Home Care vs. Home Health in Ohio (2026): Cost, Coverage, Choosing

"Home care" and "home health" sound interchangeable, but in Ohio they are two different services paid for by two different funders, and choosing the wrong word can cost a family thousands of dollars. Non-medical home care is the aide who helps your mother bathe, dress, prepare a meal, and stay safe at home. Skilled home health is the registered nurse or therapist who comes in under a doctor's orders after a hospital stay or a fall. The split decides who pays: Medicare covers skilled home health at $0 out of pocket when a person is homebound and needs intermittent skilled care, but it does not cover ongoing personal care when that is the only care needed. Non-medical home care is what families pay for privately or through Ohio Medicaid waivers such as PASSPORT and the Ohio Home Care Waiver. This guide explains the difference, lays out who pays for each, and walks through how to choose.

Most Ohio families end up using both across an aging parent's later years. A skilled home health team comes in for a few weeks after a hospitalization, gets the patient stabilized, and the case closes. Non-medical home care is the ongoing support that fills the gap between full independence and a facility.

A 60-Second Decision Tree

Before the detail, here is the rule of thumb that resolves the home care vs. home health question for most Ohio families.

If your family member needs skilled nursing, therapy, or medical social work after a hospital stay, a fall, or a new diagnosis, and they are largely homebound, they need home health. Ask the hospital discharge planner or the primary care physician for an order, and the office or hospital refers to a Medicare-certified home health agency. The family generally does not pay; Medicare or Medicaid covers it when the criteria are met.1

If your family member needs help with the daily business of living (bathing, dressing, meal preparation, transportation, errands, companionship, medication reminders, supervision), they need non-medical home care. This is the ongoing support, hours per day or per week, that lets a person stay home as they age. It is paid privately, through a Medicaid waiver, through long-term care insurance, or through VA programs for eligible veterans.

If your family member needs both, they can have both. The services are structurally separate. A Medicare home health team can visit twice a week for skilled wound care while a non-medical home care aide is in the home several hours a day for personal-care help. The home health agency does not bill for the aide's hours, and the home care agency does not bill for the nurse's visits; the two coexist without conflict.1

Non-Medical Home Care in Ohio

Non-medical home care is the larger and more loosely regulated of the two services. The defining feature is that no skilled clinical service is being delivered: the worker is a home care aide or personal-care attendant, not a nurse or therapist.

What an Ohio home care aide does

An Ohio home care aide can assist with bathing, dressing, grooming, toileting, transferring, eating, meal preparation, light housekeeping, laundry, errands, transportation, medication reminders, and companionship. An aide generally cannot administer medications, perform sterile procedures, give injections, or perform any task that constitutes the practice of nursing. Those tasks belong to a licensed nurse or a home health aide working under nurse supervision within the skilled home health benefit, which is a different service. When the line between aide-permissible and nurse-only is unclear for a specific task, ask the agency and the resident's physician.

Ohio Medicaid waiver pathways for non-medical home care

Ohio Medicaid pays for non-medical home care through home and community-based services (HCBS) waivers, each with its own age band, eligibility, and administering agency. The two main pathways for older adults and adults with disabilities are below.

Ohio PASSPORT waiver. PASSPORT is a federal section 1915(c) HCBS waiver governed by Ohio Administrative Code Chapter 5160-31. To enroll, an individual must be age 60 or older, be determined to need an intermediate or skilled level of care, be financially eligible for Ohio Medicaid, and have a monthly cost of waiver services that does not exceed $14,700. The Ohio Department of Aging is responsible for daily operations of the waiver and delegates case management to its designees, which include the area agencies on aging. Covered services include personal care, homemaker, adult day, home-delivered meals, transportation, out-of-home respite, personal emergency response systems, home modification, and structured family caregiving, among others.2 Calling 1-866-243-5678 connects an Ohio caller to the area agency on aging serving their community, which is where PASSPORT intake starts.4

Ohio Home Care Waiver. The Ohio Home Care Waiver (OHCW) is the parallel HCBS waiver for Ohioans from birth through age 59 who have a nursing-facility-based level of care and are eligible for Ohio Medicaid. Unlike PASSPORT, it is administered directly by the Ohio Department of Medicaid: case management is provided by an ODM-designated case management contractor (a contracted case management agency, a MyCare Ohio plan, or ODM itself), and eligibility is determined by a comprehensive assessment under Ohio Administrative Code Chapter 5160-45, not by an area agency on aging. Covered services include personal care aide service, home care attendant, waiver nursing, home-delivered meals, structured family caregiving, and out-of-home respite. Enrollees are disenrolled from the Ohio Home Care Waiver no later than 120 calendar days after their 60th birthday, and are offered the opportunity to transition to PASSPORT if they meet all of PASSPORT's eligibility criteria. The transition is an offer conditioned on re-qualifying, not automatic, so a family should start the PASSPORT determination well before the 60th birthday rather than after the disenrollment notice arrives.5

MyCare Ohio for dual eligibles. Ohioans who have both Medicare (Parts A, B, and D) and full Medicaid and are age 21 or older are served through Next Generation MyCare, Ohio's integrated managed-care program structured as a Medicare Advantage Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP). The Ohio Department of Medicaid rolled out Next Generation MyCare in 29 counties on January 1, 2026, and is expanding it to the rest of Ohio between April 1 and August 1, 2026. Three plans are available statewide to new members (Anthem Blue Cross and Blue Shield, CareSource, and Molina Healthcare of Ohio), while Buckeye Health Plan is not an option for new members in plan year 2026. For dual eligibles in launched counties, MyCare absorbs the PASSPORT and Ohio Home Care personal-care services under one managed-care plan.6

To qualify financially for any of these long-term-care Medicaid pathways, an applicant generally must fall under Ohio's Special Income Level (which is $2,982 per month in 2026, or 300 percent of the Supplemental Security Income (SSI) Federal Benefit Rate) and hold no more than $2,000 in countable assets if single. An applicant whose income exceeds the Special Income Level must establish a Qualified Income Trust (a Miller Trust), because Ohio does not extend medically needy coverage to long-term care.7

Getting paid as a family caregiver

Ohio Medicaid lets some family members be paid as the in-home caregiver. Structured Family Caregiving is a service available under both PASSPORT and the Ohio Home Care Waiver: an agency provider employs or contracts a caregiver who lives with the individual and provides daily care. Structured Family Caregiving has been added as a PASSPORT service and is also covered under the Ohio Home Care Waiver. Consumer-direction options let the recipient (or a representative) hire, train, and supervise the aide, with a financial-management service handling payroll. Across PASSPORT, the Ohio Home Care Waiver, and MyCare Ohio, parents of minor children, spouses, and relatives holding legal decision-making authority may serve as a paid direct-care worker only through the conditional pathway in Ohio Administrative Code rule 5160-44-32, which requires that no other willing and able worker be available and that the state (or its designee) find the person's health and safety can still be ensured; a spouse is also capped at 40 paid hours a week absent an exception, and spousal hours may not be billed as respite. The rule restricts only those categories, so other adult relatives are not held to it.8 The deeper guide on getting paid to care for a family member is at How to Get Paid as a Family Caregiver in Ohio.9

Private pay, long-term care insurance, and VA home care

For families who do not qualify for Medicaid, non-medical home care is paid out of pocket, through long-term care insurance, or through VA benefits for eligible veterans. Private pay is the dominant funding source; hourly agency rates vary by metro and agency, a four-hour minimum visit is common, and around-the-clock coverage can rival the cost of a residential facility. Request itemized rate sheets from two or three agencies before committing.

Long-term care insurance, where the resident has a policy, often pays for non-medical home care under the policy's home care benefit. Check the daily or monthly benefit cap, the elimination period (the waiting period before benefits begin), whether the policy requires a particular type of agency, and whether it pays the agency directly or reimburses the family.

The U.S. Department of Veterans Affairs covers non-medical home care for eligible veterans through several pathways, including the Homemaker and Home Health Aide program, Veteran-Directed Care (where the veteran controls a budget and can hire family members), and the Aid and Attendance pension benefit, which can be applied to private-pay home care. Availability varies by VA medical center, so confirm what is offered locally with the veteran's VA team.

Skilled Home Health in Ohio

Skilled home health is a fundamentally different service. Non-medical home care is hours per day of supportive presence; skilled home health is visits per week of clinical intervention. Home care is open-ended; home health is time-limited and tied to a specific clinical episode such as a hospitalization, a fall, a wound, or a new diagnosis. And where home care is generally private-pay or Medicaid-waiver-paid, skilled home health is generally Medicare-paid.

What skilled home health includes

A Medicare-certified home health agency offers a mix of clinical services, each delivered by an appropriately licensed clinician:

• Skilled nursing by a nurse: wound care, intravenous therapy management, complex medication administration, catheter and ostomy care, diabetes management, post-surgical care, and disease-management education.
• Physical therapy: gait and balance training, strength training, post-surgical rehabilitation, fall-prevention work, and mobility-equipment assessment.
• Occupational therapy: retraining in the activities of daily living after a stroke or hospitalization, home-safety assessment, and adaptive-equipment recommendations.
• Speech-language pathology: swallowing (dysphagia) evaluation and treatment, and cognitive-communication therapy after a stroke or brain injury.
• Medical social work: psychosocial assessment, connection to community resources, and advance-care-planning support.
• Home health aide services, but only alongside a skilled need. When a nurse is visiting for skilled care, the plan of care may include limited aide time in support of that need; once the skilled need resolves, the aide visits end.1

The Medicare home health benefit: eligibility and cost

Medicare covers home health only when the beneficiary meets all of the following:

• Homebound. Leaving home requires considerable and taxing effort, and the person leaves home infrequently and for short durations. Narrow exceptions allow medical appointments, religious services, adult day attendance, and occasional short trips.
• Skilled need. The beneficiary needs intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy. Combined skilled nursing and home health aide care must generally be 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).
• Plan of care. The beneficiary is under a plan of care established and reviewed by a physician or allowed practitioner.
• Medicare-certified agency. The services are delivered by a Medicare-certified home health agency.

When these criteria are met, the beneficiary generally pays $0 for the covered home health services, and coverage continues for as long as those criteria keep being met. Durable medical equipment ordered through the agency carries the standard 20 percent Part B coinsurance, which is the main typical out-of-pocket cost. Medicare home health does not cover 24-hour-a-day care, meals delivered to the home, homemaker services unrelated to the care plan, or custodial personal care when that is the only care needed.1

A common misunderstanding is that Medicare stops paying once a patient is "no longer improving." Under the Jimmo v. Sebelius settlement, Medicare coverage of skilled nursing and skilled therapy does not depend on the potential for improvement; coverage turns on the need for skilled care. Skilled care to maintain a person's condition, or to prevent or slow further decline, is covered when the skills of a professional are required to deliver it safely. If a family is told Medicare will not continue "because Mom isn't improving," ask the agency to document the continued skilled need, and file an appeal if appropriate.10

Ohio Medicaid home health for those without Medicare

For Medicaid-only Ohioans, the Ohio Medicaid home health benefit covers skilled home services without requiring a waiver. For dual eligibles, Medicare is the primary payer for home health and Medicaid is secondary. The Medicaid home health benefit and the waiver personal-care pathways can run at the same time, and a family does not need to coordinate this: the area agency on aging case manager or the MyCare plan care manager handles it.

2026 Cost: Home Care vs. Home Health in Ohio

The cost picture is the clearest way to see why the home care vs. home health distinction matters. Skilled home health, when Medicare-covered, is $0 to the patient. Ongoing non-medical home care is the part families pay for. In Ohio, the 2025 median cost of a non-medical caregiver was about $77,792 a year (roughly $6,483 per month, or about $34 an hour) according to the CareScout (Genworth) 2025 Cost of Care Survey, which ranks Ohio 32nd among states. Ohio sits just below the national non-medical-caregiver median of $80,080 a year, or about $35 an hour. For context, a semi-private nursing-home room in Ohio runs about $110,230 a year.3,1

The home-care hourly figure is the CareScout 2025 non-medical-caregiver median for Ohio; the survey now reports homemaker and home-health-aide help as a single "non-medical caregiver" category. A full-week schedule of private-pay non-medical home care can approach the cost of an Ohio assisted-living unit (about $6,102 a month), and around-the-clock home care can exceed the cost of memory care (an average of about $6,894 a month in Ohio). Medicare home health, by contrast, is $0 out of pocket when the eligibility test is met, which is why a family should never decline skilled home health on the assumption that Medicare will not pay for it.3,11,1

When a family qualifies for a Medicaid waiver, consumer-direction can stretch the dollars further: paying an adult child as the in-home aide through a waiver, instead of contracting a private-pay agency, moves more of the spending to the family caregiver. The trade is that the family takes on the employer-of-record responsibilities (recruiting, scheduling, supervising), with a financial-management service handling payroll.

How to Choose a Home Health Agency in Ohio

Choosing a Medicare-certified home health agency is a fairly structured process because federal data is published for every certified agency.

Look up Care Compare star ratings. The federal Medicare Care Compare tool publishes overall, quality-of-patient-care, and patient-experience star ratings for every Medicare-certified home health agency, plus the underlying quality measures (timely initiation of care, improvement in mobility and bathing, and more). Three stars is roughly the national average; four and five stars indicate above-average quality.

Confirm in-network status. If the family member has a Medicare Advantage plan or a Medicaid managed-care plan, verify that the agency is in-network with that specific plan. An agency may participate with traditional Medicare but not with a given Medicare Advantage plan, and the gap can create out-of-pocket costs.

Ask about service mix and continuity. Some agencies have strong rehabilitation programs; others have strong skilled-nursing programs. Ask the intake nurse what experience the team has with the patient's primary diagnosis, who provides clinical supervision, and whether the patient will see the same nurse and therapist throughout the episode.

How to Choose a Non-Medical Home Care Provider in Ohio

Because the non-medical side carries less public oversight than the Medicare-certified side, more of the due diligence falls on the family.

Decide between an agency and an independent provider. An agency employs the worker, carries liability insurance and workers' compensation, handles tax withholding, supervises the aide, and provides backup coverage. An independent provider is hired directly and is cheaper hourly, but leaves the family with the employer-of-record responsibilities and more exposure if the aide is suddenly unavailable.

Verify Medicaid provider status if Medicaid will pay. For Medicaid-paid services, the agency or independent provider must hold an active Ohio Medicaid provider agreement and be enrolled in the waiver (PASSPORT, Ohio Home Care, or MyCare) that will pay for the service.5

Verify insurance, bonding, and background checks. Ask for proof of liability insurance and workers' compensation. Ask which background checks the agency runs (criminal, abuse-registry, driving record) and how often it re-runs them.

Ask about training, matching, and turnover. Ask to see the agency's training curriculum, how it matches an aide to a client, how often the assigned aide changes, and the trailing 12-month turnover rate. High turnover is the most consistent predictor of poor caregiver-client continuity. Ask for two or three current client families as references.

When Home-Based Care Is Not Enough

For some families, the right answer is a different setting rather than more home care. The signals that a person has outgrown home-based care, even with maximum support, are well-defined:

• Caregiver burnout. The primary family caregiver is exhausted past the point where additional respite makes a sustainable difference.
• Safety incidents. Repeated falls, medication errors, wandering, or kitchen near-misses that the home setup cannot mitigate.
• Clinical complexity. Conditions needing around-the-clock skilled oversight that intermittent home health cannot manage.
• Cost. When around-the-clock home care exceeds what the family can sustain, an assisted living or memory care unit can be the more sustainable financial answer.11

The downstream care types are covered in detail at Assisted Living in Ohio, Nursing Homes in Ohio, and Memory Care in Ohio. The companion caregiver-side guides at Respite Care in Ohio and Caregiver Programs in Ohio cover the support layer that often makes the difference between home-based care continuing and a move to a facility.

Next Steps for Ohio Families

The single most useful first step is to call the local area agency on aging at 1-866-243-5678 for a no-cost intake conversation. The AAA can map the family's situation against the available Medicaid waiver pathways (PASSPORT for adults 60 and older, the Ohio Home Care Waiver for those under 60), explain when a skilled home health episode is appropriate, connect the family to a Medicare-certified home health agency for a clinical assessment, and identify non-Medicaid resources that round out the funding map. The call is free.4,2

If a loved one is recently hospitalized or has had a clinical event that points to a skilled need, work with the hospital discharge planner or primary care physician to put a home health referral in motion. The discharge planner already knows the Medicare-certified agencies with capacity in the area, and Medicare pays the bill when the criteria are met.

If a family is paying privately for non-medical home care, ask each agency for proof of insurance, bonding, background-check policy, training, and references, and call at least two or three references before committing.

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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.