How Do You Start A Home Care Business In West Virginia In 2026?

May 25, 2026 Team Carepolicy.us

Starting a home care business in West Virginia is still a smart move for entrepreneurs passionate about helping others and seeking a steady business opportunity. With an aging population, high disability needs, and many rural communities that need dependable in-home support, the demand for both medical and non-medical home care services remains strong.

However, launching a home care agency in West Virginia involves much more than just good intentions. In 2026, the biggest mistake new owners make is not usually marketing, branding, or hiring. It is choosing the wrong regulatory path before they understand whether they are starting private-pay non-medical home care, Medicaid Personal Care, a skilled Home Health Agency, or a small residential care model.

This guide breaks down everything you need to know to start a compliant and profitable home care business in West Virginia, from choosing the right business model to Certificate of Need planning, licensing, Medicaid certification, staffing, insurance, policies, procedures, and marketing.

If you want help choosing the correct West Virginia pathway before spending money on filings, book a licensing consultation with CarePolicy.

Who Is This West Virginia Home Care Startup Guide For?

This guide is for entrepreneurs who want to build a West Virginia home care business the right way. That includes first-time founders, experienced caregivers, nurses, CNAs, social workers, agency managers, senior-care professionals, franchise buyers, and family caregivers who want to turn lived experience into a compliant agency.

It is also for owners who are still deciding whether they should start with non-medical private-pay care, Medicaid Personal Care, Home Health, or a small residential model. These are not the same business. They have different regulators, payer rules, policies, staffing expectations, and startup costs.

Founder Insight From Anton Fonseka: In our experience, the most expensive delay is not a missing logo, brochure, or website. It is building the wrong agency type on paper and then discovering that the services, payer source, county service area, policies, and approval pathway do not match.

Why Is West Virginia A Strong But Regulated Home Care Market In 2026?

West Virginia has a clear need for in-home support. The state has a large older-adult population, many residents with disabilities, and rural areas where access to reliable care can be limited. Many seniors and people with chronic conditions prefer receiving help in the comfort of their homes instead of moving into institutional settings when home-based care is appropriate and safe.

The opportunity is real, but it is not automatic. Rural demand does not always mean fast profitability. A county can need services, yet still be difficult to staff. Medicaid can provide a payer source, yet it adds prior authorization, documentation, EVV, billing, and audit requirements. Home Health can serve higher-acuity patients, yet Medicare certification and federal Conditions of Participation raise the operational bar.

That is why the most successful West Virginia founders usually start with three questions:

What services will we actually provide?
Who will pay for those services?
Which West Virginia approval pathway applies before we accept clients?

Which West Virginia Home Care Model Should You Choose First?

Before you file applications, order policies, hire caregivers, or market to families, decide which model you are launching. West Virginia founders commonly confuse private-pay non-medical home care, Medicaid Personal Care, Home Health, and Legally Unlicensed Health Care Homes. The differences matter.

Business Model	Type Of Care	Common Payer Source	Primary West Virginia Pathway	Practical Warning
Private-Pay Non-Medical Home Care	Companionship, homemaker help, errands, meal preparation, light housekeeping, and non-medical support within the allowed scope	Private pay, long-term care insurance, family payment, and private contracts	Business registration, screening workflow, insurance, policies, and confirmation of whether OHFLAC home care agency registration applies to your exact scope	Do not advertise skilled nursing, therapy, medication administration, or Medicaid Personal Care unless you are approved for that pathway.
West Virginia Medicaid Personal Care Provider	Hands-on assistance with activities of daily living and instrumental activities of daily living for eligible Medicaid members	West Virginia Medicaid	Certificate of Need review when required, certification through the operating agency process, Medicaid enrollment, RN care planning, prior authorization, and EVV	This is not just “private duty caregiving.” It is a Medicaid program with clinical, documentation, authorization, and billing rules.
Home Health Agency	Skilled nursing, therapy, home health aide services, and medically ordered care	Medicare, Medicaid, private insurance, and private pay where applicable	Certificate of Need review when required, OHFLAC licensure or certification pathway, CMS Conditions of Participation, Medicare certification if billing Medicare, and Medicaid enrollment if billing Medicaid	This is a higher-compliance model. Build the clinical governance, QAPI, emergency preparedness, infection control, and survey readiness systems early.
Legally Unlicensed Health Care Home	Small residential care for one to three unrelated residents in a home-like setting	Private arrangements and other permitted payer arrangements depending on the resident and service scope	Registration with OHFLAC, not a traditional license, and compliance with registration and safety expectations	This is not a full home care agency model. It is a small residential model with a narrow resident limit and specific rules.

How Should You Decide Between Private-Pay Home Care And Medicaid Personal Care?

Choose private-pay non-medical home care if your goal is to serve families directly with non-medical support and you want a simpler payer model. Choose Medicaid Personal Care only if you are prepared for state program certification, Medicaid enrollment, care planning, prior authorization, EVV, documentation, and payment-cycle discipline.

How Should You Decide Between Home Health And Non-Medical Home Care?

Choose Home Health only if you are building a skilled clinical agency with nursing, therapy, federal home health compliance, and survey readiness. If your services are companionship, homemaking, meal preparation, transportation support, bathing help, or routine personal assistance, your model may be non-medical home care or Medicaid Personal Care depending on payer source and scope.

Which West Virginia Agencies Regulate Home Care Businesses In 2026?

West Virginia reorganized its former Department of Health and Human Resources structure into separate departments beginning January 1, 2024. For home care founders, that means you may interact with more than one state entity depending on the services you provide.

West Virginia Health Care Authority: Handles Certificate of Need review and publishes CON forms, standards, review cycles, filing fees, and service-specific need methodologies through the West Virginia Certificate of Need program.
Office of Health Facility Licensure and Certification: Handles licensure, certification, registration, inspection, and complaint-related functions for applicable health care facilities through OHFLAC.
West Virginia Bureau for Medical Services: Administers Medicaid policy, including relevant provider manuals through the BMS policy manuals.
Acentra Health West Virginia ASO: Supports utilization management and operational processes for the West Virginia Personal Care Program through the Acentra Health Personal Care Program portal.
CMS: Applies when you operate a Medicare-certified Home Health Agency under federal home health standards through the CMS Home Health Conditions of Participation.
WV CARES: Supports fingerprint-based background checks and registry screening through West Virginia Clearance for Access: Registry and Employment Screening.

How Do You Register Your West Virginia Home Care Business?

Before you can legally operate, you need to create the business entity and register it with the state. Most home care founders choose an LLC because it offers liability protection and flexible management, but corporations may be appropriate for larger or investor-backed agencies. Sole proprietorships are simple, but they generally do not provide the same personal liability protection.

Use the West Virginia One Stop Business Portal to register your business, file with the Secretary of State when applicable, register with the State Tax Department, and complete WorkForce West Virginia unemployment compensation registration when applicable.

Before using the One Stop Business Portal, obtain your Federal Employer Identification Number from the IRS. West Virginia’s business registration instructions state that the EIN should be obtained before registering online through the One Stop Business Portal.

Your startup sequence should look like this:

Choose the agency model and service scope.
Choose the legal structure and business name.
Obtain the Federal EIN.
Register through the West Virginia One Stop Business Portal.
Set up tax, payroll, bookkeeping, unemployment, and insurance systems.
Confirm whether your specific care model requires CON, licensure, certification, Medicaid enrollment, registration, or a determination request.

Do You Need A Certificate Of Need In West Virginia?

A Certificate of Need is a state approval process used to determine whether certain health services are needed in a proposed service area. In West Virginia, this is one of the most important early questions for Home Health and Medicaid Personal Care founders.

Do not assume the answer from a generic blog or another state’s rules. Start with the West Virginia Health Care Authority, review the current standards, and consider whether a Determination of Reviewability request is appropriate for your proposed service model.

For in-home personal care, West Virginia publishes specific need methodology and service-area standards. A major practical point is that partial service areas cannot be approved for in-home personal care; need must be demonstrated in each county in the proposed service area.

CON costs also need to be planned carefully. West Virginia’s published CON filing fee schedule includes a $100 fee for a request for determination of reviewability and CON application fees that vary by project cost category. Depending on project size, the application fee can range from $1,500 to $35,000.

Founder Insight From Anton Fonseka: If you are applying for a West Virginia Medicaid Personal Care or Home Health pathway, do not write the CON narrative after everything else is finished. Build the county service-area logic, staffing plan, payer strategy, and policy framework together. Weak need narratives and overbroad service areas are common reasons founders lose time.

How Do You Get Licensed, Certified, Or Registered For Each Model?

How Do You Start A Home Health Agency In West Virginia?

A Home Health Agency is the medical model. It may include skilled nursing, physical therapy, occupational therapy, speech therapy, medical social services, and home health aide services when ordered and provided under applicable rules.

A West Virginia Home Health Agency startup may involve:

Certificate of Need review or determination through the West Virginia Health Care Authority when required.
OHFLAC licensure or certification steps.
Compliance with CMS Home Health Conditions of Participation if seeking Medicare certification.
Medicaid enrollment and compliance with West Virginia Medicaid Home Health policy if billing Medicaid.
Clinical governance, QAPI, infection control, emergency preparedness, patient rights, care planning, and survey readiness.

Home Health is a strong model, but it is not the easiest entry point. It requires clinical leadership, documentation discipline, and enough working capital to survive the pre-certification and early census period.

How Do You Start A Medicaid Personal Care Agency In West Virginia?

West Virginia Medicaid Personal Care is a non-institutional support model for eligible Medicaid members who need assistance with activities of daily living and instrumental activities of daily living. It is not the same as simply opening a private-pay caregiver company.

For Medicaid Personal Care, expect to plan for:

Certificate of Need review when required.
Certification through the required operating agency process.
Medicaid provider enrollment.
RN assessment and nursing plan-of-care processes.
Prior authorization and service limits.
Electronic Visit Verification for qualifying services.
Documentation that supports every billed unit.

West Virginia’s Personal Care program is attractive because it serves people who need real help at home. It is also documentation-heavy. Build billing, EVV, caregiver scheduling, supervisory visit, and care-plan systems before your first authorization.

How Do You Start A Private-Pay Non-Medical Home Care Agency In West Virginia?

Private-pay non-medical home care may include companionship, homemaker support, meal preparation, light housekeeping, errands, transportation support, and help with routine daily activities within the non-medical scope. This model is often more flexible than Medicaid or Home Health, but it still needs proper business registration, screening, insurance, written policies, service agreements, caregiver training, documentation, and legal review.

If your agency is not otherwise licensed, certified, or registered with OHFLAC, confirm whether West Virginia’s home care agency registration requirements apply to your business so you can access the central abuse registry and follow the correct screening process.

For a strong private-pay launch, use a professional manual such as the Non-Medical Home Care Agency Policy And Procedure Manual, then customize it to your West Virginia scope, contracts, screening process, caregiver duties, incident reporting, and client-service workflow.

How Do You Register A Legally Unlicensed Health Care Home In West Virginia?

The correct term is Legally Unlicensed Health Care Home. This is a small residential model, not a broad home care agency license. It generally applies to a residence that provides accommodations, personal assistance, and supervision for one to three unrelated people for more than twenty-four hours.

A Legally Unlicensed Health Care Home is not licensed in the same way as a larger facility, but it must be registered with OHFLAC and must follow applicable rules. Do not use this model to operate a larger residential facility, advertise a full agency, or accept more residents than allowed.

What Insurance And Legal Protections Should You Set Up?

Insurance should be in place before you serve clients, hire caregivers, or send staff into homes. Requirements and underwriting vary by model, payer, contract, and employee structure, so work with an insurance professional familiar with home care and health care services.

Common coverages to evaluate include:

Workers’ Compensation Insurance: Needed when you have employees and required in many employer situations.
General Liability Insurance: Protects against bodily injury, property damage, and general business claims.
Professional Liability Insurance: Important for care-related errors, omissions, negligence allegations, and professional service claims.
Commercial Auto Insurance: Needed if the agency owns vehicles or if caregivers drive for work-related duties.
Cyber Liability Insurance: Important when you store client health information, employee records, or billing data electronically.
Employment Practices Liability Insurance: Useful for hiring, discipline, harassment, wrongful termination, and employment-related claims.
Umbrella Liability Insurance: Adds higher protection above core liability policies.

Insurance does not replace compliance. Your policies, caregiver training, supervisory documentation, incident reporting, and care-plan controls are what help prevent claims in the first place.

How Should You Hire, Screen, Train, And Supervise Caregivers?

Staffing is one of the hardest parts of operating a home care business in West Virginia. A beautiful website cannot fix missed shifts, weak documentation, poor caregiver fit, or unclear scope-of-duty boundaries.

Every agency should build a caregiver hiring system before launch. That system should include:

Written job descriptions by role.
Scope-of-duty rules for caregivers, aides, nurses, supervisors, and administrators.
Background checks and registry screening through the applicable West Virginia process.
Credential checks for licensed staff.
Abuse, neglect, exploitation, patient rights, HIPAA, infection control, emergency procedures, and incident-reporting training.
Competency checks before unsupervised client assignment.
Supervisory visits and documentation.
Annual training and performance reviews.

For Home Health, aides must meet federal and state training and supervision expectations. For Medicaid Personal Care, follow the West Virginia Medicaid Personal Care manual, nursing plan-of-care rules, prior authorization limits, and program-specific documentation requirements.

A complete employee handbook can also reduce confusion around attendance, call-offs, documentation, confidentiality, overtime, travel, conduct, and discipline. CarePolicy offers a Home Care Employee Handbook that can be customized to your agency’s operating model.

What Policies And Procedures Do You Need Before Opening?

Your policy manual is not just paperwork. It is the operating system for your agency. Regulators, surveyors, Medicaid reviewers, insurers, referral partners, and families all expect your agency to have written processes that match the care you actually provide.

At minimum, a West Virginia home care or home health startup should build policies and procedures for:

Admission, intake, eligibility, and service agreements.
Assessment, care planning, nursing plan of care, and reassessment when applicable.
Client rights, privacy, consent, complaints, and grievance handling.
HIPAA and confidentiality.
Caregiver scope of duties and prohibited tasks.
Medication assistance or medication administration boundaries.
Infection prevention and control.
Emergency preparedness and continuity of operations.
Incident reporting, abuse, neglect, exploitation, and critical event escalation.
Background checks, registry screening, credentialing, and exclusions monitoring.
Orientation, training, competency checks, supervision, and annual education.
EVV and visit documentation for Medicaid-covered services when applicable.
Billing, claims documentation, refunds, and record retention.
Quality assurance, performance improvement, audits, and corrective action.

For Home Health, use a Home Health-specific manual such as the Home Health Agency Policy And Procedure Manual. For custom licensing or unclear West Virginia models, use customized policies and procedures for any agency type.

Founder Insight From Anton Fonseka: A template alone does not pass a survey. The manual must match your service model, payer, staff roles, forms, training files, client records, EVV workflow, complaint process, and incident-reporting system. Survey readiness comes from implementation, not just ownership of documents.

What Should Be In A West Virginia Home Care Business Plan?

Your business plan should do more than impress a lender. It should prove that your agency can operate legally, staff reliably, document accurately, and survive the first six to twelve months of inconsistent census.

A West Virginia-specific home care business plan should include:

Executive Summary: Agency model, mission, county service area, payer strategy, and launch timeline.
Market Analysis: Older-adult population, disability needs, rural access gaps, competitors, hospitals, senior centers, and referral sources.
Service Model: Private-pay non-medical care, Medicaid Personal Care, Home Health, or Legally Unlicensed Health Care Home.
Regulatory Plan: CON, OHFLAC, BMS, Acentra Health, CMS, WV CARES, EVV, and registration steps that apply to your model.
Staffing Plan: Administrator, RN supervisor when needed, caregivers, aides, billing staff, scheduler, and backup coverage.
Operations Plan: Intake, scheduling, visit verification, care planning, documentation, billing, complaint handling, and emergency response.
Financial Plan: Startup costs, monthly burn rate, payroll reserve, insurance, technology, marketing, payer delays, break-even census, and cash-flow scenarios.
Marketing Plan: Local SEO, Google Business Profile, referral relationships, senior-community outreach, county-specific pages, and reputation-building.

For founders who need a structured plan, CarePolicy offers a Home Care Business Plan and an Any Agency Type Customized Business Plan.

How Much Does It Cost To Start A Home Care Business In West Virginia?

Startup costs vary widely by model. A private-pay non-medical agency is usually less expensive to launch than a Medicaid Personal Care provider or Medicare-certified Home Health Agency. A CON pathway, clinical staffing, software, insurance, policy development, and pre-revenue payroll can significantly increase the required budget.

Cost Category	What To Budget For	2026 Planning Note
Business Formation	Entity filing, business registration, EIN, tax setup, accounting, and legal review	Complete the EIN first, then register through the West Virginia One Stop Business Portal.
Certificate Of Need	Determination request, CON application, supporting documents, service-area analysis, and filing fees	Published CON application fees vary by project cost and can reach $35,000 for larger projects.
Licensure, Certification, Or Registration	OHFLAC, Medicaid, Acentra Health, CMS, or registration steps depending on model	Do not budget from another state’s checklist. West Virginia pathway selection matters.
Policies, Procedures, And Forms	Policy manual, employee handbook, client handbook, service agreements, incident forms, QA tools, and HR forms	Use state-specific customization instead of relying on generic forms only.
Insurance	General liability, professional liability, workers’ compensation, cyber, auto, EPLI, and umbrella coverage	Quotes vary by services, employees, revenue, driving exposure, and clinical risk.
Technology	Scheduling, EVV, EHR, billing, payroll, secure communication, document storage, and website	Medicaid and Home Health models need stronger documentation and verification systems.
Staffing And Training	Recruitment, background checks, registry checks, onboarding, competency checks, and payroll reserve	Plan for turnover and backup coverage from the beginning.
Marketing	Website, Google Business Profile, local SEO, printed materials, community outreach, and referral development	Marketing should begin before opening, but do not promise services before approvals are in place.
Working Capital	Payroll, rent, software, insurance, and operating expenses before consistent revenue	Many founders underestimate the cash gap between approval, first clients, first claims, and stable collections.

A practical private-pay launch can require tens of thousands of dollars, while Medicaid Personal Care and Home Health pathways can require more because of CON, certification, clinical staffing, technology, compliance, and working capital. Build your budget from your actual model, not a generic national estimate.

How Should You Market A New Home Care Agency In West Virginia?

Marketing a home care business in West Virginia should combine trust, local visibility, referral relationships, and compliance-safe messaging. Families want reliability. Referral partners want professional communication. Regulators and payers want accuracy. Your marketing should never promise services you are not approved or staffed to provide.

How Should You Build Your Online Presence?

Create a professional website that clearly explains your approved services, service area, care model, and contact process.
Set up and maintain a Google Business Profile.
Create county-specific pages only for counties you can actually serve.
Use plain-language content for terms families search, such as home care in West Virginia, help for seniors at home, non-medical home care, personal care services, and home health services.
Collect reviews ethically and respond professionally.

How Should You Build Local Referrals?

Introduce your agency to discharge planners, senior centers, physicians, rehab centers, community organizations, and aging-service partners.
Join your local Chamber of Commerce and participate in senior-focused community events.
Host educational sessions on fall prevention, caregiver burnout, respite planning, home safety, and long-term care planning.
Build relationships before you need referrals.

How Should You Stay Compliance-Safe While Marketing?

Do not use misleading medical claims, guarantee outcomes, imply Medicare or Medicaid approval before approval is complete, or offer inducements for referrals. Keep your language accurate, service-specific, and consistent with your approvals, payer contracts, and policy manual.

What Mistakes Delay West Virginia Home Care Startups?

West Virginia home care can be a rewarding business, but it is not a shortcut business. The owners who struggle are often the ones who move fast on branding and slow on compliance.

Avoid these common mistakes:

Choosing The Wrong Model: Private-pay home care, Medicaid Personal Care, Home Health, and Legally Unlicensed Health Care Homes are different pathways.
Skipping The CON Question: For Home Health and Medicaid Personal Care, the Certificate of Need pathway can be a major early gate.
Choosing Too Many Counties Too Early: A broad service area can create staffing, marketing, and need-demonstration problems.
Underestimating Staffing: Rural demand does not help if you cannot recruit, train, retain, and supervise caregivers.
Using Generic Policies: Policies must match West Virginia rules, payer requirements, your service model, and actual operations.
Ignoring EVV: Medicaid-funded personal care and home health services require electronic visit verification workflows when applicable.
Assuming Medicaid Equals Immediate Cash Flow: Prior authorization, documentation, billing edits, claim cycles, and denials can delay revenue.
Marketing Before Approval: Do not represent yourself as licensed, certified, Medicare-approved, or Medicaid-ready until the proper approval is complete.

CarePolicy can help you reduce these risks through West Virginia provider licensing consultation, policy support, and launch planning.

What Is The 2026 West Virginia Home Care Launch Checklist?

Choose your exact business model: private-pay non-medical home care, Medicaid Personal Care, Home Health, or Legally Unlicensed Health Care Home.
Define your services, payer sources, and county service area.
Check whether CON, Determination of Reviewability, OHFLAC licensure, Medicaid certification, CMS certification, or OHFLAC registration applies.
Get your EIN and register the business through the West Virginia One Stop Business Portal.
Set up legal, accounting, payroll, tax, insurance, and HR systems.
Build your policy and procedure manual, employee handbook, client handbook, forms, and service agreements.
Set up background checks, WV CARES, registry screening, credential checks, and exclusions screening where applicable.
Recruit and train caregivers, aides, supervisors, nurses, and administrative staff based on the model.
Choose scheduling, documentation, EVV, billing, and recordkeeping software.
Prepare your care planning, supervisory visit, complaint, incident, QA, and emergency preparedness workflows.
Build your local SEO, referral outreach, Google Business Profile, and community education strategy.
Do a pre-launch compliance audit before accepting your first client.

For forms, client documents, and operational tools, review the List Of All Forms For Any Agency Type, the Home Care Agency Client Handbook, and the Home Care Agency Operational Form Pack.

What Questions Do West Virginia Home Care Founders Ask Most Often?

Do I Need A License To Start A Home Care Business In West Virginia?

It depends on your model. A skilled Home Health Agency has a different pathway than private-pay non-medical home care, Medicaid Personal Care, or a Legally Unlicensed Health Care Home. Before launching, confirm whether your exact service model requires CON, OHFLAC licensure, Medicaid certification, CMS certification, OHFLAC registration, or another approval step.

Does West Virginia Require A Certificate Of Need For Home Care?

Home Health and Medicaid Personal Care models commonly raise Certificate of Need issues in West Virginia. Do not guess. Review the West Virginia Health Care Authority’s CON standards and consider a Determination of Reviewability if your scope is unclear.

Is Private-Pay Non-Medical Home Care The Same As Medicaid Personal Care?

No. Private-pay non-medical home care is usually paid directly by families or private sources. Medicaid Personal Care is a Medicaid program with certification, eligibility, care planning, prior authorization, EVV, service limits, billing, and documentation rules.

What Is A Legally Unlicensed Health Care Home In West Virginia?

A Legally Unlicensed Health Care Home is a small residential model for one to three unrelated individuals who receive accommodations, personal assistance, and supervision for more than twenty-four hours. It is not a traditional license, but it must be registered with OHFLAC and must follow applicable limits and requirements.

How Long Does It Take To Start A Home Care Business In West Virginia?

The timeline depends on your model. A private-pay non-medical launch may move faster than Medicaid Personal Care or Home Health. CON, licensure, certification, Medicare approval, Medicaid enrollment, background checks, staffing, policy development, and payer readiness can extend the timeline from weeks to months.

How Much Money Do I Need To Start A Home Care Agency In West Virginia?

Costs vary by model. A lean private-pay home care launch may require tens of thousands of dollars, while Medicaid Personal Care and Home Health can require more because of CON, clinical staffing, software, policy development, insurance, certification, survey readiness, and working capital.

Can I Run A Home Care Business From My House In West Virginia?

Some administrative work may be possible from a home office, but licensing, Medicaid certification, zoning, records access, staff training, inspections, and payer requirements may require a compliant physical office setup. Confirm requirements before assuming a home address is acceptable.

What Background Checks Are Needed For West Virginia Home Care Staff?

Build a screening process that includes WV CARES where applicable, criminal background checks, abuse registry checks, credential checks, exclusions screening, reference checks, and ongoing monitoring when required by your model or payer.

What Policies Do I Need Before Opening?

You need policies for intake, care planning, caregiver duties, supervision, client rights, HIPAA, infection control, emergency preparedness, incident reporting, abuse and neglect, background checks, training, EVV, billing documentation, complaints, quality assurance, and record retention. Home Health and Medicaid models need additional payer-specific and clinical policies.

Should I Start With Home Health Or Non-Medical Home Care?

Start with the model that fits your experience, capital, staffing access, payer strategy, and compliance readiness. Home Health can be powerful but more complex. Non-medical private-pay care may be a more practical first step for some founders. Medicaid Personal Care sits between the two: non-medical in service type, but much more regulated because of Medicaid.

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