Michigan Home Care vs Home Health 2026: What's the Difference?

In Michigan, "home care" and "home health" sound interchangeable, but the difference decides whether Medicare pays. Home health is short-term, skilled medical care that a doctor orders, and Medicare covers it at $0 to the patient when the person is homebound with a skilled need. Home care (also called non-medical home care or personal care) is longer-term help with daily life that Medicare does not cover. Michigan Medicaid can pay for both, through separate programs, and the two often run side by side for the same person.

The Simplest Explanation for Michigan Families

The decision turns on one test. A person who has just left the hospital or needs a procedure done that requires a nurse at home needs home health. A person who needs help bathing, dressing, or taking medications every day for the foreseeable future needs home care. Many people need both at once, and the two services can be coordinated together.

Home Health in Michigan

Home health is skilled, medical care. Medicare pays for it only when a Medicare-certified home health agency provides it, so certification is the first thing to confirm when you choose an agency.1

What Home Health Covers

Medicare's covered home health services are:

• Skilled nursing
• Physical therapy, occupational therapy, and speech-language pathology
• Medical social services
• Home health aide services, such as help with walking, bathing or grooming, and feeding, but only while the patient also needs skilled care
• Certain medical supplies and durable medical equipment1

All home health services must be ordered under a plan of care from a physician or allowed practitioner, provided to a homebound patient, and tied to an intermittent skilled need.1

Medicare's Home Health Rules

Medicare covers home health when all of the following are true: a physician or allowed practitioner establishes and reviews a plan of care; the patient is homebound, meaning their condition makes leaving home inadvisable or they need help such as a cane, walker, wheelchair, or another person to leave, and they normally can't leave home and leaving takes a lot of effort; the patient needs intermittent skilled care; and a Medicare-certified home health agency provides it.1,6 Leaving home for medical treatment, or for short, infrequent non-medical absences such as religious services, does not disqualify a homebound patient, and neither does attending adult day care.6

"Part-time or intermittent" generally means combined skilled nursing and home health aide services furnished less than 8 hours each day and 28 or fewer hours each week (up to 35 hours per week on case-by-case review). For covered home health services, the patient generally pays $0; for durable medical equipment, the patient pays 20% of the Medicare-approved amount after the Part B deductible.1

Medicare home health does not cover 24-hour-a-day care at home, meals delivered to the home, homemaker services unrelated to the care plan, or custodial personal care when that is the only care needed. Those are home care, and a different payer must cover them.1

Michigan Medicaid Home Health

Michigan Medicaid covers medically necessary home health care, and some services may require prior approval.7 Home health is a required Medicaid benefit in every state, and federal Medicaid rules do not let it be limited to people who are homebound, so a Medicaid member who needs skilled home nursing does not have to meet Medicare's homebound standard.8 For people enrolled in both Medicare and full Medicaid, Medicare pays first for Medicare-covered services, and Medicaid pays last and may cover services Medicare does not.9

Finding a Home Health Agency in Michigan

• Medicare Care Compare lets you look up and compare Medicare-certified agencies that serve your area.
• Hospital discharge planners routinely refer to home health agencies; ask for two or three options.
• For a clinical event such as a hospitalization or a fall, the primary care physician's office can put a home health referral in motion. For a patient who qualifies, the covered home health services themselves cost $0.1

Home Care in Michigan

Home care is typically non-medical: help with activities of daily living rather than skilled nursing. Several funding streams pay for different forms of home care.

Who Pays for Home Care

Medicaid Home Help Program. Medicaid funds this MDHHS personal care benefit for people who need hands-on help with activities of daily living, and need is set by an in-person, face-to-face assessment in the client's home by a Michigan Department of Health and Human Services (MDHHS) Adult Services Worker. The 2026 individual caregiver pay rate is $17.13 per hour, effective January 1, 2026. The client chooses the caregiver, who must be 18 or older, pass a criminal history screen, and meet MDHHS's other caregiver criteria. The program bars a responsible relative (a spouse, or a parent of a minor child) from being paid, and the manual names no other relationship as barred. A spouse cannot be the paid provider, and the rule reaches eligibility itself: a spouse must be unable or unavailable to give the care for the client to qualify for Home Help. See the Home Help guide.2

Medicaid MI Choice Waiver. MI Choice is Michigan's 1915(c) Home and Community-Based Services waiver for people 65 or older, or adults 18 or older with disabilities, who meet a nursing-facility level of care and Medicaid's financial rules. Its income test is more generous than ordinary Medicaid's, up to 300% of the SSI federal benefit rate, but an applicant over that limit cannot spend down medical bills to qualify.3 On top of Michigan Medicaid's regular benefits, participants get supports coordination and waiver services such as adult day health, community living supports, home delivered meals, respite, and personal emergency response systems.7 Because it is a capped waiver rather than an entitlement, capacity is limited and each waiver agency is allocated a specific number of slots each fiscal year, which MDHHS can reallocate; when participants exceed capacity, screened applicants are placed on the waiver agency's waiting list, ordered by priority and then by service-request date. That ranking is not a guarantee of enrollment order: the approved waiver application notes that because of unique circumstances pertaining to each applicant, actual enrollment may vary from an individual's waiting list ranking.3 Its self-direction option is closed to spouses, but that is not the only door: Michigan's CMS-approved waiver application allows a spouse to be paid as a provider of Community Living Supports in limited situations, hired through a home care agency in the waiver agency's network that supervises the work, when the participant requires extraordinary care.4 See the MI Choice guide.

VA benefits. Aid and Attendance adds a monthly payment to the VA pension of a veteran who qualifies.10 VA's Homemaker and Home Health Aide program sends a trained aide, supervised by a registered nurse, to help an enrolled veteran with daily activities such as bathing and dressing, where the veteran is eligible for community care, meets the clinical criteria, and the service is available.11 Veteran-Directed Care gives a veteran a flexible budget to hire their own personal care aides, which can include a family member or neighbor.12

Long-term care insurance. A policy may help pay for private-pay home care; read it for what it covers, its benefit cap, and its elimination period.

Private pay. This is the default path for families without Medicaid or VA coverage.

What Home Care Costs in Michigan in 2026

Brevy's cost figures come from the CareScout 2025 Cost of Care Survey, released in March 2026. Beginning with the 2025 survey, CareScout merged the former "homemaker" and "home health aide" categories into a single non-medical caregiver rate, a change CareScout attributes to the two rates converging. In Michigan, that non-medical caregiver rate runs about $6,626 per month (roughly $79,508 per year, or about $35 per hour), essentially on par with the national median of $80,080 per year. CareScout calculates the annual figure as 44 hours of care per week for 52 weeks.5

That puts home care above assisted living and well below nursing-home care in Michigan:

These are statewide survey medians, not government rates, and costs vary within Michigan. For assisted living, CareScout's Michigan release gives $69,000 a year and its data tables give $69,816 ($5,818 a month).13

How to Check Out a Home Care Provider

Medicare certification matters for home health, because Medicare pays only a Medicare-certified agency.1 It tells you nothing about a private-pay home care agency, so ask any private home care agency directly about:

• Background-check procedures for caregivers
• Bonding and liability insurance
• Supervision model (is a nurse or care coordinator overseeing the aides?)
• Backup staffing if the assigned caregiver is unavailable
• Workers' compensation coverage for the aide

For Medicaid Home Help, individual providers must pass a criminal background check and enroll in Michigan's CHAMPS provider system before being paid.2

Using Home Care and Home Health Together

A common Michigan scenario: a parent is discharged from the hospital after a hip replacement. The care plan typically splits in two:

• Home health, ordered by the physician, including a nurse to check the surgical site, physical therapy to rebuild mobility, and occupational therapy to adapt the bathroom. Medicare covers this while the skilled need lasts.1
• Home care to help with showering, cooking, and medication reminders. While the nurse or therapist is still visiting, ask the home health agency for Medicare-covered home health aide hours for bathing and similar hands-on help; those hours end when the skilled care ends.1 Medicare does not pay for this help when it is the only care needed, but Medicaid Home Help can, or private pay can bridge the gap.

Both services can run at the same time. They are paid by different sources, but they can be coordinated by the same family.

Independent Caregivers vs. Agency Caregivers

For private-pay home care, families choose between two arrangements:

Agency-employed caregivers. The agency handles payroll, taxes, background checks, scheduling, and backup coverage, and the family has less direct control over which caregiver shows up.

Independently hired caregivers. The family hires the worker directly and takes on payroll, background checks, and backup coverage itself. A family that hires a caregiver directly and controls how the work is done becomes a household employer for tax purposes. If it pays a household employee cash wages of $3,000 or more in 2026, it generally must withhold the employee's 7.65% share (6.2% Social Security tax plus 1.45% Medicare tax) and pay a matching 7.65% employer share, 15.3% of cash wages in total; paying total cash wages of $1,000 or more in any calendar quarter generally triggers federal unemployment (FUTA) tax, which is never withheld from the employee. Wages paid to your own spouse or your child under 21 do not count toward either threshold. Wages paid to your parent never count toward the FUTA test and, outside a narrow IRS exception, do not count toward the Social Security and Medicare test either. A caregiver provided by an agency that controls what work is done and how is not the family's employee, though hiring through an agency does not by itself change that when the family still controls how the work is done.14

In Medicaid Home Help, the client, not the State of Michigan, is the caregiver's employer, with the right to hire and fire, while Medicaid funds the hourly rate. Private pay requires the family to handle payroll itself or hire a payroll service.2

Common Misconceptions

Medicare does not cover long-term home care. Medicare home health requires an intermittent skilled need, and its home health aide hours end when that skilled care ends. Long-term custodial home care is funded through Medicaid, the VA, long-term care insurance, or private pay.1

Going to church does not disqualify a person from Medicare home health. Leaving for medical treatment, or for short, infrequent non-medical outings such as religious services, is allowed under the homebound rule, as is attending adult day care, so a person who leaves home occasionally can still qualify.6

Home Help and Medicare home health are different programs. They have different rules, funding, and covered services. Home Help is non-medical personal care; Medicare home health is skilled medical care.2

Home care in Michigan is reachable for many families. Medicaid Home Help pays individual caregivers $17.13 per hour in 2026, and the client chooses who that caregiver is, within MDHHS's caregiver criteria.2 VA benefits add another layer for veterans. Even private-pay home care, at about $6,626 per month, sits below the cost of nursing-home care.5,13

Medicare certification does not vouch for a private home care agency. Certification is what lets a home health agency bill Medicare; it says nothing about a private-pay home care agency, so ask the agency directly about caregiver screening, bonding, insurance, and supervision.1

Related Terms

• HCBS waiver: The federal authority under MI Choice.
• Consumer Directed Services (CDS): The general term for self-direction options like MI Choice's.
• Activities of Daily Living (ADLs): The functional basis for a home care assessment.

Learn More

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, 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.