In North Carolina, "home health" and "home care" are two different services, licensed and paid for differently, even though families use the names interchangeably. Home health is skilled, doctor-ordered care from a Home Health Agency that Medicare covers when someone is homebound and needs intermittent skilled care; home care is broader, non-medical help that families pay for privately or, for eligible people, cover through Medicaid.
This guide draws the line between the two. The label decides who can provide the care, which North Carolina license that provider holds, and which program pays the bill. Getting it right is how a family avoids paying out of pocket for care a program would have covered, or waiting on Medicare coverage that was never going to come.
In This Guide
- Key Takeaways
- The Core Difference
- Home Health: The Home Health Agency and What Medicare Covers
- Home Care: The Home Care Agency and Who Pays
- Which One Do You Need?
- What It Costs
- Frequently Asked Questions
The Core Difference
The split is medical versus non-medical, and in North Carolina it settles three things at once: who provides the care, which DHSR license that provider holds, and which program pays.
Home health is skilled care. A physician orders it because the person has a medical need that requires a licensed professional: a nurse, or a physical, occupational, or speech therapist. Wound care after surgery, IV medication, injections a patient can't manage alone, therapy to rebuild strength after a stroke or a fall: those are skilled needs. The care is part-time and intermittent, not round-the-clock.
Home care is broader and reaches into non-medical help. Much of what a Home Care Agency does is personal care: an aide helps with the activities of daily living, bathing, dressing, getting to the bathroom, preparing meals, light housekeeping, and companionship. 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 North Carolina provider labels, Home Health Agency and Home Care Agency, are worth knowing before you start making calls.
Home Health: The Home Health Agency and What Medicare Covers
Skilled home health in North Carolina is delivered by a Home Health Agency licensed by DHSR and certified for Medicare and Medicaid. The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. North Carolina adds one step that other states don't always require: a home health agency must obtain a Certificate of Need before it can operate, the state's way of regulating how many agencies serve a given area. Because the care is skilled and physician-ordered, a certified Home Health Agency can bill Medicare, Medicaid, or private insurance.
Medicare's home health benefit covers this Home Health Agency 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 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, the medical social services, and the home health aide help that's attached 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 Home Care Agency and Who Pays
Non-medical home care in North Carolina comes from a Home Care Agency, also licensed by DHSR. A Home Care Agency supplies the aides and personal-care workers who handle bathing, dressing, meals, light housekeeping, and companionship. Because it isn't necessarily Medicare or Medicaid certified, the payer picture looks different from the home health side: a Home Care Agency is the broader, largely non-medical service, the Home Health Agency is the certified skilled service.
Who pays for Home Care Agency services comes down to a few routes:
- Private pay. Most 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.
- Medicaid. For low-income North Carolinians, NC Medicaid funds in-home care two ways. Personal Care Services (PCS) covers hands-on help with daily activities for people who meet a medical-need threshold. The North Carolina CAP/DA waiver, the Community Alternatives Program for Disabled Adults, serves adults who meet a nursing-facility level of care and want to stay home instead of entering an institution. Both run through eligibility at the local level, so the county Department of Social Services and NC Medicaid are where a family starts.
- Long-term care insurance. A private policy, if the person holds one, may reimburse home care hours.
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, long-term care insurance, or, for eligible low-income North Carolinians, Medicaid through PCS or CAP/DA.
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 (Home Health Agency) | Home Care (Home Care Agency) | |
|---|---|---|
| What it is | Skilled, physician-ordered medical care: nursing, therapy, medical social services, and home health aide care tied to that skilled need | Broader in-home help, largely non-medical: personal care, bathing, dressing, meals, housekeeping, companionship |
| Who provides it | A Home Health Agency and its clinical staff | A Home Care Agency and its aides and personal-care workers |
| Certified / licensed | DHSR-licensed and Medicare/Medicaid-certified; also needs a Certificate of Need in NC | DHSR-licensed; not necessarily Medicare/Medicaid certified |
| Who pays | Medicare (when homebound + intermittent skilled need), Medicaid, or private insurance | Private pay, long-term care insurance, or Medicaid (PCS or the CAP/DA waiver) for eligible people |
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 from a Home Health Agency, 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 home care from a Home Care Agency, and the question becomes whether to pay privately or qualify for Medicaid through PCS or CAP/DA. 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 North Carolina, a home health aide and homemaker services each ran about $68,640 a year in 2024, according to the Genworth/CareScout Cost of Care Survey, which works out to roughly $5,720 a month on a basis of 44 hours a week. Those are industry survey medians, not government rates and not a maximum, so what a specific North Carolina agency charges can land above or below them, and the Charlotte and Raleigh metros tend to run higher than rural counties. A family using fewer hours than the full-week assumption will of course pay less than the annual figure suggests.
For low-income North Carolinians who qualify, that private cost can be covered instead through Medicaid, either Personal Care Services or the CAP/DA waiver for people who meet a nursing-facility level of care.
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, physician-ordered care (nursing and therapy) from a 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, long-term care insurance, or, for eligible low-income North Carolinians, Medicaid through Personal Care Services or the CAP/DA waiver.
A Home Health Agency provides skilled home health, nursing and therapy and the home health aide services tied to that skilled care; DHSR licenses it, it's certified for Medicare and Medicaid, and in North Carolina it also needs a Certificate of Need. A Home Care Agency provides broader, largely non-medical in-home help, also DHSR-licensed but not necessarily certified, usually paid privately or through Medicaid. The simplest test is whether a physician's order and a licensed clinician are involved: if yes, it's a Home Health Agency; if not, it's a Home Care Agency.
Home health is skilled medical care a physician orders and a licensed clinician delivers, covered by Medicare when the person is homebound and needs intermittent skilled care. Home care is broader, largely non-medical help with daily living that Medicare does not cover. In North Carolina the two come from differently licensed providers, a Home Health Agency for home health, a Home Care Agency for home care.
NC Medicaid funds in-home care two ways. Personal Care Services (PCS) covers hands-on help with daily activities for people who meet a medical-need threshold. The CAP/DA waiver, the Community Alternatives Program for Disabled Adults, serves adults who meet a nursing-facility level of care and want to stay at home instead of entering an institution. Eligibility for both runs through the county Department of Social Services and NC Medicaid, so that's where a family starts.
Yes, and many do. A person recovering from surgery might receive Medicare-covered Home Health Agency care (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
- Assisted Living in North Carolina
- Nursing Homes in North Carolina
- Memory Care in North Carolina
- Medicaid Planning Strategies
- Caregiver Burnout: Signs and Support
Find personalized help arranging care at home in North Carolina 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.