These are two fundamentally different arrangements, and the cost gap is the biggest reason families look into Home Help in the first place. Private-pay home care means the family pays an agency directly, hour by hour, with no insurance or Medicaid involved. Home Help means Medicaid pays a caregiver — including, often, a family member — with no bill going to the family at all.
What private-pay home care actually costs in Metro Detroit
Non-medical private home care agencies in Wayne, Oakland, and Macomb County generally charge families somewhere in the $28-$35/hr range as of 2026, often with a minimum shift length of three to four hours. At 20 hours a week, that's roughly $2,400-$3,000 a month, entirely out of pocket, indefinitely.
What Home Help costs your family
Medicaid financial rules depend on the eligibility category and household circumstances. Ask MDHHS to identify the rules that apply to the applicant before making financial decisions.
The trade-offs that matter
Private pay means you can start immediately without an assessment or approval process, and you're not limited to Medicaid-eligible individuals. Home Help requires Medicaid eligibility and an approval process that typically takes several weeks — but for families who qualify, the cost difference over months and years is substantial, and self-direction means a trusted family member can be the one getting paid instead of a stranger.
Which one actually fits your family
If your loved one isn't yet on Medicaid but might be close to the asset limits, it's worth checking eligibility before assuming private pay is the only option — our full eligibility checklist walks through both tests. Families who don't qualify for Medicaid, or who need care to start before an assessment can happen, often use private pay as a bridge.
