- Meal delivery.
- Homemaker services.
- Home health beyond what a doctor certifies is skilled and needed.
Medicaid Home Health
For Michigan Medicaid members, home health is a covered benefit when medically necessary. It's delivered by Medicaid-enrolled home health agencies, often the same ones that serve Medicare patients.
Finding a Home Health Agency
- Medicare Home Health Compare (medicare.gov/care-compare) rates all Medicare-certified agencies on a 5-star scale.
- Michigan Home Care & Hospice Association directory.
- Hospital discharge planners routinely refer to agencies; ask for options.
Home Care in Michigan
Home care is typically non-medical: help with activities of daily living, not skilled nursing. Different funding streams pay for different flavors of home care.
Who Pays for Home Care
Medicaid Home Help Program: the primary Michigan Medicaid home care pathway for seniors. 2026 pay rate $17.13/hour, no waitlist, but spouses cannot be hired. See the Home Help guide.
Medicaid MI Choice Waiver: broader services including home care (called "Community Living Supports" within MI Choice), plus respite, adult day, home modifications, and more. See the MI Choice guide.
VA benefits: A&A pension, Veteran-Directed Care, PCAFC stipends, and home-based primary care all cover home care in different ways for veterans.
Long-term care insurance: most policies pay daily benefits that offset private-pay home care costs.
Private pay: the default path for families without Medicaid or VA coverage. 2026 Michigan private-pay home care rates:
- Non-medical home care (ADLs, companionship): $25-$35/hour
- CNA-level care: $28-$38/hour
- Specialized dementia or medically complex care: $30-$45/hour
- Live-in or 24-hour: typically structured at a daily rate.
Costs vary by geography: Detroit metro and Ann Arbor are higher; Upper Peninsula and rural Michigan are lower.
Licensing of Home Care Providers
Michigan has multiple licensing categories relevant to home care:
- Home Help individual providers: must enroll in CHAMPS, pass background checks. Not separately "licensed" as a business.
- Private home care agencies: not licensed at the state level in Michigan unless they offer home health. This is a gap families should know: Michigan does not license non-medical home care agencies the same way it licenses home health.
- Home health agencies (skilled): licensed by LARA and certified by Medicare/Medicaid.
Because non-medical home care agencies aren't licensed in Michigan, families should ask agencies specifically about:
- Background check procedures for caregivers.
- Bonding and liability insurance.
- Supervision model (is there a nurse or care coordinator overseeing aides?).
- Backup staffing if the assigned caregiver is unavailable.
- Worker's compensation coverage for the aide.
Using Home Care and Home Health Together
A common real-life scenario: your mother is discharged from the hospital after a hip replacement. She needs:
- Home health ordered by her doctor: a nurse to check the surgical site, PT to help her regain mobility, OT to adapt her bathroom. Medicare covers this for several weeks.
- Home care to help with showering, cooking, and medication reminders. Medicare doesn't pay for this: but Medicaid Home Help might, or private pay can bridge the gap.
Both services can run simultaneously. They're paid by different sources but can be coordinated by the same family.
Not sure which service your family needs: or how to get Michigan Medicaid to help pay? Chat with Brevy for a walkthrough of Home Help, MI Choice, Medicare home health, and private-pay options.
Independent Caregivers vs. Agency Caregivers
For private-pay home care specifically, families choose between:
Agency-employed caregivers:
- Agency handles payroll, taxes, background checks, scheduling, backup coverage.
- Higher hourly rate ($25-$45/hour).
- Less direct control over which caregiver shows up.
Independent (self-employed) caregivers:
- Family hires directly; family is the employer.
- Lower hourly rate ($18-$28/hour typically).
- Family handles all employer responsibilities (payroll, workers' comp, background checks, backup).
- Family assumes IRS household employer responsibilities if paying $2,700+/year to any one worker.
For Medicaid Home Help or MI Choice SDO participants, CHAMPS handles the employer paperwork on behalf of the family. Private pay requires the family to handle it or hire a payroll service.
Common Misconceptions
"Medicare covers long-term home care." Medicare does not. Medicare home health is medical and time-limited. Long-term custodial home care runs through Medicaid, VA, LTC insurance, or private pay.
"I'm not 'homebound' because I go to church on Sundays." You probably still qualify for Medicare home health. Brief absences for appointments, religious services, family events, or adult day care are allowed under the homebound rule.
"Home Help and Medicare home health are the same program." They're different programs with different rules, funding, and covered services. They can run simultaneously.
"I can't afford home care in Michigan." Medicaid Home Help pays caregivers $17.13/hour in 2026, which makes family caregiving financially feasible. VA benefits add another layer for veterans. Even private-pay rates are below memory care or nursing home costs.
"The home care agency in Michigan is licensed so it must be vetted." Non-medical home care agencies are NOT state-licensed in Michigan. Home health is. Ask the agency directly about their caregiver screening, bonding, and supervision.
Frequently Asked Questions
Home health is short-term, medical, and physician-ordered: skilled nursing, physical therapy, occupational therapy, speech therapy, and home health aide services under nurse supervision. Home care is long-term, non-medical help with activities of daily living: bathing, dressing, meal prep, medication reminders, housekeeping. Medicare pays for home health; Medicare does not pay for home care. Medicaid, VA benefits, long-term care insurance, and private pay cover home care.
No. Medicare covers home health (skilled, physician-ordered, intermittent, time-limited care for a homebound patient), not custodial home care. Long-term home care in Michigan is paid through Medicaid Home Help ($17.13/hour in 2026, no waitlist), the MI Choice Waiver, VA benefits, LTC insurance, or private pay.
Non-medical home care runs $25-$35/hour, CNA-level care $28-$38/hour, and specialized dementia or medically complex care $30-$45/hour. Live-in or 24-hour care is usually structured at a daily rate. Detroit metro and Ann Arbor are higher; Upper Peninsula and rural Michigan are lower.
Not through the Home Help Program: spouses are explicitly excluded. For paid spousal caregiving in Michigan, the pathway is the MI Choice Waiver Self-Determination Option (SDO), which does permit spouses. See the Home Help guide and MI Choice guide for details.
No. Michigan licenses home health agencies (skilled, medical) through LARA, but non-medical home care agencies are not separately state-licensed. Families should ask any private home care agency about their caregiver background check procedures, bonding and liability insurance, supervision model, backup staffing, and workers' compensation coverage before signing.
Related Terms
- HCBS waiver: The federal authority under MI Choice.
- Consumer Directed Services (CDS): National term for MI Choice's SDO.
- Activities of Daily Living (ADLs): The functional basis for home care assessment.
Learn More
- Michigan Home Help Program
- MI Choice Waiver Program
- How to Get Paid to Care for a Family Member in Michigan
- Michigan VA Senior Care Benefits
- Michigan Assisted Living
- Michigan Memory Care
Find personalized help choosing between home care and home health options at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, medical, or financial advice. Medicare, Medicaid, and VA rules change. Always verify current coverage with the agency or program directly. Brevy is not a law firm, financial advisor, or healthcare provider.