How to start a home health agency in Washington

Washington requires a In-home services agency license — home health service category from Washington State Department of Health to operate a home health agency. Fee: $5,000.

License required

Yes

License

In-home services agency license — home health service category

Issuing agency

Washington State Department of Health

Fee

$5,000

Fee details

$5,000 initial 12-month fee per service category (effective June 1, 2026); county surcharge for each county beyond the first: $500 urban, $100 rural. Partial refunds possible before surveys.

Renewal

Every 2 years · 24-month renewal fee by FTEs for home health: $5,100 (5 or fewer) to $10,600 (101+); $3,600 to $7,400 if Medicare-certified or accredited. Late fee $50/day up to $1,000. CHOW $500 per category.

Certificate of need

Required

Medicare certification

A Medicare/Medicaid-certified HHA is a health care facility needing a CON under RCW 70.38.105(4)(a); the CON sets the approved county and requires Medicare and Medicaid certification. Separately, CMS put a 6-month nationwide moratorium on new Medicare enrollment of home health agencies (including new branches and practice locations) into effect on May 13, 2026; it can be extended in 6-month increments, and CMS left any Medicaid/CHIP moratorium to each state.

Regulation

RCW 70.127; WAC 246-335 (fees WAC 246-335-990); RCW 70.38.105; WAC 246-310

1. Obtain a Certificate of Need first if establishing a Medicare/Medicaid-certified HHA
2. Apply to DOH for the in-home services license with the home health category and pay the fee and county surcharges
3. DOH survey (follow-up or extended surveys may cost $5,000)

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 →

For this business

Required (licensing source)

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.

Home health agencies — active organization NPIs (NPPES)

531 (as of Sep 13, 2026)

Medicare-certified home health agencies (CMS Care Compare)

74 (as of May 27, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

All Washington Home health Medicaid rates, ranked →