Home Care vs. Home Health in Oregon (2026)

"Home care" and "home health" sound like the same thing, but in Oregon they're two different services, and the difference decides who pays. In a twist worth knowing, both come from agencies licensed by the Oregon Health Authority, not the state agency that licenses facilities. Home health is skilled, doctor-ordered care that Medicare can cover; home care is non-medical daily help it won't.1

This guide draws that line so an Oregon family doesn't pay out of pocket for care a program would have covered, or wait on Medicare coverage that was never coming. The label that matters isn't the agency's name. It's whether the care is skilled or non-medical, and which program pays the bill.

In This Guide

• Key Takeaways
• Home Care vs. Home Health in Oregon: The Core Difference
• Home Health in Oregon: The Home Health Agency
• Home Care: The In-Home Care Agency and Who Pays
• Home Care vs. Home Health in Oregon: Which One Do You Need?
• What Home Care Costs in Oregon
• Frequently Asked Questions

Home Care vs. Home Health in Oregon: The Core Difference

The split is skilled versus non-medical, and in Oregon it's written into two different licenses, both held by the same regulator. The Oregon Health Authority (OHA) doesn't run in-home care under one rulebook. It licenses a Home Health Agency to deliver skilled care under OAR 333-027, and it licenses an In-Home Care Agency, under the separate OAR 333-536, to deliver non-medical help.1

That OHA detail is more than trivia. In most people's mental model, in-home care belongs with nursing homes and assisted living. In Oregon it doesn't: the facilities go through the Department of Human Services, while both kinds of in-home agency go through OHA. So when you check a provider's license, you're looking at OHA records either way, and the division number, 027 or 536, tells you which service you're actually getting.1

A Home Health Agency provides skilled, intermittent care: nursing and physical, occupational, or speech therapy that a physician orders because the person has a medical need only a licensed professional can meet. Wound care after surgery, an injection 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.1

An In-Home Care Agency provides non-medical support: help with daily living and personal care that keeps someone safe at home. The person can be medically stable and still need this help every day.1

That separation is what decides the money. Every Oregon Home Health Agency must also meet the federal Medicare Conditions of Participation, and Medicare covers home health only when a Medicare-certified agency furnishes it.1,3 An In-Home Care Agency provides care Medicare doesn't pay for at all.

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 for months. Those come from different agencies under different OHA licenses, and they run on separate payment tracks.

Home Health in Oregon: The Home Health Agency

Skilled home health in Oregon comes from a Home Health Agency licensed by OHA under OAR 333-027, which must also comply with the federal Medicare Conditions of Participation.1 The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. For Medicare to pay, the care has to come from a Medicare-certified home health agency.3

Medicare's home health benefit covers this care when a beneficiary meets the conditions.1,3 The two that trip families up most:

• Homebound. Medicare treats this as two conditions that must both be met. First, leaving home isn't recommended because of the person's condition, or they have trouble leaving without help such as a cane, walker, wheelchair, special transportation or another person. Second, they're normally unable to leave home, and leaving takes a lot of effort.1
• 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. Federal rules generally cap combined skilled-nursing and home health aide hours at fewer than 8 hours a day and 28 or fewer hours a week (up to 35 on case-by-case review).3

When those conditions are met, Medicare pays for the covered skilled services: the nursing visits, the therapy, and the home health aide help that's attached to that skilled care.3 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 personal care, and it's the next section.

Home Care: The In-Home Care Agency and Who Pays

Non-medical home care in Oregon comes from an In-Home Care Agency, licensed by OHA under OAR 333-536 to provide help with daily living and personal care.1 Because it isn't skilled medical care, the payer picture looks nothing like home health.

Who pays for in-home 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.
• The Oregon Health Plan. For low-income Oregonians, the state's Medicaid program funds non-medical in-home care through the K Plan (Community First Choice), so a person can stay at home rather than enter a facility. Oregon's separate Aged and Physically Disabled Waiver covers case management, community transition, and housing support services rather than the in-home care hours themselves.1
• 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 when that is the only care a person needs.1 A family expecting Medicare to cover an aide for daily help will find it won't unless the person is also getting skilled nursing or therapy, no matter how much that help is needed.3 The ways to pay are private funds, long-term care insurance, or, for eligible low-income Oregonians, the Oregon Health Plan.

Home Care vs. Home Health in Oregon: Which One Do You Need?

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. The license is your first clue: a Home Health Agency under OAR 333-027 delivers skilled care, while an In-Home Care Agency under OAR 333-536 delivers the non-medical help.1

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 an In-Home Care Agency, and the question becomes whether to pay privately or qualify through the Oregon Health Plan. Both can be in play at once, and plenty of Oregon families arrange both.

What Home Care Costs in Oregon

Home health, when Medicare covers it, generally costs the beneficiary nothing for the covered services; durable medical equipment is the exception, at 20% of the Medicare-approved amount after the Part B deductible.3 The cost question really lives on the non-medical side, where families pay out of pocket unless the Oregon Health Plan covers it.

For non-medical home care in Oregon, a non-medical caregiver ran about $91,520 a year (roughly $40 an hour) per the CareScout 2025 Cost of Care Survey, on a basis of 44 hours a week.2 Oregon's long-term care costs run among the highest in the nation, and that rate is tied for 10th highest among the states, above the national median of $35 an hour. (The 2025 survey reports this as a single "non-medical caregiver" rate, merging the older homemaker and home-health-aide categories.) These are industry survey medians, not government rates and not a maximum, and CareScout collects them by metropolitan area, so the statewide figure averages metro markets that differ from one another, and what a specific Oregon agency charges can land above or below it. A family using fewer hours than the full-week assumption will pay less than the annual figure suggests.2

For low-income Oregonians who qualify, that private cost can be covered instead through the Oregon Health Plan's K Plan.1

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.