In New York, "home health" and "home care" are two different services with two different agency types and two different payers. Home health is skilled, doctor-ordered care from a Certified Home Health Agency that Medicare covers when someone is homebound and needs intermittent skilled care; home care is non-medical help that families pay for privately or, on Medicaid, direct themselves through CDPAP.
This guide draws the line between the two. New York adds its own wrinkle: each service comes from a differently licensed agency, and the program that pays for one will not touch the other. Getting the labels straight is how families avoid paying for care a program would have covered, or waiting on coverage that was never going to come.
In This Guide
- Key Takeaways
- The Core Difference
- Home Health: The CHHA and What Medicare Covers
- Home Care: The LHCSA and CDPAP
- Which One Do You Need?
- What It Costs
- Frequently Asked Questions
The Core Difference
The split is medical versus non-medical, and in New York it decides three things at once: who provides the care, which state license that provider holds, and which program pays.
Home health is skilled care. A doctor orders it because the person has a medical need that requires a licensed professional, a nurse, a physical or occupational or speech therapist, or a medical social worker. Wound care after surgery, IV medication, injections a patient can't manage alone, therapy to recover function after a stroke or a fall: these are skilled needs.
Home care is non-medical. No clinical license is involved in the hands-on work. An aide helps with the activities of daily living, bathing, dressing, getting to the bathroom, preparing meals, and supervision. The person can be medically stable and still need this help every day.
The same person often needs both. Someone discharged after hip surgery might get home health (a nurse and a physical therapist for a few weeks) and also need home care (an aide for bathing and meals for months). The two run on separate tracks with separate payers, which is exactly why the New York agency labels, CHHA and LHCSA, are worth knowing before you start making calls.
Home Health: The CHHA and What Medicare Covers
Skilled home health in New York is delivered by a Certified Home Health Agency (CHHA). NYSDOH certifies these agencies under Article 36 of the Public Health Law, and a CHHA can bill Medicare, Medicaid, or private insurance. The agency employs the clinical staff, registered nurses, therapists, and medical social workers, who carry out the plan of care a physician has ordered.
Medicare's home health benefit covers this CHHA 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 doctor certifies that the person needs skilled nursing or therapy on a part-time or intermittent basis, under a plan of care the doctor reviews. Home health is not round-the-clock care.
When those conditions are met, Medicare pays for the covered skilled services, the nursing visits, the therapy, and the home health aide help that is tied 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 home care, and it's the next section.
Home Care: The LHCSA and CDPAP
Non-medical home care in New York reaches families through two main routes.
The Licensed Home Care Services Agency (LHCSA). An LHCSA is the agency that supplies non-medical aides and personal-care workers. It's a New York licensure regulated under the same Article 36, but with no federal counterpart, no Medicare standard sits behind it. LHCSA clients typically pay privately or through private insurance, or the agency works under contract to a CHHA or a managed long-term care plan that arranges and pays for the hours.
The Consumer Directed Personal Assistance Program (CDPAP). For New Yorkers on Medicaid, CDPAP is the route that lets the person direct their own care. Instead of an agency assigning an aide, the consumer recruits, hires, and supervises their own personal assistant, and Medicaid pays that assistant. CDPAP is the largest consumer-directed Medicaid personal-care program in the country, and it can pay many family members and friends as the assistant. Because the eligibility test, the assessment process, and who can be paid all have their own rules, the mechanics live in our dedicated New York CDPAP guide; the point here is that CDPAP funds home care, the non-medical help, not skilled home health.
One line is worth stating plainly. Medicare does not pay for non-medical home 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 home care are private funds, private insurance, or Medicaid, through CDPAP or a managed long-term care plan, for those who qualify.
Which One Do You Need?
Start with the need, not the brochure. The table maps the two services across the dimensions that decide who provides the care and who pays.
| Home Health (CHHA) | Home Care (LHCSA) | |
|---|---|---|
| What it is | Skilled medical care: nursing, physical/occupational/speech therapy, home health aide, medical social work | Non-medical help with daily living: bathing, dressing, meals, supervision |
| Who provides it | Certified Home Health Agency, NYSDOH-certified | Licensed Home Care Services Agency (New York licensure), or a self-directed assistant under CDPAP |
| Regulated under | Article 36 of the NY Public Health Law; certified by NYSDOH | Article 36 of the NY Public Health Law; New York licensure, no federal standard |
| Who pays | Medicare (when homebound + intermittent skilled need), Medicaid, or private insurance | Private pay or private insurance; Medicaid via CDPAP or a managed long-term care plan |
A quick way to place a situation: if a doctor has ordered skilled care and the person is homebound, you're looking at home health from a CHHA, and Medicare is the payer to check first. If the need is ongoing help with everyday tasks with no skilled medical component, you're looking at home care, and the question becomes whether to pay privately or use Medicaid through CDPAP or a managed long-term care plan. Plenty of families arrange both at once.
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 home care side, where families pay out of pocket unless Medicaid covers it.
For non-medical home care in New York, the statewide median ran about $77,792 a year for a home health aide or homemaker in 2024, according to the Genworth/CareScout Cost of Care Survey. That works out to roughly $6,483 a month at about 44 hours a week. The figure is an industry survey median, not a government rate and not a maximum, so what a specific agency charges can land above or below it, and downstate costs in New York City, Long Island, and Westchester run materially higher than upstate. Many families also use fewer hours than the full-week assumption and pay less.
For New Yorkers who qualify for Medicaid, that private cost can be covered instead, either through a managed long-term care plan that arranges agency aides or through CDPAP, where the consumer directs and Medicaid pays their own assistant.
Frequently Asked Questions
No. Medicare does not pay for non-medical home care, the help with bathing, dressing, meals, and supervision that an aide provides. Medicare's home health benefit covers skilled, doctor-ordered care (nursing and therapy) from a Certified Home Health Agency for people who are homebound and need it on an intermittent basis. For non-medical home care, the options are private pay or, for those who qualify, Medicaid through CDPAP or a managed long-term care plan.
A Certified Home Health Agency (CHHA) provides skilled home health, nursing, therapy, home health aide services, and medical social work, and NYSDOH certifies it under Article 36; its care is reimbursable by Medicare, Medicaid, or private insurance. A Licensed Home Care Services Agency (LHCSA) provides non-medical home care, a New York licensure with no federal standard, also under Article 36, usually paid privately or by contract to a CHHA or a managed long-term care plan. The simplest test is whether a doctor's order and a licensed clinician are involved: if yes, it's a CHHA; if not, it's an LHCSA.
Home health is skilled medical care a doctor orders and a licensed clinician delivers, covered by Medicare when the person is homebound and needs intermittent skilled care. Home care is non-medical help with daily living that Medicare does not cover. In New York the two come from differently licensed agencies, a CHHA for home health, an LHCSA (or a self-directed CDPAP assistant) for home care.
CDPAP, New York's Consumer Directed Personal Assistance Program, is a Medicaid route to home care, not home health. Instead of an agency assigning an aide, the Medicaid recipient recruits, hires, and supervises their own personal assistant, who can be many family members or friends, and Medicaid pays that assistant. It does not provide skilled nursing or therapy; for that you need a CHHA. The eligibility and enrollment details live in our New York CDPAP guide.
Yes, and many do. A person recovering from surgery might receive Medicare-covered CHHA home health (a nurse and a therapist for a set period) while also needing ongoing non-medical home care (an aide for bathing and meals). The two run on separate tracks with separate payers, so arranging one does not arrange or pay for the other.
Learn More
- Nursing Homes in New York
- Memory Care in New York
- Assisted Living in New York
- New York CDPAP
- New York Managed Long-Term Care
- Medicare in New York
- Getting Paid as a Family Caregiver in New York
Find personalized help arranging care at home in New York at brevy.com.
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