Home Care vs. Home Health in West Virginia (2026)

"Home care" and "home health" sound interchangeable, but in West Virginia they're two different services, and the difference decides who pays. Home health is the skilled nursing and therapy a doctor orders from a home health agency, one of the facility types the West Virginia Office of Health Facility Licensure and Certification covers, and it's what Medicare can cover; home care is non-medical daily help that Medicare doesn't pay for when it's the only care someone needs.1

This guide draws that line so a West Virginia family doesn't pay out of pocket for care a program would have covered, or wait on Medicare coverage that was never coming. What matters isn't the word on the agency's sign, 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 West Virginia: The Two Services
• Home Health: What Medicare Covers in West Virginia
• What It Costs and Other Ways to Pay
• How to Choose Between Home Care vs. Home Health in West Virginia
• Frequently Asked Questions

Home Care vs. Home Health in West Virginia: The Two Services

The split is skilled versus non-medical, and in West Virginia the skilled side is a facility type OHFLAC covers and falls under the state's Certificate of Need program.1

A home health agency provides skilled, physician-ordered care: nursing and physical, occupational, or speech therapy ordered because the person has a medical need only a licensed professional can meet. Wound care after surgery, IV medication, injections 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. In West Virginia, home health agencies are among the facility types the Office of Health Facility Licensure and Certification (OHFLAC) covers, an office whose stated mission ties quality care to compliance with state licensure rules and federal certification regulations.1

West Virginia also runs a Certificate of Need program. Health care providers, unless exempt, must obtain a Certificate of Need from the West Virginia Health Care Authority before adding or expanding health care services, and the Authority publishes a county-by-county Home Health Need Methodology that counts Certificate of Need approvals when it judges whether an area needs more home health.1

Non-medical home care is everyday help with bathing, dressing, grooming, meals, and homemaking, the tasks that keep someone safe at home. The person can be medically stable and still need this help every day. This is the work most people mean when they say "home care." Because it isn't skilled care, Medicare doesn't pay for it when it's the only care someone needs.1

That separation is what decides the money. Medicare pays for home health only when a Medicare-certified agency provides the care, so certification is what puts an agency's skilled care on the Medicare track.1 Non-medical personal care, when it's the only care someone needs, is care Medicare doesn't pay for.1 So when a West Virginia family hears "home health," that points to the skilled, often Medicare-certified track, and "personal care" or "homemaker" points to the non-medical one.

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 over the months that follow. Those run on separate payment tracks: Medicare pays for the skilled piece, and something else pays for the personal-care piece.

Home Health: What Medicare Covers in West Virginia

Skilled home health in West Virginia comes from a home health agency, a facility type OHFLAC covers, and for Medicare to pay, that agency must be Medicare-certified.1 The agency's nurses and therapists carry out the plan of care a physician has ordered.

Medicare's home health benefit covers this care only when a beneficiary meets every condition.1 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.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.1

When those conditions are met, Medicare pays for the covered skilled services and the beneficiary generally pays $0 for them: the nursing visits, the therapy, and the home health aide help attached to that skilled care, with a 20% coinsurance, after the Part B deductible, only on any durable medical equipment. "Part-time or intermittent" has a specific meaning here, combined skilled nursing and aide help running fewer than 8 hours a day and 28 or fewer hours a week (up to 35 on case-by-case review).5 What Medicare home health will not do is staff an aide in the home for general daily help with no skilled-care purpose, or pay for homemaker services unrelated to the plan of care, or 24-hour care. That's personal care, and it's the next section.

What It Costs and Other Ways to Pay

Non-medical home care covers help with bathing, dressing, grooming, meals, and homemaking. Because it isn't skilled medical care, the payer picture looks nothing like home health, and the cost question lives almost entirely on this side.1

Per the CareScout 2025 Cost of Care Survey, its latest edition, a non-medical caregiver in West Virginia ran a median of $30 an hour. CareScout projects that to $68,640 a year, or $5,720 a month, by assuming 44 hours a week for 52 weeks.2 The 2025 survey merged CareScout's former "homemaker" and "home health aide" categories into this single "non-medical caregiver" rate, so the one figure covers both the housekeeping help and the hands-on personal care an aide provides, and it isn't a like-for-like match with earlier editions. The 44-hour assumption matters: a family hiring an aide for only a few hours a day pays a fraction of the annual figure. These are industry survey medians from one commercial publisher, not government rates and not a ceiling, and costs vary within the state, so what a specific West Virginia agency charges can land above or below them. In this survey, West Virginia's in-home care runs below the national median of $35 an hour, while its nursing-home care, $154,030 a year for a semi-private room, runs well above the national $114,975.2

Who pays for personal care comes down to a few routes:

• Private pay. Because Medicare doesn't pay for personal care when it's the only care needed, families who don't qualify for a public program pay out of pocket.1
• West Virginia Medicaid. For eligible members, West Virginia Medicaid offers in-home help two ways: the Personal Care Services program, which assists with activities of daily living in the member's home, and the Aged and Disabled Waiver, an in-home care option that lets a person remain at or return home instead of receiving nursing home care. The waiver requires a nursing home level of care, and even after acceptance a program opening must be available. West Virginia Medicaid is administered by the West Virginia Bureau for Medical Services.3,4
• Long-term care insurance. A private long-term care policy, if the person holds one, is designed to cover the personal and custodial care health insurance doesn't, including at home, but it pays only after the policy's benefit trigger and waiting period are met.6

One line is worth stating plainly. Medicare does not pay for non-medical personal care when that is the only care someone needs.1 A family expecting Medicare to cover an aide for daily help, with no nurse or therapist involved, will find it won't, no matter how much that help is needed; aide hours are covered only while skilled care is also being provided.5 The ways to pay for personal care on its own are private funds, long-term care insurance, or, for eligible West Virginians, Medicaid's Aged and Disabled Waiver or Personal Care Services.

How to Choose Between Home Care vs. Home Health in West Virginia

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.1 Whether the care is skilled is your first clue: skilled, physician-ordered care points to home health, and everyday non-medical help points to personal care.

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 West Virginia Medicaid.

Once you know which service you need, the checks differ by track. For skilled home health, the certification and the doctor's order are the substance, not the marketing:

• Confirm Medicare certification. Medicare pays for home health only when a Medicare-certified agency provides the care.1 Confirm the agency is Medicare-certified before assuming Medicare will pay.
• Match the agency to the doctor's order. Medicare coverage hinges on a physician's plan of care and the homebound and intermittent-skilled tests, so confirm the agency will work from your doctor's order and bill Medicare directly.1

Non-medical home care is where West Virginia families have to do more of their own diligence, because Medicare certification, the check that anchors home health, plays no part in it.1 A few steps are worth taking before you hire:

• Ask how caregivers are screened. Confirm the agency runs criminal background checks and verifies credentials on the aides it sends, and ask whether caregivers are employees the agency covers for liability and workers' compensation or independent contractors you'd be responsible for.
• Check references. Ask for references from current clients and follow up on them, since you're the one vetting the agency.
• Get a written care plan and rate. Insist on a written plan that lists the specific tasks, the hours, the hourly rate, and any minimums, so expectations and cost are clear before care starts.
• Check the Medicaid path early if money is tight. If private pay isn't sustainable, contact the West Virginia Bureau for Medical Services about the Aged and Disabled Waiver and Personal Care Services before a crisis, because the Aged and Disabled Waiver requires a nursing home level-of-care assessment and an available program opening before services start.3,4

Learn More

Find personalized help matching the right in-home service to the need and payer in West 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.