CHHA vs LHCSA in New York: Home Health Agency Types Explained

Two Types of Home Care Agencies, Two Different Purposes

Two categories families commonly compare in New York are certified home health agencies and licensed home care services agencies, and confusing them is one of the most common mistakes families make when arranging care for an aging parent. They sound similar but serve fundamentally different functions.

A Certified Home Health Agency (CHHA) provides skilled clinical care — visiting nurses, physical therapists, occupational therapists, speech-language pathologists, and medical social workers. A CHHA is the agency that arrives after a hospital discharge or surgery to deliver rehabilitative services. Medicare pays for it. The care is temporary: it ends once the clinical goals are met or the patient no longer needs skilled intervention.

A Licensed Home Care Services Agency (LHCSA) provides non-medical custodial care — personal care aides and home health aides who help with bathing, dressing, cooking, light housekeeping, and supervision. Medicaid pays for it through your parent's Managed Long Term Care (MLTC) plan. This care can be long-term, continuing for years as long as eligibility is maintained.

The Staff: Home Health Aide vs Personal Care Aide

The staff distinction mirrors the agency distinction:

Home Health Aides (HHAs) complete a 75-hour DOH-approved training program that includes clinical content — taking vital signs, basic wound care observation, range-of-motion exercises under a nurse's supervision. HHAs can work in both CHHAs and LHCSAs.

Personal Care Aides (PCAs) complete a shorter 40-hour training program focused on custodial tasks — help with ADLs, meal preparation, light housekeeping, and companionship. PCAs work exclusively through LHCSAs.

In practice, the day-to-day tasks overlap substantially. Both help with bathing, dressing, and meal preparation. The difference is that an HHA can perform limited clinical observations under an RN's supervision, while a PCA cannot. For most families arranging long-term Medicaid home care, the aide who shows up is either an HHA or PCA employed by the LHCSA contracted through their parent's MLTC plan.

Who Pays for What

This is where families get tripped up:

Medicare covers CHHA services when the patient is "homebound" (leaving home requires considerable effort) and needs intermittent skilled care — nursing visits, therapy sessions, medication management. There is no co-pay for Medicare home health services. But Medicare does not cover long-term custodial aides who help with daily living tasks.

Medicaid covers LHCSA services (personal care and home health aides for custodial care) through the MLTC managed care system. The patient must meet both financial eligibility ($1,836/month income, $33,038 assets for 2026) and clinical eligibility (the 3-ADL physical assistance requirement, or supervisory assistance with 2 ADLs for documented dementia, since September 2025).

Private pay can access either type. Families paying out of pocket for long-term custodial care hire directly through an LHCSA. Hourly rates range from $25 to $35 in the New York metro area, varying by region and shift.

A parent can receive CHHA and LHCSA services simultaneously. After a hip fracture, for example, a CHHA nurse might visit three times per week for wound assessment and physical therapy (Medicare-funded), while an LHCSA aide comes daily for bathing and meal preparation (Medicaid-funded). The two agencies coordinate through the MLTC plan's Care Manager.

When Your Parent Needs a CHHA

Your parent needs a Certified Home Health Agency if they:

• Were just discharged from a hospital or rehabilitation facility and need skilled nursing follow-up
• Require wound care, IV therapy, or catheter management at home
• Need physical, occupational, or speech therapy as part of a recovery plan
• Are "homebound" under Medicare's definition and have a physician order for home health services

CHHA services are episodic. A visiting nurse might come two to three times per week for six to eight weeks after surgery, then discharge the case when clinical goals are met. If your parent's needs are ongoing and custodial — they need someone there every day to help them get dressed and eat — the CHHA is not the right fit.

When Your Parent Needs an LHCSA

Your parent needs a Licensed Home Care Services Agency if they:

• Need daily help with bathing, dressing, grooming, eating, or transfers
• Require supervision due to cognitive impairment or fall risk
• Need light housekeeping, meal preparation, and medication reminders
• Qualify for Medicaid Community Care and are enrolled (or enrolling) in an MLTC plan

LHCSA services can continue indefinitely as long as your parent maintains Medicaid eligibility and meets the clinical threshold. Hours are authorized by the MLTC plan's Care Manager based on the NYIA assessment.

The CDPAP Alternative

There is a third path that bypasses both CHHAs and LHCSAs entirely. The Consumer Directed Personal Assistance Program (CDPAP) lets your parent hire their own caregiver — including family members — to perform approved personal-care and skilled tasks. The consumer directs the care, but the program's rules still govern which tasks may be authorized and how they are performed.

The full comparison of agency-based care versus self-directed CDPAP, along with MLTC plan selection guidance, is in the Aging in Place in New York guide.

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