How to start a home care agency in Delaware

Delaware requires a Personal Assistance Services Agency license from Delaware Department of Health and Social Services, Division of Health Care Quality (DHCQ), Office of Health Facilities Licensing and Certification to operate a home care agency. Fee: $250.

License required

Yes

License

Personal Assistance Services Agency license

Issuing agency

Delaware Department of Health and Social Services, Division of Health Care Quality (DHCQ), Office of Health Facilities Licensing and Certification

Fee

$250

Fee details

$250 non-refundable application fee (16 Del.C. 122(3)x).

Renewal

Every year · $100 annual license renewal fee.

Insurance and bonds

General liability insurance of at least $1 million per occurrence and $500,000 single limit, covering property damage, bodily injury, libel and slander. The rule also requires proof of bonding but gives no bond amount.

Survey and inspection

On-site survey within the first 90 days of operation; the agency must be serving consumers at that time. DHCQ inspects periodically after that, scheduled or unannounced.

Regulation

16 Del.C. 122(3)x; 16 Del. Admin. Code 3345 (Personal Assistance Services Agencies)

1. Send DHCQ a written statement of intent describing the services and request a license application
2. Submit the completed application with policies and procedures manual, ownership and governing body details, felony disclosures, director name, management list with credentials, the direct care worker competency test, and proof of insurance and bonding
3. Show compliance with the state criminal background check (16 Del.C. 1145) and drug testing (16 Del.C. 1146) policies
4. Pay the $250 application fee
5. Receive a 90-day initial license, begin serving consumers, and pass the on-site survey during the first 90 days
6. Receive the 1-year annual license; renew yearly with the $100 fee

Staffing

• Full-time agency director with at least an associate degree plus 2 years of health care or home care supervisory experience (directors in place by June 1, 2020 are exempt)
• A similarly qualified designee to act when the director is absent
• Pre-employment and annual TB testing per CDC recommendations
• Criminal background checks and drug testing under 16 Del.C. 1145 and 1146

Training

• Agency orientation for every direct care worker before serving a consumer, covering 24 listed topics including infection control, ADLs, body mechanics, consumer rights and dementia care
• Direct care workers must pass a competency test before providing care and every year after
• Annual dementia-specific training if the agency serves people with dementia
• Infection control orientation at hire and annual in-service

Program

Delaware Medical Assistance Program (DMAP) / Diamond State Health Plan

Enrollment portal

DMAP Provider Portal — Provider Enrollment

Fiscal agent

Gainwell Technologies (DMAP provider portal and Provider Relations/enrollment help desk)

Application fee

DMAP states that from January 1, 2026, institutional providers pay $750 at initial application, reactivation, revalidation, re-enrollment and when adding a location. Its screening-level lists mark which taxonomies owe the fee; hardship exceptions go to CMS. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

DMAP publishes taxonomy screening-level lists (limited/moderate/high) for fee-for-service and managed-care-only providers; the high-risk taxonomies on those lists are subject to fingerprinting. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Risk levels for site-visit purposes follow DMAP's published taxonomy screening-level lists. Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

DMAP mails revalidation instructions 60 days before the due date and terminates providers who miss it; it warns that CMS is requiring many providers to revalidate within the next 24 months. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Delaware Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Public Review (CPR)

Agency

Delaware Health Resources Board, staffed by the Bureau of Health Planning and Resources Management (Department of Health and Social Services)

Services covered

• hospitals
• nursing homes
• freestanding surgical centers
• freestanding birthing centers
• freestanding acute inpatient rehabilitation hospitals
• freestanding emergency centers
• capital expenditures above $5.8 million (inflation-adjusted)
• bed capacity changes of more than 10 beds or 10% (whichever is less) over 2 years
• acquisition of a nonprofit health-care facility

Moratoria

Until July 1, 2028, only charities / not-for-profit entities may apply for a Certificate of Public Review to build, establish or acquire an acute care hospital; the Board may not accept other applicants (16 Del. C. §9304(b), added by 85 Del. Laws c. 350).

Delaware certificate of need details →

Model

open/provider choice

State vendor

Sandata

Services in scope

• personal care
• home health

Alternate EVV allowed

Yes

Program

https://dhss.delaware.gov/dmma/home/electronic-visit-verification/

Delaware EVV requirements →

State minimum wage

$15.00 an hour

Effective

2025-01-01

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Personal care / in-home supportive care organizations — active organization NPIs (NPPES)

162 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

234,783 (as of Jun 1, 2026)

All Delaware Home care Medicaid rates, ranked →

• Diamond State Health Plan Plus (DSHP-Plus) — managed LTSS under the DSHP Section 1115 demonstration (1115)
• DDDS Lifespan Waiver (1915(c))

Delaware waivers and waiting lists →