Home Care vs. Home Health in Washington (2026)

In Washington, "home health" and "home care" sound like the same thing, but they're different services with different rules about who provides the care and who pays. Home health is skilled, doctor-ordered care from a Home Health Agency 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 Washingtonians may cover it through Apple Health.1,2

This guide draws the line between the two. The label decides which provider can deliver the care, which Washington 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 DOH-Licensed Home Health Agency
• Home Care: The Home Care Agency, Apple Health, and COPES
• Which One Do You Need?
• What It Costs
• Frequently Asked Questions
• Your Next Step

The Core Difference

The split is medical versus non-medical, and in Washington it settles three things at once: who provides the care, which 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.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.

Home care is non-medical help. Much of what this care covers is help with the activities of daily living, bathing, dressing, getting to the bathroom, eating, and moving around, plus homemaking like housework, shopping, and meal preparation. 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 distinction is worth knowing before you start making calls.

Home Health: The DOH-Licensed Home Health Agency

Skilled home health in Washington is delivered by a Home Health Agency that the Department of Health licenses.1 The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. A Washington home health agency must first obtain approval through the state's Certificate of Need program, and then it can seek Medicare certification. Once certified, the agency can bill Medicare for covered services.

Medicare's home health benefit covers this Home Health Agency care when a beneficiary meets the conditions.1,3 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. In practice, "part-time or intermittent" generally means skilled nursing and home health aide care combined runs less than 8 hours a day and 28 or fewer hours a week.3

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 $0.3 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 home care, and it's the next section.

Home Care: The Home Care Agency, Apple Health, and COPES

Non-medical home care in Washington is the everyday help that keeps someone safe and supported at home: personal care with daily activities, plus homemaking like housework, shopping, and meals.1 It isn't skilled medical care, so it doesn't run through a Medicare-certified Home Health Agency. In Washington it comes from a DOH-licensed Home Care Agency, and the payer picture looks different.

Who pays for non-medical 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.
• Apple Health and COPES. For financially eligible Washingtonians, Apple Health, the state's Medicaid program, pays for in-home personal care through Community First Choice and Medicaid Personal Care; COPES, a Medicaid waiver for people who meet nursing facility level of care, adds wraparound services.2 Some home care agencies contract with the state's Department of Social and Health Services (DSHS) to deliver that care. Eligibility for these long-term services runs through the DSHS Aging and Long-Term Support Administration, so that is 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 when that is the only care needed.1 A family expecting Medicare to cover an aide for daily help, with no skilled nursing or therapy alongside it, will find it won't, no matter how much that help is needed.3 The ways to pay for home care are private funds, long-term care insurance, or, for eligible low-income Washingtonians, Apple Health.

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.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 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 a Home Care Agency, and the question becomes whether to pay privately or qualify through Apple Health. Plenty of families arrange both at once.

What It Costs

Home health, when Medicare covers it, generally costs the beneficiary nothing for the covered home health services.3 The cost question really lives on the home care side, where families pay out of pocket unless Apple Health covers it.

For non-medical home care in Washington, a non-medical caregiver in the home ran a median of about $8,580 a month in 2025, according to the CareScout 2025 Cost of Care Survey, which works out to roughly $102,960 a year on a basis of 44 hours a week. That puts Washington among the highest-cost states in the country.4 Those are industry survey medians, not government rates and not a maximum, so what a specific Washington agency charges can land above or below them, and the Seattle metro tends to run higher than rural counties. A family using fewer hours than the full-week assumption will of course pay less than the monthly figure suggests.4

For low-income Washingtonians who qualify, that private cost can be covered instead through Apple Health's in-home personal care programs.2

Your Next Step

Learn More

Find personalized help arranging care at home in Washington 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.