"Home care" and "home health" sound interchangeable, but in New Hampshire they're licensed as two different things, and the difference decides who pays. Home health is the skilled nursing and therapy a doctor orders from a provider licensed under RSA 151:2, and it's what Medicare can cover; home care is non-medical daily help delivered under a separate set of rules.
This guide draws that line so a New Hampshire 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 word on the agency's sign, it's whether the care is skilled or non-medical, and which program pays the bill.
In This Guide
- Key Takeaways
- The Two Services, Defined
- What Medicare Covers
- What It Costs and Other Ways to Pay
- How to Choose and Vet an Agency
- Frequently Asked Questions
The Two Services, Defined
The split is skilled versus non-medical, and New Hampshire licenses each one under its own authority. The skilled side falls under one statute; the non-medical side falls under two rules, with an agency path and an individual-provider path.
A home health care provider delivers skilled, physician-ordered care: nursing and physical, occupational, or speech therapy 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 part-time and intermittent, not round-the-clock. In New Hampshire, that provider is licensed under RSA 151:2, the health-facility licensing statute.
Non-medical home care is everyday help with bathing, dressing, grooming, meals, and homemaking, the tasks that keep someone safe at home. The person can be medically stable and still need this help every day. This is the work most people mean when they say "home care." New Hampshire licenses it two ways, and the distinction matters when you hire:
- A Home Care Service Provider Agency is licensed under rule He-P 822. The agency employs the aides, sends them to the home, and carries the responsibility for screening, supervision, and liability.
- An Individual Home Care Service Provider is registered under rule He-P 820. This is a single caregiver who registers with the state to provide non-medical personal care directly, without an agency between the caregiver and the family.
That individual-provider path is unusual. Most states route non-medical care through agencies only, so a New Hampshire family hiring help can choose between an agency that manages the caregiver and a registered individual who works directly with the household. The trade-off is supervision and backup: an agency covers a missed shift and handles screening, while an individual provider often costs less but leaves more of the vetting and coverage to the family.
That separation under New Hampshire law is what decides the money. Medicare certification, layered on top of the state license, is the step that lets a home health care provider bill Medicare for the skilled care it delivers. Non-medical personal care is care Medicare doesn't pay for at all. So when a New Hampshire family hears "home health," that points to the skilled, often Medicare-certified track licensed under RSA 151:2, and "personal care" or "homemaker" points to the non-medical one under He-P 820 or 822.
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 over the months that follow. Those run on separate payment tracks: Medicare pays for the skilled piece, and something else pays for the personal-care piece.
What Medicare Covers
Skilled home health in New Hampshire comes from a provider licensed under RSA 151:2, and to bill Medicare that provider must also be Medicare-certified. The provider 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; Medicare certification is the additional step that lets the agency bill Medicare for those services.
Medicare's home health benefit covers this care only when a beneficiary meets every condition. 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 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.
What It Costs and Other Ways to Pay
Non-medical home care covers help with bathing, dressing, grooming, meals, and homemaking. Because it isn't skilled medical care, the payer picture looks nothing like home health, and the cost question lives almost entirely on this side.
Per the 2024 Genworth/CareScout Cost of Care Survey, the most recent state-level data, a home health aide in New Hampshire ran about $89,232 a year and homemaker services about $86,944 a year. Both annual figures are built on a roughly 44-hour week. That matters: a family hiring an aide for only a few hours a day pays a fraction of the annual figure, which assumes a near full-time schedule. At a 44-hour week, the aide figure works out to roughly $39 an hour and the homemaker figure to roughly $38, so a few hours of help two or three days a week runs in the hundreds of dollars a month, not the tens of thousands. These are industry survey medians, not government rates and not a ceiling, so what a specific New Hampshire agency or registered individual provider charges can land above or below them. New Hampshire's in-home care sits among the highest in the country in this survey, well above the national medians.
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. An individual provider registered under He-P 820 is often the lower-cost private option, since there's no agency overhead.
- New Hampshire Medicaid. For eligible low-income older New Hampshirites, the state funds non-medical personal care through the Choices for Independence waiver, the home and community-based path that helps a person who meets a nursing-facility level of care stay out of a nursing home. New Hampshire Medicaid is administered by the Department of Health and Human Services.
- 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 are private funds, long-term care insurance, or, for eligible low-income New Hampshirites, the Choices for Independence waiver.
How to Choose and Vet an Agency
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. Whether the care is skilled is your first clue: skilled, physician-ordered care points to home health, and everyday non-medical help points to personal care.
| Home Health (Skilled) | Home Care (Non-Medical) | |
|---|---|---|
| New Hampshire license | Home health care provider licensed under RSA 151:2; bills Medicare only if also Medicare-certified | Home Care Service Provider Agency (He-P 822) or registered Individual Home Care Service Provider (He-P 820) |
| What it is | Skilled, physician-ordered care: nursing and physical, occupational, or speech therapy under a plan of care, part-time or intermittent | Everyday non-medical help with daily living (bathing, dressing, grooming, meals, homemaking) |
| Who provides it | A licensed home health care provider, often Medicare-certified, and its clinical staff (nurses and therapists) | An agency and its aides, or a single registered individual caregiver |
| Who pays | Medicare (when homebound + intermittent skilled need) | Private pay, long-term care insurance, or the Choices for Independence waiver for eligible low-income New Hampshirites |
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 personal care, and the question becomes whether to pay privately or qualify through New Hampshire Medicaid.
Once you know which service you need, the checks differ by track. For skilled home health, the license and the certification are the substance, not the marketing:
- Confirm the RSA 151:2 license and Medicare certification. A skilled home health care provider must hold a license under RSA 151:2, and for Medicare billing it must also be Medicare-certified. Ask to see the license and confirm the provider is Medicare-certified before assuming Medicare will pay.
- Match the provider to the doctor's order. Medicare coverage hinges on a physician's plan of care and the homebound and intermittent-skilled tests, so confirm the provider will work from your doctor's order and bill Medicare directly.
Non-medical home care is where the New Hampshire license paths matter, because you're choosing between an agency and an individual provider:
- Decide between an agency and an individual provider. A Home Care Service Provider Agency under He-P 822 screens, supervises, and covers its aides, and fills in a missed shift; a registered Individual Home Care Service Provider under He-P 820 often costs less but leaves more of the screening, backup coverage, and liability to you. Match the choice to how much oversight the household can manage.
- Ask how caregivers are screened. With an agency, confirm it runs criminal background checks and verifies credentials, and whether caregivers are employees the agency covers for liability and workers' compensation. With an individual provider, you'll often handle that diligence yourself.
- Get a written care plan and rate. Insist on a written plan that lists the specific tasks, the hours, the hourly rate, and any minimums, so expectations and cost are clear before care starts.
- Check the Choices for Independence path early if money is tight. If private pay isn't sustainable, contact New Hampshire DHHS about the Choices for Independence waiver before a crisis, because home and community-based eligibility takes time to establish.
Frequently Asked Questions
Yes, but only skilled care. Medicare's home health benefit covers physician-ordered nursing and physical, occupational, or speech therapy for a person who is homebound and needs that care on a part-time or intermittent basis, delivered by a Medicare-certified agency. It does not pay for non-medical personal care, the help with bathing, dressing, meals, and everyday support an aide provides, on its own.
Home health is skilled medical care a physician orders and a licensed clinician delivers, provided by a home health care provider licensed under RSA 151:2 and 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, delivered by a Home Care Service Provider Agency under He-P 822 or a registered Individual Home Care Service Provider under He-P 820.
Per the 2024 Genworth/CareScout Cost of Care Survey, a home health aide in New Hampshire ran about $89,232 a year and homemaker services about $86,944 a year, each on a roughly 44-hour week. Those annual figures assume a near full-time schedule, which works out to roughly $38 to $39 an hour, so a family hiring an aide for only a few hours a day pays far less than the annual number. New Hampshire's in-home care runs among the highest in the country, and the figures are survey medians, not fixed rates, so a given agency or individual provider can charge above or below them.
Yes. For eligible low-income older New Hampshirites, New Hampshire Medicaid funds non-medical personal care through the Choices for Independence waiver, the home and community-based path for people who would otherwise need a nursing-facility level of care. The program is administered by the New Hampshire Department of Health and Human Services, which is where a family begins.
Yes. New Hampshire registers Individual Home Care Service Providers under rule He-P 820, a path that lets a single caregiver provide non-medical personal care directly without an agency in between. The alternative is a Home Care Service Provider Agency licensed under He-P 822, which employs and supervises its aides. An individual provider often costs less, but an agency handles screening, backup coverage, and liability, so the right choice depends on how much oversight the household can take on.
Learn More
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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.