How to start a home care agency in Washington

Washington requires a In-Home Services Agency license, home care service category from Washington State Department of Health to operate a home care agency. Fee: $5,000. Processing time: Applicants have nine months from submission to complete all licensing steps, or DOH may close the application without refund.

License required

Yes

License

In-Home Services Agency license, home care service category

Issuing agency

Washington State Department of Health

Fee

$5,000

Fee details

$5,000 initial 12-month license fee per service category (home care). One county of operation is included; each additional county costs $500 (urban) or $100 (rural).

Renewal

Every 2 years · 24-month renewal fee for home care scales with FTEs: $2,400 (5 or fewer) up to $3,700 (101+); reduced table ($1,700 to $2,600) for agencies under DSHS or Area Agency on Aging contract. Change of ownership $500.

Processing time

Applicants have nine months from submission to complete all licensing steps, or DOH may close the application without refund.

Insurance and bonds

Commercial general liability insurance: $1 million per occurrence for bodily injury, property damage and contractual liability, or $2 million combined single limit.

Survey and inspection

Initial announced survey by DOH before licensure; DOH may charge $5,000 for certain follow-up or additional on-site surveys.

Regulation

RCW 70.127; WAC 246-335 (incl. 246-335-315, -320, -410, -990)

1. Complete the DOH in-home services orientation class
2. Obtain commercial general liability insurance ($1 million per occurrence or $2 million combined single limit)
3. Get Washington State Patrol background checks and DOH-approved disclosure statements for the administrator and the supervisor of direct care services (within 3 months of applying)
4. Write home care policies and procedures meeting WAC 246-335
5. Submit the initial application with FTE worksheet, business license, org chart, orientation certificate and fees
6. Pass DOH's initial announced survey
7. Renew every 24 months

Staffing

• Administrator and a supervisor of direct care services
• Long-term care workers giving hands-on personal care must be certified home care aides (RCW 18.88B / WAC 246-980) unless exempt
• WSP criminal background checks and disclosure statements for staff with access to vulnerable people

Training

• Owner/applicant must complete the DOH in-home services orientation class before applying
• Aide training and certification follow WAC 246-980 (home care aide credential) unless exempt

Program

Washington Apple Health (Medicaid), Washington State Health Care Authority (HCA)

Enrollment portal

ProviderOne

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. HCA's enrollment and revalidation pages do not list a separate state fee.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. HCA's enrollment and revalidation pages do not describe a separate state fingerprint process.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. HCA's enrollment and revalidation pages do not describe a separate state site visit process.

Revalidation

HCA revalidates providers every five years under 42 CFR 455 and mails one letter per group or facility to the ProviderOne mailing address. The provider has 30 days from the notice date. After that a deactivation notice is sent and the provider gets 90 more days before billing privileges are affected. Billing providers revalidate through ProviderOne's 'Manage Provider Information' Business Process Wizard. They update ownership, managing-employee and controlling-interest disclosures and submit the Core Provider Agreement, Debarment Statement, W-9 and type-specific documents. Nonbilling providers use the nonbilling forms and the HCA support portal or fax. HCA and DSHS are doing off-cycle revalidations of certain providers by June 5, 2028.

Full Washington Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Washington State Department of Health, Certificate of Need Program

Services covered

• new health care facilities: hospitals, behavioral health hospitals, nursing homes, hospices and hospice care centers, home health agencies, kidney disease treatment centers, ambulatory surgical facilities
• sale, purchase or lease of an existing hospital
• nursing home capital expenditures above the expenditure minimum or that substantially change services
• bed capacity increases and redistribution among acute, nursing home and assisted living care
• new tertiary health services
• added dialysis stations

Washington certificate of need details →

Model

open/provider choice

Services in scope

• personal care
• respite
• home health

Alternate EVV allowed

Yes

Program

https://www.dshs.wa.gov/altsa/stakeholders/electronic-visit-verification

Washington EVV requirements →

State minimum wage

$17.13 an hour

Effective

2026-01-01

Scheduled increases

Rises to $17.73 on 2027-01-01 (CPI-W indexing; no tip credit).

Rate pass-through

When individual-provider home care wages and benefits change under the collective bargaining agreement, DSHS adds the per-quarter-hour amount to the home care agency vendor rate, and agencies must use any increase only for direct-care workers' wages, benefits and related employer costs. From FY2028 a set share of the vendor rate is dedicated to compensation, with verification of agency spending from 2027-07-01.

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)

467 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,781,187 (as of Jun 1, 2026)

All Washington Home care Medicaid rates, ranked →

• WA Basic Plus Waiver (1915(c))
• WA Children's Intensive In-Home Behavioral Support Waiver (1915(c))
• WA Community Protection Waiver (1915(c))
• WA COPES Waiver (1915(c))
• WA Core Waiver (1915(c))
• WA Individual and Family Services Waiver (1915(c))
• WA New Freedom Waiver (1915(c))
• WA Residential Support Waiver (1915(c))
• Washington Medicaid Transformation Project 2.0 (1115)

Washington waivers and waiting lists →