Non-medical home care vs. home health: how the licensing paths differ
Education only. This article is general information, not legal, tax, medical, nursing, employment, or regulatory advice. Licensing rules vary by state and change over time. Check every requirement with your state agency and a licensed advisor before you apply, hire, bill, or provide services.
Why this is the first decision
People often say “home care” when they mean two different businesses. One helps people with daily living at home: bathing, dressing, meals, light housekeeping, companionship, and reminders. The other provides skilled medical care at home, such as nursing visits or therapy ordered by a physician. Most states license and oversee these two models differently, and payers treat them differently too. Pick the wrong one and you may end up researching the wrong license, hiring the wrong roles, or marketing services you are not allowed to provide.
This guide explains the usual differences in plain terms. It won’t tell you what your state requires. It will help you ask the right questions when you contact your state.
What “non-medical” home care usually means
Non-medical agencies are also called personal care, companion care, homemaker, or in-home support agencies. The official name differs from state to state, so look for the term your state’s licensing office uses. Services usually center on:
- Help with activities of daily living, like bathing, grooming, dressing, toileting, and moving around the home
- Help with household tasks, like meal prep, laundry, errands, and light cleaning
- Companionship, supervision, and safety checks
- Medication reminders, where allowed. What an aide may and may not do with medications is a boundary your state sets, so read its rules before you write a policy
Some states require a license for non-medical home care. Some register these agencies. Some have little oversight unless the agency takes public funding. Your state’s health or licensing department can tell you which applies to you. Don’t assume “non-medical” means “unregulated.”
What “home health” usually means
Home health agencies deliver skilled services, such as nursing, physical therapy, occupational therapy, or speech therapy, usually under a plan ordered by a physician or other authorized practitioner. They often also employ home health aides who work under clinical supervision.
If you want to bill Medicare for home health, there is a federal certification layer on top of state licensing. The Centers for Medicare & Medicaid Services (CMS) describes a Medicare home health agency as an organization that is, among other things, “primarily engaged in providing skilled nursing services and other therapeutic services,” with physician and registered-nurse involvement in its policies, supervision by a physician or RN, clinical records on all patients, and a state or local license or equivalent approval. Those requirements appear in the Conditions of Participation at 42 CFR Part 484. (Source: CMS, Home Health Agencies, checked on 2026-09-25.)
In practice, that means home health usually needs clinical leadership, clinical documentation systems, and a survey or accreditation process before Medicare will pay. Non-medical models usually do not.
Side-by-side: the questions that change
| Question | Non-medical home care (typical) | Home health (typical) |
|---|---|---|
| Who oversees it? | Often a state health or human services department, though the overseeing office differs by state | State licensing agency, plus CMS certification if billing Medicare |
| Clinical staff needed? | Often not. Some states require an RN supervisor for certain services, so check your state’s rules | Yes. RN and/or therapist leadership is central |
| Who pays? | Private pay, long-term care insurance, and sometimes Medicaid waiver/HCBS programs | Medicare, Medicaid, and commercial insurance, plus some private pay |
| Physician orders? | Usually not required for non-medical services | Usually required |
| Documentation | Care or service plans, visit notes, timekeeping, EVV where required | Clinical records, plans of care, visit notes, EVV where required |
Read the table as a starting point, not a rule set. Your state’s definitions decide which column you are in.
Where Medicaid waiver programs fit
Many states pay for non-medical supports, such as personal care or homemaker services, through Medicaid home- and community-based services (HCBS) programs, often called “waivers.” To be paid by those programs, an agency usually needs to meet state licensing rules and enroll as a Medicaid provider for specific services. Enrollment is a separate step from licensing. Being licensed doesn’t automatically make you an enrolled Medicaid provider. See our guide on how Medicaid waiver provider enrollment generally works.
How to research your state (a practical order)
- Find your state’s definitions. Search your state’s health department or licensing agency site for terms like “home care agency,” “personal care agency,” “home health agency,” and “companion services.” Write down the exact names and the services each one covers, in your state’s own words.
- List the services you actually want to offer. Be specific. “Help with bathing” and “wound care” land in very different categories.
- Match each service to a license type. If one service pushes you into a clinical license, decide whether to drop it for now or plan for the larger model.
- Note the requirements for each license. Record what the state lists: application forms, fees, required policies, staffing, background checks, training, inspections, and timelines. Use only the numbers your state publishes, because fees and timelines change.
- Check payer rules separately. If you plan to accept Medicaid waiver clients, look up the state Medicaid agency’s provider enrollment pages. If you plan to bill Medicare, read the CMS certification material.
- Ask a professional. A healthcare attorney or consultant who works in your state can confirm your reading before you spend money on leases, branding, or hiring.
Common mistakes to avoid
- Marketing services before you are authorized. A website that promises “nursing care” when you hold a non-medical license can create real problems.
- Assuming another state’s rules apply. Blog posts and forums often describe one state’s process as if it were universal.
- Treating licensing and payer enrollment as one step. They usually involve different agencies, forms, and timelines.
- Skipping the medication boundary. Decide early, in writing, what your aides will and won’t do with medications, based on your state’s rules.
A simple way to decide
If you’re not sure, many founders start by writing a one-page “model statement”: the services you’ll offer, who you’ll serve, who will pay, and which roles you’ll need. Take that page to your state agency and your advisor. The model statement makes your questions specific, and it keeps you from drifting into services you haven’t planned for.
If you want a structured place to record what you find, the state-research workbook in our Home Care / Medicaid Waiver Startup Pack includes a research log and gap tracker. They are planning templates, not filing-ready applications.
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Common questions
- Is non-medical home care always licensed?
- No. Some states license it, some register it, and some have limited oversight. Your state’s licensing office can tell you which approach it takes.
- Can a non-medical agency add skilled services later?
- Often yes, but that usually means a different or additional license, clinical staff, and new policies. Plan for it as a separate project.
- Do I need Medicare certification to run a home health agency?
- Only if you want Medicare to pay. Certification follows the CMS Conditions of Participation at 42 CFR Part 484 on top of state licensing.
- Does a license let me bill Medicaid?
- Not by itself. Medicaid provider enrollment is usually a separate step with its own requirements.