Home Care vs. Home Health in New York (2026)

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.1,2,3

This guide draws the line between the two. New York adds its own wrinkle: each service comes from a differently licensed agency, and Medicare, which pays for skilled home health, does not pay for non-medical home care when that is the only care needed.1 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
• Home Care vs. Home Health in New York: The Core Difference
• Home Health: The CHHA and What Medicare Covers
• Home Care: The LHCSA and CDPAP
• Choosing Home Care or Home Health in New York
• What It Costs
• How to Get Started
• Frequently Asked Questions

Home Care vs. Home Health in New York: 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.1 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, usually 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 the Public Health Law, and CHHA care can be paid by Medicare, Medicaid, private payment, or commercial insurance.1 Its nurses, therapists, and medical social workers carry out the plan of care a physician has ordered.

Medicare's home health benefit covers this CHHA care when a beneficiary meets the federal conditions.1,2 The two that trip families up most:

• Homebound. Leaving home takes a lot of effort, and the person normally can't leave without help such as a cane, walker, wheelchair or another person, or has been advised not to because of their condition. Leaving for medical treatment, or for short, infrequent outings such as religious services, doesn't disqualify someone.1
• 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; under federal rules, "part-time or intermittent" generally means combined skilled nursing and aide services of less than 8 hours a day and 28 or fewer hours a week (up to 35 hours on case-by-case review).2

When those conditions are met, the beneficiary generally pays $0 for the covered skilled services, the nursing visits, the therapy, and the home health aide help that is tied to that skilled care.2 What Medicare home health will not do is staff an aide in the home for general daily help with no skilled-care purpose, or cover 24-hour care, meals, or custodial-only help. 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 with no federal counterpart, so no Medicare standard sits behind it, and since January 1, 2019 an LHCSA must also be registered with NYSDOH to operate.1 LHCSA clients typically pay privately or through private insurance, or the agency works under contract to serve Medicare or Medicaid patients whose care someone else manages, for instance by supplying home health aides to a CHHA's patients.1

The Consumer Directed Personal Assistance Program (CDPAP). For New Yorkers on Medicaid who are eligible for home care services, CDPAP is the route that lets the person direct their own care. Instead of an agency assigning an aide, the consumer (or a designated representative) recruits, hires, and supervises their own personal assistant, and the assistant's wages run through the program's single statewide fiscal intermediary, Public Partnerships LLC (PPL).3 The assistant can be a friend or family member, though not a spouse, the consumer's designated representative, or another person legally responsible for the consumer's care and support.3 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 is a Medicaid route to home care, separate from the Medicare home health benefit a CHHA delivers.

One line is worth stating plainly. Medicare does not pay for non-medical home care when that is the only care needed.1 A family expecting Medicare to cover an aide for daily help with no nurse or therapist involved will find it won't, no matter how much that help is needed. The exception families miss: while a home health nurse or therapist is visiting, Medicare's covered aide care includes help with walking, bathing or grooming, and feeding, so ask the agency for aide hours.2 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.3,5

Choosing Home Care or Home Health in New York

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.1,3,5

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.5 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.2 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 $80,080 a year, according to the CareScout Cost of Care Survey for 2025, released March 2, 2026.4 That figure assumes 44 hours of care a week for 52 weeks. Note that the 2025 survey no longer prices homemaker services and home health aide work separately: it merges them into a single non-medical caregiver category, so there is no longer a distinct survey median for each. New York's $80,080 sits exactly on the national line, which is also $80,080.4 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 costs in New York City and downstate generally run higher than upstate.4 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, which delivers Medicaid community-based long-term services and supports such as personal care and home health aide services,5 or through CDPAP, where the consumer hires and directs their own assistant.3

How to Get Started

Once you know which service you need, the starting point differs.

• For home health (a CHHA): Ask the hospital discharge planner or the treating physician for a home health referral and an order. Medicare-covered CHHA care begins with a doctor's plan of care, so the physician's office or the discharge planner is the right first call; Medicare's home health coverage page explains what is covered, and you can compare certified agencies on Medicare's Care Compare tool.
• For home care (an LHCSA or CDPAP): If you are paying privately, contact a Licensed Home Care Services Agency directly. If you think you may qualify for Medicaid, start with NY Connects, which offers free, unbiased information about long-term services and supports in New York,6 or contact your local department of social services about Medicaid. Whether someone needs enough help to qualify for Medicaid home care is assessed through the New York Independent Assessor Program (NYIAP).3 For self-directed care, see our New York CDPAP and New York Managed Long-Term Care guides.

When in doubt about which track applies, ask the doctor whether a skilled need (nursing or therapy) is involved: a "yes" points to home health and Medicare; a "no" points to home care and either private pay or Medicaid.

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.