"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 an agency the West Virginia Office of Health Facility Licensure and Certification licenses, and it's what Medicare can cover; home care is non-medical daily help the state doesn't separately license.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
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 carries a state license and a supply control the non-medical everyday help does not.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
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, that agency must be licensed by the West Virginia Office of Health Facility Licensure and Certification (OHFLAC).Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
West Virginia adds a step most states don't. Before a new home health agency can begin serving an area, it must obtain a Certificate of Need, a state approval that a new agency is warranted in that service area. That requirement limits how many home health agencies operate locally, so families in some parts of the state choose from fewer skilled-care providers than the size of the population alone would suggest.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
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." West Virginia generally does not separately license it as a category, so unlike a home health agency, a non-medical home care provider operates without a state license of its own.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
That separation is what decides the money. Medicare certification, layered on top of the state license, is the step that lets a home health agency bill Medicare for the skilled care it delivers.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services Non-medical personal care is care Medicare doesn't pay for at all. 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 an agency licensed by OHFLAC, and to bill Medicare that agency must also be Medicare-certified.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. The state license is the floor; Medicare certification is the additional step that lets the agency bill Medicare for those services.
Medicare's home health benefit covers this care only when a beneficiary meets every condition.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services 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 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 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).U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualification requirements, home health (govinfo.gov). govinfo.gov. Retrieved Jun 23, 2026, from https://www.govinfo.gov/content/pkg/CFR-2023-title42-vol2/xml/CFR-2023-title42-vol2-sec409-42.xml 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 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
Per the CareScout 2025 Cost of Care Survey, the most recent state-level data, in-home non-medical caregiver services in West Virginia ran a median of about $68,640 a year, roughly $5,720 a month.CareScout. (n.d.). Cost of Long Term Care by State. carescout.com. Retrieved Jun 25, 2026, from https://www.carescout.com/cost-of-care Starting with the 2025 survey, CareScout combined its former "homemaker" and "home health aide" categories into a single "non-medical caregiver" rate, so this one figure now covers both the housekeeping help and the hands-on personal care an aide provides. The annual figure is built on a roughly 44-hour week. That matters: a family hiring an aide for only a few hours a day pays a fraction of the annual figure, which assumes a near full-time schedule. At a 44-hour week, $68,640 a year works out to about $30 an hour, so a few hours of help two or three days a week runs in the hundreds of dollars a month, not the tens of thousands. These are industry survey medians, not government rates and not a ceiling, 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, while its nursing-home care, about $154,030 a year for a semi-private room, runs well above the national figure.CareScout. (n.d.). Cost of Long Term Care by State. carescout.com. Retrieved Jun 25, 2026, from https://www.carescout.com/cost-of-care
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
- West Virginia Medicaid. For eligible low-income older West Virginians, West Virginia Medicaid funds non-medical personal care through the Aged and Disabled Waiver and the state's Personal Care Services program, the home and community-based paths that help a person stay out of a nursing home. The program is administered by the West Virginia Bureau for Medical Services.U.S. Social Security Administration. (2026). SSI Federal Payment Amounts for 2026. ssa.gov. Retrieved Jun 25, 2026, from https://www.ssa.gov/oact/cola/SSI.html
- 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services 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 are private funds, long-term care insurance, or, for eligible low-income 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services 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.
| Home Health (Skilled) | Home Care (Non-Medical) | |
|---|---|---|
| West Virginia oversight | Agency licensed by OHFLAC and requires a Certificate of Need to open; bills Medicare only if also Medicare-certified | Non-medical personal care, generally not separately licensed by the state |
| What it is | Skilled, physician-ordered care: nursing and physical, occupational, or speech therapy under a plan of care, part-time or intermittent | Everyday non-medical help with daily living (bathing, dressing, grooming, meals, homemaking) |
| Who provides it | A licensed home health agency, often Medicare-certified, and its clinical staff (nurses and therapists) | A home care or personal-care agency and its aides |
| Who pays | Medicare (when homebound + intermittent skilled need) | Private pay, long-term care insurance, or Medicaid's Aged and Disabled Waiver or Personal Care Services for eligible low-income West Virginians |
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 license and the certification are the substance, not the marketing:
- Confirm the OHFLAC license and Medicare certification. A skilled home health agency must hold a license from OHFLAC, and for Medicare billing it must also be Medicare-certified.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services Ask to see the license and 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
Non-medical home care is where West Virginia families have to do more of their own diligence, because the state generally doesn't license these providers, so there's no license to check.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services 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 the usual signal of a state license isn't available here.
- 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.CareScout. (n.d.). Cost of Long Term Care by State. carescout.com. Retrieved Jun 25, 2026, from https://www.carescout.com/cost-of-care
- 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 home and community-based eligibility takes time to establish.U.S. Social Security Administration. (2026). SSI Federal Payment Amounts for 2026. ssa.gov. Retrieved Jun 25, 2026, from https://www.ssa.gov/oact/cola/SSI.html
Frequently Asked Questions
Does Medicare cover home health in West Virginia?
Yes, but only skilled care. Medicare's home health benefit covers physician-ordered nursing and physical, occupational, or speech therapy for a person who is homebound and needs that care on a part-time or intermittent basis, delivered by a Medicare-certified agency.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services It does not pay for non-medical personal care, the help with bathing, dressing, meals, and everyday support an aide provides, on its own.
What is the difference between home care and home health in West Virginia?
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 that Medicare does not cover.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services In West Virginia, the skilled home health agency is licensed by OHFLAC and must obtain a Certificate of Need to open; non-medical personal care generally isn't separately licensed by the state.
How much does home care cost in West Virginia?
Per the CareScout 2025 Cost of Care Survey, in-home non-medical caregiver services in West Virginia ran a median of about $68,640 a year, roughly $5,720 a month, on a 44-hour week.CareScout. (n.d.). Cost of Long Term Care by State. carescout.com. Retrieved Jun 25, 2026, from https://www.carescout.com/cost-of-care That annual figure assumes a near full-time schedule and works out to about $30 an hour, so a family hiring an aide for only a few hours a day pays far less than the annual number. The figure is a survey median, not a fixed rate, so a given agency can charge above or below it. The 2025 survey folded the former "homemaker" and "home health aide" rates into this single non-medical caregiver category.
Does West Virginia Medicaid cover personal care?
Yes. For eligible low-income older West Virginians, West Virginia Medicaid funds non-medical personal care through the Aged and Disabled Waiver and the state's Personal Care Services program, the home and community-based paths for people who would otherwise need a nursing-facility level of care.U.S. Social Security Administration. (2026). SSI Federal Payment Amounts for 2026. ssa.gov. Retrieved Jun 25, 2026, from https://www.ssa.gov/oact/cola/SSI.html Enrollment runs through the West Virginia Bureau for Medical Services, which is where a family begins.
Why are there fewer home health agencies in some parts of West Virginia?
West Virginia requires a Certificate of Need before a new home health agency can begin serving an area, a state approval that the new agency is warranted there.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home health services coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services That requirement controls how many skilled home health agencies operate locally, so in some areas families choose from fewer providers than the population alone would suggest. It applies to skilled home health, not to non-medical personal care.
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