Home Health After Hospital Discharge Maryland

Your parent is coming home from the hospital and the discharge planner says they need "home health." But "home health" in Maryland covers two fundamentally different categories of care — one covered by Medicare, one not — and confusing them can leave your family with a surprise bill.

Home Health Agency vs. Residential Service Agency

Maryland's Office of Health Care Quality (OHCQ) licenses two distinct categories of home-based care providers:

Home Health Agencies (HHAs) provide skilled, intermittent clinical services: registered nursing, physical therapy, occupational therapy, and speech-language pathology. These are medical professionals performing clinical tasks — wound care, IV management, therapy exercises, medication management. Services require a physician's order.

Residential Service Agencies (RSAs) provide supportive, non-clinical personal care: help with bathing, dressing, grooming, toileting, light meal preparation, and household tasks. These are personal care aides assisting with daily living, not clinical practitioners.

The distinction matters because Medicare covers one and not the other.

Medicare Home Health Coverage

Medicare Part A and Part B cover skilled home health services when all of these conditions are met:

• A physician certifies that the patient needs skilled care
• The patient is homebound — leaving home requires considerable effort and is done infrequently, only for medical appointments or limited non-medical reasons
• The home health agency is Medicare-certified
• The care is intermittent (not 24-hour continuous)

When Medicare covers home health, it pays 100% — no copay, no deductible. This includes skilled nursing visits, physical/occupational/speech therapy, medical social work, and limited home health aide services when provided alongside skilled care.

What "homebound" means in practice: Your parent doesn't need to be bedridden. They qualify as homebound if leaving home requires the assistance of another person, a medical device (walker, wheelchair), or special transportation, and leaving home takes considerable and taxing effort. Short absences for medical appointments, religious services, or adult day care are permitted.

What Medicare Does Not Cover

Medicare does not cover:

• Custodial personal care (bathing, dressing, meal prep) provided without skilled care
• 24-hour home care or round-the-clock aide services
• Homemaker services (cleaning, laundry, grocery shopping)
• Residential Service Agency care (unless the patient qualifies for CFC or a Medicaid waiver)

If your parent needs only personal care assistance — help with daily living activities without skilled medical services — Medicare won't pay. This care is financed privately, through long-term care insurance, or through Maryland's Community First Choice program or Community Options Waiver for Medicaid-eligible individuals.

Verifying OHCQ Licensing

Before accepting any home health or personal care agency recommended by the hospital, verify they're licensed:

• Check the OHCQ Licensee Directory on the Maryland Department of Health website
• Confirm the agency is licensed for the specific type of care your parent needs (HHA vs. RSA)
• Ask about any recent deficiency citations or corrective action plans

Maryland law requires hospital discharge planners to verify this licensing before making referrals — but it's worth confirming yourself.

The Maryland Hospital Discharge Guide includes the OHCQ compliance checklist and a side-by-side comparison of HHA vs. RSA services to help you match the right provider type to your parent's care needs.

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