Home Care vs. Home Health in Virginia (2026)

"Home health" and "home care" sound like the same thing, but they're different services with different rules about what the care is and who pays for it. Home health is skilled, doctor-ordered care that Medicare covers when someone is homebound and needs intermittent skilled care; non-medical home care is everyday help that Medicare won't pay for, though low-income Virginians may cover it through Medicaid. Virginia adds a twist: it licenses both under one license type.1,2

This guide draws the line between the two. In Virginia the same licensed organization can deliver both, so the label that actually matters isn't the agency's name, it's whether the care is skilled or non-medical, and which program pays the bill. Getting that 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 in Virginia
• Home Health: Skilled Care and What Medicare Covers
• Home Care: Personal Care and Who Pays
• Which One Do You Need?
• What Home Care Costs in Virginia
• Frequently Asked Questions

The Core Difference in Virginia

The split is medical versus non-medical, and it settles two things that matter to a Virginia family: what the care actually is, and which program pays for it.

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.1 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.

Personal care is non-medical help. Much of this is help with the activities of daily living, bathing, dressing, getting to the bathroom, eating, and moving around, plus the everyday support that keeps someone safe at home. The person can be medically stable and still need this help every day.

Here's where Virginia differs from a lot of states. It doesn't license a separate "home health agency" and "home care agency." It licenses one thing, the Home Care Organization, and a single HCO license can authorize home health services, personal care services, or both.1 So the question isn't which type of agency to call. It's which kind of service you need, because that decides who pays, and the two run on separate payment tracks even when one organization delivers both.

The same person often needs both at once. Someone discharged after hip surgery might get home health (a nurse and a physical therapist for a few weeks) and also need personal care (an aide for bathing and meals for months). One HCO can provide both, but Medicare pays for the skilled piece (plus part-time aide help while that skilled care lasts) and something else pays for the personal care that continues after it.

Home Health: Skilled Care and What Medicare Covers

Skilled home health in Virginia is the medical side of what a VDH-licensed Home Care Organization provides.1 The organization employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. To bill Medicare for those services, the agency must be Medicare-certified.

Medicare's home health benefit covers this care when a beneficiary meets the conditions.1,2 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 or allowed practitioner certifies that the person needs skilled nursing or therapy on a part-time or intermittent basis, under a plan of care that practitioner periodically 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. For those covered home health services the beneficiary generally pays $0.2 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: Personal Care and Who Pays

Personal care in Virginia is the non-medical help that keeps someone safe and supported at home: help with daily activities and the everyday support around them.1 A Home Care Organization can be licensed to provide it, the same license type that covers skilled home health, but because it isn't skilled medical care, the payer picture looks different.

Who pays for personal 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.
• CCC Plus (Cardinal Care) waiver. For low-income Virginians, Virginia Medicaid's CCC Plus waiver covers personal care and respite.1 It offers two models: agency-directed, where an HCO manages the aide, and consumer-directed, where the member hires and directs their own aide. Eligibility runs through Virginia Medicaid, so that's where a family starts.
• 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 needed.1 A family expecting Medicare to cover an aide for daily help with no skilled care alongside it will find it won't, no matter how much that help is needed. The exception is narrower than families assume: while a home health nurse or therapist is visiting, Medicare can also cover part-time home health aide help with tasks like walking, bathing, grooming and feeding, so ask the agency about aide hours, but that aide coverage ends when the skilled care ends.2 The ways to pay for ongoing personal care are private funds, long-term care insurance, or, for eligible low-income Virginians, the CCC Plus waiver.

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. In Virginia one HCO can deliver both, so read the columns as two kinds of service, not two kinds of agency.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 personal care, and the question becomes whether to pay privately or qualify through CCC Plus. Both can come from the same Home Care Organization, and plenty of families arrange both at once.

What Home Care Costs in Virginia

Home health, when Medicare covers it, costs the beneficiary nothing for the covered skilled services.1,2 The cost question really lives on the personal-care side, where families pay out of pocket unless CCC Plus covers it.

For non-medical personal care in Virginia, a non-medical caregiver ran a median of about $80,080 a year in 2025, according to the CareScout (Genworth) 2025 Cost of Care Survey.3 (In its 2025 survey, CareScout merged the former "homemaker" and "home health aide" categories into one "non-medical caregiver" category.) Those are industry-survey medians, not government rates and not a maximum, so what a specific Virginia agency charges can land above or below them. A family using fewer hours pays correspondingly less than the annual median suggests.3

For low-income Virginians who qualify, that private cost can be covered instead through the CCC Plus waiver as personal care, under either the agency-directed or consumer-directed model.1

Learn More

Find personalized help arranging care at home in Virginia 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.