Home Care vs Home Health Maryland: The Licensing Difference That Determines Who Pays

Two Services That Sound Identical but Aren't

Families looking for in-home help for an aging parent in Maryland run into two terms that seem interchangeable: "home care" and "home health." They are not the same service, they're delivered by differently licensed agencies, and — most critically — they're paid for by completely different programs. Confusing them leads to billing surprises, coverage denials, and wasted months pursuing the wrong kind of help.

Here's the short version: home health is medical. Home care is personal. One is covered by Medicare. The other is not.

Home Health: Skilled Medical Services at Home

Home health agencies (HHAs) in Maryland are licensed under COMAR 10.07.10 and provide intermittent, physician-ordered medical services. A doctor must certify that your parent is homebound and needs skilled care. The services include:

• Clinical nursing — wound care, IV management, catheter care, medication management
• Physical therapy, occupational therapy, and speech-language pathology
• Medical social work
• Home health aide services — but only during the active skilled care period, and only to supplement the clinical treatment plan

Who pays: Medicare Part B covers home health services at 100% when the qualifying conditions are met. Your parent must be certified as homebound (leaving home requires a taxing effort), and the care must be physician-ordered, medically necessary, and delivered on an intermittent basis — typically under 8 hours per day and 28 hours per week.

What Medicare does not cover through home health: ongoing personal care, companionship, meal preparation, housekeeping, general supervision, or any non-medical assistance. When the skilled treatment plan ends (the wound heals, the therapy goals are met), Medicare home health coverage ends. There is no transition to ongoing personal care under Medicare.

New HHAs in Maryland must secure a Certificate of Need from the Maryland Health Care Commission, demonstrating a geographic shortage of skilled providers. This limits the number of agencies operating in some counties.

Home Care: Non-Medical Personal Assistance

Home care agencies in Maryland are licensed as Residential Service Agencies (RSAs) under COMAR 10.07.05. They provide non-medical personal care: bathing, dressing, grooming, toileting, meal preparation, light housekeeping, medication reminders (not administration), and companionship. This is the daily, hands-on help that keeps a person functioning safely at home.

RSAs are classified into two levels:

• Level 1 — non-skilled personal care and companion services
• Level 2 — skilled services (the agency employs an RN to supervise clinical staff), but their primary purpose remains custodial support

RSAs do not require a Certificate of Need, so there are more of them — and more competition on pricing and service quality.

Who pays: Not Medicare. Home care through an RSA is funded by one of three sources:

1. Private pay — the family pays out of pocket. Median hourly rate in Maryland: approximately $35, with most agencies requiring a 4-hour minimum per visit. Full-time care (44 hours per week) runs about $80,080 per year.
2. Maryland Medicaid — through Community First Choice (CFC), Community Personal Assistance Services (CPAS), or the Community Options Waiver (COW). CFC and CPAS are entitlements with no waitlist. The COW has a multi-year waitlist.
3. SOAR — the state's gap-filling program for moderate-income seniors who don't qualify for Medicaid.

Why This Distinction Costs Families Money

The most common mistake: a family assumes that because Medicare covered their parent's home health visits after a hospitalization, Medicare will continue paying for daily personal care once the medical treatment ends. It won't. When the home health agency discharges your parent from skilled services, the daily bathing and dressing help that was bundled into the treatment plan disappears too.

The second mistake: assuming a home care agency (RSA) can bill Medicare. RSAs are not Medicare-certified providers. They can't bill Medicare at all. If a family hires an RSA expecting Medicare to reimburse them, the entire cost comes out of pocket.

The practical sequence for many families looks like this:

1. Parent is hospitalized → discharged home with Medicare-funded home health (HHA) for short-term skilled nursing and therapy
2. Skilled treatment ends after 4-8 weeks → home health agency discharges the patient
3. Parent still needs daily help with bathing, dressing, meals → family must now arrange and fund home care (RSA) separately

Step 3 is where families hit a wall. The post-hospital transition is one of the most stressful decision points in elder care precisely because of this coverage gap.

Choosing Between Agency Types

Some agencies hold both an HHA and RSA license, which means they can provide the full spectrum of care — medical and personal — under one organizational roof. This can simplify coordination but doesn't change the underlying payment rules. The Medicare-funded portion still ends when skilled care ends.

The Decision Framework

If your parent needs skilled medical treatment at home (wound care, IV therapy, post-surgical rehabilitation), start with a home health agency and verify Medicare coverage with their physician's order.

If your parent needs ongoing daily help with personal care — the kind of support that keeps them safe, fed, and clean — you need a home care agency (RSA) and a funding strategy: Medicaid, SOAR, or private pay.

The Maryland home care navigation guide walks through both pathways and maps the funding options for each, including how to time the transition from Medicare home health to Medicaid-funded personal care without a gap in coverage.

See more Maryland guides →