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.
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
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. 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. 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. 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, 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. 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 low-income Washingtonians, Apple Health, the state's Medicaid program, funds in-home personal care directly and through the COPES waiver. 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 state, so that's 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 Washingtonians, Apple Health and COPES.
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 Agency | 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 | Everyday non-medical help: personal care with daily activities (bathing, dressing, eating, mobility) and homemaking (housework, shopping, meals) |
| Who provides it | A Home Health Agency and its clinical staff (nurses and therapists) | Caregivers and home care aides employed by a Home Care Agency |
| Licensed by | DOH-licensed; must clear Certificate of Need before Medicare certification | DOH-licensed |
| Who pays | Medicare (when homebound + intermittent skilled need) | Private pay, long-term care insurance, or Apple Health and COPES for eligible low-income Washingtonians |
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, 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 Apple Health covers it.
For non-medical home care in Washington, a home health aide ran about $96,096 a year in 2024, according to the Genworth/CareScout Cost of Care Survey, which works out to roughly $8,008 a month on a basis of 44 hours a week. That puts Washington among the highest-cost states in the country. 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 annual figure suggests.
For low-income Washingtonians who qualify, that private cost can be covered instead through Apple Health and the COPES waiver as in-home personal care.
Frequently Asked Questions
No. Medicare does not pay for non-medical home care, the help with bathing, dressing, meals, and homemaking that a home care 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 Washingtonians, Apple Health and COPES.
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. Non-medical home care is everyday help with daily living and homemaking that Medicare does not cover. In Washington, both are licensed by the Department of Health, but a Home Health Agency is the skilled, Medicare-certified provider, while a Home Care Agency delivers the non-medical help, funded for eligible people through Apple Health.
A Home Care Agency is a provider that the Washington State Department of Health licenses to deliver non-medical in-home services: help with daily activities such as bathing, dressing, eating, and mobility, plus homemaking like housework, shopping, and meal preparation. It is a different license from a Home Health Agency, which provides skilled medical care. Some home care agencies also contract with the state's Department of Social and Health Services to deliver Apple Health and COPES-funded care.
COPES is a Washington Apple Health waiver that funds in-home personal care for eligible low-income people who need long-term help with daily activities, so they can stay at home rather than enter a nursing facility. Apple Health funds in-home personal care both directly and through COPES. Eligibility for these long-term services and supports runs through the state, which is where a family begins.
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) from a Home Care Agency. 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 Washington
- Nursing Homes in Washington
- Memory Care in Washington
- Medicaid Planning Strategies
- Caregiver Burnout: Signs and Support
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.