Home Health vs Home Care in Colorado: What's Covered, Who Pays, and Which You Need
They Sound the Same. They're Funded Completely Differently.
Families searching for help keeping a parent at home run into two terms that look interchangeable: "home health" and "home care." In Colorado, they describe fundamentally different services, regulated under different licenses, and paid for through different systems. Confusing them leads to either paying privately for services Medicare would cover, or waiting for Medicaid to approve services that Medicare could start this week.
Skilled Home Health (Class A Agencies)
Skilled home health delivers medical services in the home: wound care, physical therapy, occupational therapy, speech therapy, skilled nursing assessments, medication management, and IV administration. These are performed by licensed professionals — RNs, LPNs, PTs, OTs, and CNAs working under clinical supervision.
CDPHE licensure: Class A. This is the highest tier of home-based medical licensure in Colorado. Class A agencies can also provide non-medical personal care services.
Who pays: Medicare Part A covers skilled home health when a physician orders it for a homebound patient who needs intermittent skilled care. The patient pays nothing — no copay, no deductible — as long as the homebound and medical necessity criteria are met. Coverage can continue as long as the physician certifies ongoing need and the applicable Medicare criteria remain met.
When it starts: Fast. A physician's order (often written at hospital discharge) triggers agency intake within 1 to 3 days. If your parent is being discharged after a fall, stroke, or surgery, the hospital social worker should coordinate the home health referral before discharge.
What it doesn't cover: Long-term personal care. Medicare pays for skilled nursing visits and therapy sessions — typically a few hours per week. It does not pay someone to help your parent bathe, dress, prepare meals, or manage daily routines on an ongoing basis.
Non-Medical Home Care (Class B Agencies)
Non-medical home care provides the daily personal support that keeps a parent functioning at home: help with bathing, grooming, dressing, toileting, transfers, companionship, meal preparation, light housekeeping, medication reminders, and errands.
CDPHE licensure: Class B. These agencies are strictly prohibited from providing any skilled healthcare services — no nursing, no medication administration, no therapy.
Who pays: Medicare doesn't cover non-medical home care. The funding sources are:
- Private pay: $32–$45/hour in the Denver metro area
- EBD waiver: Colorado Medicaid's Elderly, Blind, and Disabled waiver covers personal care, homemaker, and health maintenance services for qualifying seniors
- Community First Choice (CFC): The Medicaid state plan benefit covering basic personal care and homemaker services
- Veterans benefits: Aid and Attendance pension supplement
- AAA vouchers: Limited hours through the Area Agency on Aging
When it starts: Depends on the funding source. Private pay can start within 3 to 10 days (agency scheduling). Medicaid-funded care takes 60 to 90 days from initial CMA contact to authorized service delivery.
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When Your Parent Needs Both
Most families navigating a care crisis need both — skilled home health for the immediate medical recovery, and non-medical home care for the ongoing daily support.
The sequencing usually looks like this:
Week 1-2: Parent comes home from the hospital. Medicare-funded skilled home health starts within days — a visiting nurse checks vitals, a physical therapist works on mobility, a home health aide helps with bathing during therapy visits.
Week 3-12: Medicare home health continues on a reduced schedule (2-3 visits per week). Meanwhile, the family files for EBD waiver enrollment to fund ongoing non-medical care.
Month 3+: Medicare home health discharges when skilled needs are met. EBD waiver services take over, funding daily personal care through CDASS or IHSS.
Under Colorado's CFC and EBD waiver system, the CMA case manager can coordinate both skilled and non-skilled services in a single Person-Centered Support Plan. Ask for a combined CFC and waiver assessment at your parent's next annual Continued Stay Review.
How to Verify an Agency's License
The CDPHE Health Facility Search portal shows every licensed home care agency's class (A or B), inspection history, deficiency citations, and complaint records. Before signing with any agency, verify:
- License class matches the services you need: A Class B agency cannot legally send a nurse to your parent's home
- Active status: Licenses can lapse or be suspended
- Complaint history: Look for patterns, not just individual incidents
Under Community First Choice rules effective July 2025, only Class A or Class B licensed agencies can provide Medicaid-reimbursed personal care services. Unlicensed providers and independent contractors are excluded.
The Key Takeaway
If your parent needs medical recovery at home, start with skilled home health — Medicare covers it and it begins within days. If your parent needs daily help with living independently, that's non-medical home care — and the funding path runs through Medicaid, private pay, or veterans benefits.
The Aging in Place in Colorado guide walks through both systems side by side, with a care modality comparison table and CMA intake checklist designed to help you coordinate skilled and non-skilled services under one plan.
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Download the Colorado — Aging in Place Resource Checklist — a printable guide with checklists, scripts, and action plans you can start using today.