How to start a home care agency in Alaska and reach your first client faster
Alaska does not license nonmedical home care, so many new owners think they can open and start billing Medicaid. They cannot. Alaska Medicaid personal care requires SDS certification, a trained program administrator, a supervising registered nurse for agency based care, Background Check Program clearances, nurse taught PCA training, Medicaid enrollment and electronic visit verification. Distances between communities make supervision harder still. Home health and hospice add a state license and Medicare on top. We put all of it in the right order for you.
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Get your free Alaska launch plan
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Alaska rules7 AAC 125, 7 AAC 127 and the SDS PCS and CFC Provider Conditions of Participation
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Alaska requires.
Personal care for Alaska Medicaid PCS and CFC recipients
- State license
- None for nonmedical care; SDS Personal Care Services certification (7 AAC 125.060) instead
- Who you deal with
- SDS Provider Certification and Compliance Unit, Alaska Medicaid provider enrollment, the Background Check Program
- Must haves
- SDS certification, trained program administrator, supervising registered nurse for agency based care, Background Check Program clearances, 40 hour PCA training or a qualifying credential, Medicaid enrollment, EVV
- Realistic time to first client
- Several months
Orientation for Alaska only. We confirm your exact path on the free call.
Three places new Alaska agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Opening before SDS certification
No license for nonmedical care does not mean no rules for Medicaid. Under 7 AAC 125.060, an agency must be certified by SDS before it can be paid for personal care, and SDS says certification and Medicaid enrollment are both required before you provide services. The program administrator must finish the SDS agency training course before the application goes in.
What it costs: Months of payroll and rent with no billable Medicaid hours, and care given before certification that you cannot bill.
Caregivers you cannot bill for
Alaska Medicaid will not pay for a personal care assistant who is not associated with your agency in the Background Check Program, lacks a valid or provisional clearance, or has no training records on file. Each PCA also needs 40 hours of nurse taught training and a competency test, or a qualifying credential, plus CPR and first aid.
What it costs: Shifts already worked that cannot be claimed, and a caregiver who may leave while paperwork catches up.
Supervision across long distances
Agency based programs must retain a supervising registered nurse who visits each recipient's home at least once every six months. SDS can stretch that to 12 months for remote communities, but only with a waiver request and a phone or video review in between. Flights and travel time add up quickly outside the road system.
What it costs: Nurse hours and travel you did not budget for, or findings at your next SDS review.
What does a delay cost your agency?
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Home care vs home health vs hospice in Alaska
The three sound alike and are regulated differently. The one you choose decides your regulator, staffing, startup capital and timeline.
| Topic | Nonmedical home care | Home health (skilled) | Hospice |
|---|---|---|---|
| What your staff do | Help with bathing, dressing, eating, mobility, shopping, laundry and light housework | Part time skilled nursing, therapy, home health aide and medical social services | Palliative care for people who are terminally ill, and support for their families |
| State license | None; SDS certification for Medicaid personal care | Home health agency license (AS 47.32; 7 AAC 12.500 to 12.590) | Hospice agency license (AS 47.32; 7 AAC 12.310 to 12.349) |
| Certificate of Need | No | No: home health agencies are not on the Certificate of Need facility list | No: hospices are not on the Certificate of Need facility list |
| Main payers | Private pay, Alaska Medicaid PCS, Community First Choice, HCBS waivers with separate certification | Medicare, Alaska Medicaid, commercial insurance | Medicare hospice benefit, Alaska Medicaid |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment | Accreditation or state survey, then Medicare enrollment |
| Key staff | Program administrator; supervising registered nurse for agency based care; qualified PCAs | Administrator, director of clinical services (physician or RN), professional advisory committee, certified nurse aides as home health aides | Administrator and an interdisciplinary team with a physician, RN, social worker and spiritual counselor |
| Startup capital | Lowest, but SDS requires proof you can cover three months of operating expenses | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks (private pay) to months (Medicaid) | Longest: licensure, survey, enrollment | Longest: licensure, survey, enrollment |
Many Alaska owners start with personal care, build cash flow and a caregiver team, then add home health. A certified personal care agency can also apply to SDS to offer HCBS waiver services, which has its own certification. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Alaska requirements at a glance
| Nonmedical home care license | None at the state level. AS 47.32.010 does not list nonmedical home care agencies. |
|---|---|
| Medicaid personal care certification | Division of Senior and Disabilities Services (SDS), Provider Certification and Compliance Unit, under 7 AAC 125.060 (PCS) and 7 AAC 127 (Community First Choice) |
| Home health and hospice licensing | Health Facilities Licensing and Certification, Division of Health Care Services, under AS 47.32 and 7 AAC 12 (12.500 to 12.590 home health, 12.310 to 12.349 hospices) |
| Medicaid programs | Personal Care Services (agency based and consumer directed), Community First Choice (1915(k)), and five HCBS waivers: ALI, APDD, CCMC, IDD and ISW |
| Caregiver training | At least 40 hours of department approved, nurse taught PCA training and a competency test, or an RN, CNA or community health aide credential; CPR and first aid every two years (7 AAC 125.090, 125.160) |
| Background screening | Alaska Background Check Program through the New Alaska Background Check System (NABCS), AS 47.05.300 to 47.05.390 and 7 AAC 10.900 to 10.990, plus state and federal exclusion list checks |
| Electronic visit verification | Required for personal care since January 1, 2021 and home health care since January 1, 2023. Use the state's Therap system at no cost or an approved third party system. |
| Certificate of Need | Not required for home health agencies or hospices; AS 18.07 covers hospitals, nursing and other listed facilities |
| Medicare (home health, hospice) | Accreditation or state survey, then Medicare enrollment. CMS paused new enrollments from May 13, 2026 for six months; check whether it has ended or been extended. |
| Entity filing | Division of Corporations, Business and Professional Licensing (entity filing and Alaska business license) |
Summary of Alaska requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Alaska
The order matters. Steps 4 and 6 should start long before step 7, because the program administrator must finish SDS training before you apply, and every PCA needs a clearance and training on file before you can bill.
Form the business and get an Alaska business license
File your LLC or corporation with the Division of Corporations, Business and Professional Licensing, get an Alaska business license in the exact name you will certify under, get an EIN, and open an unemployment insurance account with the Department of Labor and Workforce Development. Check your borough or city tax and license rules.
You do this; we give you the checklistDecide your payer mix and program type
Private pay, Medicaid personal care or both. Under Medicaid, choose agency based PCS (you hire, train and supervise PCAs), consumer directed PCS (the recipient directs care and you handle employer tasks) or both, and decide whether to add Community First Choice or HCBS waiver services later. Use the path finder above.
Decided on your free consultationSet up insurance and a three month reserve
SDS requires commercial general liability and commercial auto liability of at least $300,000 each, workers' compensation that waives subrogation against the state, and a certificate of insurance naming SDS as certificate holder. You must also show records proving you can cover at least three months of operating expenses.
You do this; we specify what is requiredHire your program administrator and supervising nurse
The program administrator must be at least 21 and meet the SDS education and human services experience rules, then complete the SDS PCS agency training course and critical incident reporting training before you apply. Agency based programs also retain a supervising registered nurse with supervisory experience.
You do this; we specify what is requiredWrite policies to 7 AAC 125 and the SDS Conditions of Participation
SDS requires written policies for admissions, assistance with self administration of medication, background checks, PCA backup plans, complaints, confidentiality, conflicts of interest, critical incident reporting, emergency response, employee evaluation, financial accountability, quality improvement, restrictive interventions, termination of services and training.
We write this for youBuild the caregiver pipeline
Set up your NABCS account, run every PCA through the Background Check Program and the Alaska and federal exclusion lists, collect three reference letters for agency based hires, and track 40 hour training or credentials, CPR and first aid, medication assistance, restrictive intervention and critical incident training.
We set up the system and trackerApply for SDS certification
Submit the PCS provider certification application with your business license, certificate of insurance, organization chart, program administrator documents and policies. Email the name of your EVV vendor to SDS on the same day. New agencies receive a one year probationary certification and cannot add services or locations during it.
We prepare the applicationEnroll in Alaska Medicaid and set up EVV
After certification, enroll through the Alaska Medicaid Provider Enrollment Portal and pay the application fee unless you qualify for an exemption. Each PCA is also individually enrolled. Set up the state's Therap EVV system or an approved third party system before your first authorized visit.
We prepare and manage it
PCA training and background checks
Alaska sets personal care assistant rules in 7 AAC 125.090 and 125.160 and the SDS Conditions of Participation. A PCA must be at least 18, be associated with a certified agency, be individually enrolled with Alaska Medicaid, have no barrier crime or condition unless a variance is granted, and be able to physically assist the recipient with the activities in their service level authorization.
- 40 hour PCA training: Department approved, taught by a licensed nurse, at least 40 hours, covering infection control, bowel and bladder care, nutrition and meals, transfers and emergency evacuation, body mechanics, death and dying, record keeping, confidentiality and Medicaid fraud. The PCA then passes a standardized competency test.
- Credential route: Registered nurses, certified nurse aides and certified community health aides or practitioners qualify without the 40 hour course. Equivalent training or experience in the last two years also counts if the PCA passes the competency test.
- Training waiver: SDS can approve a PCA who has done similar work, has a good evaluation from a past employer, has at least 16 hours of the required topics and is enrolled in training that will qualify them within four months.
- CPR and first aid: Training that meets American Heart Association or American Red Cross standards, on file and renewed at least every two years.
- Other required training: Assistance with self administration of medication, restrictive intervention training, and critical incident reporting at least every two years. The program administrator and PCA supervisors take the SDS course.
- Background Check Program: Every PCA goes through the Alaska Background Check Program in NABCS, which only agencies can use. A PCA needs at least a provisional clearance, and a check of the Alaska Medical Assistance Excluded Provider List and the federal LEIE, before working with clients or their health information.
- References: Agency based programs collect three letters from people who are not agency staff and have known the applicant for at least three years.
- Home health aides: In a licensed home health agency, aides must be certified nurse aides with a valid background check, pass a competency evaluation, get an RN or therapist supervisory visit to the patient's home at least every two weeks, and complete 12 hours of inservice training each year.
Six mistakes that slow Alaska agencies down
We look for every one of these in the first week of an engagement.
Serving Medicaid clients before certification and enrollment
- What it costs
- Care you cannot bill, because 7 AAC 125.060 ties payment to SDS certification and SDS requires Medicaid enrollment too.
- How we prevent it
- Your first call ends with your exact Alaska path and the order to do it in.
Letting a PCA work before their background check clears
- What it costs
- Claims for that PCA's hours are not payable, and the agency is out of compliance with 7 AAC 10.900 to 10.990.
- How we prevent it
- A tracker that blocks scheduling until the clearance, exclusion checks and training records are on file.
An insurance certificate SDS will not accept
- What it costs
- A returned packet when coverage is under $300,000 or SDS is not named as certificate holder.
- How we prevent it
- We give you the exact SDS insurance wording before you call your broker.
Planning to grow during the probationary year
- What it costs
- New agencies cannot add services or locations during the one year probationary certification, so expansion plans stall.
- How we prevent it
- We plan your first year around what probation allows and prepare for standard certification.
Missing the renewal deadline
- What it costs
- Renewal applications are due at least 60 days before certification expires; a late one puts Medicaid payments at risk.
- How we prevent it
- Renewal dates and the quality improvement report built into your compliance calendar from day one.
Drifting into skilled care without a home health license
- What it costs
- Exposure to enforcement under AS 47.32 and problems with every payer.
- How we prevent it
- Clear service definitions so PCAs never perform skilled tasks.
In a free 30 minute call we confirm your Alaska path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Alaska launch packages
Three fixed price packages, matched to the path you choose. Your exact price is quoted in writing after your free call, before any work starts.
Private pay launch
For nonmedical agencies serving families who pay privately.
- Alaska path and a dated launch plan
- Policy and procedure manual written to 7 AAC 125, 7 AAC 127 and the SDS PCS and CFC Provider Conditions of Participation
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Alaska Medicaid PCS and CFC ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Alaska Medicaid PCS and CFC requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for SDS certification and Alaska Medicaid enrollment
- Survey and audit readiness
- Alaska city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to HFLC rules and the Medicare Conditions of Participation
- License application and inspection readiness
- Accreditation survey preparation
- Medicare and Medicaid enrollment support
Every package: one fixed price agreed in writing · you own 100% of your agency · no franchise fees or royalties.
On your own vs a franchise vs Lunaria
| Topic | On your own | Home care franchise | With Lunaria |
|---|---|---|---|
| Who owns the business | You | You, under the franchisor's brand and rules | You, 100% |
| Ongoing fees | None | Royalties and brand fees, usually a share of revenue | None. One fixed project fee |
| Knowing what Alaska requires | Pieced together from manuals and forums | A national playbook, adapted | Confirmed on your first call, then in writing |
| Policy manual | A template, often from another state | The franchisor's standard manual | Written to 7 AAC 125, 7 AAC 127 and the SDS PCS and CFC Provider Conditions of Participation |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for SDS certification and Alaska Medicaid enrollment prepared together |
| Your brand and marketing | Up to you | The franchisor's brand, with territory limits | Your brand, plus local search set up for you |
The Alaska home care startup checklist
Every Alaska step in order: business setup, your payer path, policies, caregiver screening and training, Medicaid enrollment and getting found. The items to start first are starred.
- Choose your care type and payer mix (private pay, Medicaid PCS, or both)
- Form your LLC or corporation with the Division of Corporations, Business and Professional Licensing
- Get an Alaska business license in the exact name you will certify under
- Get an EIN and open an unemployment insurance account with the Department of Labor and Workforce Development
- Buy workers' compensation, plus general and auto liability of at least $300,000 each, naming SDS as certificate holder
- and 14 more steps
Christine Ochimas, RN, LMFT, MBA
Christine founded Lunaria Care Consulting to give nurses and caregivers a direct route from "I want my own agency" to a compliant business with clients. She reads state requirements the way a reviewer does and writes policies the way a nurse would actually use them.
- We serve owners in all 50 states and DC, with a plan written for Alaska
- We help through enrollment and survey readiness, not just the application
- We tell you what we cannot promise: no one can guarantee a state or health plan decision
Have these ready for your consultation
- The care you want to provide and the clients you want to serve
- The Alaska cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Alaska Medicaid PCS and CFC, Medicare
- Your target opening month and rough budget
No client or patient records. We never need them for a first call.
What it costs to start a home care agency in Alaska
| Item | Notes |
|---|---|
| State license | None for nonmedical care. No SDS certification fee was found; check with SDS. Home health provisional license: $1,000 for five or fewer FTEs, up to $3,000 for 51 or more, plus $500 per branch; biennial renewal $2,000 to $6,000 (7 AAC 12.615). |
| Hospice license | Provisional license $100 for a volunteer hospice, $250 for a full service hospice, $250 plus $75 per bed for an inpatient facility; biennial renewal $200, $500 or $500 plus $150 per bed. |
| Alaska Medicaid application fee | $750 for calendar year 2026 for personal care agencies, home health agencies, hospices and other listed provider types, unless already paid to Medicare or another state's Medicaid or CHIP. A hardship waiver can be requested. |
| Entity formation and business license | Division of Corporations filing fee and Alaska business license fee; check current amounts |
| Background checks | Background Check Program fees per applicant, plus fingerprinting; fees are nonrefundable. Check current amounts with the program. |
| PCA training | 40 hour nurse taught program and competency test for caregivers without a qualifying credential, plus CPR and first aid |
| Supervising nurse and travel | RN time for home visits every six months, including flights and lodging for communities off the road system |
| Insurance | Workers' compensation, plus general and auto liability of at least $300,000 each for SDS certification |
| EVV | The state's Therap system is free; an approved third party system is paid by the agency |
| Operating reserve | SDS requires proof you can cover at least three months of operating expenses, including payroll, insurance and office space |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Alaska
Weeks, once the business, insurance and hiring process are in place.
Several months: program administrator training, SDS certification, then Alaska Medicaid enrollment, followed by a one year probationary certification.
Longest: a 30 day completeness review, onsite inspection and provisional license, then a certification survey and Medicare enrollment, which the CMS moratorium that began May 13, 2026 may still delay.
Most Alaska home care demand sits on or near the road system, in Anchorage, the Mat-Su Valley, Fairbanks, the Kenai Peninsula and Juneau, where agencies compete on reliable staffing. In rural and off road communities, travel shapes everything: supervising nurse visits, caregiver recruiting and backup coverage. SDS rules allow the department to contract with tribal health programs to serve specific areas, and partnering locally is often the practical route. Many families search for care for a parent from outside Alaska, so a strong Google Business Profile and clear community pages matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Alaska?
No. Alaska does not license nonmedical home care agencies, and AS 47.32.010 does not list them. You still need an entity filing, an Alaska business license, employer accounts and insurance. To be paid by Alaska Medicaid for personal care, you need SDS certification under 7 AAC 125.060 and Medicaid enrollment.
What is SDS personal care certification?
It is how the Division of Senior and Disabilities Services approves agencies to provide Medicaid Personal Care Services and Community First Choice personal care. You submit an application with your business license, insurance, organization chart, program administrator documents and policies. New agencies receive a one year probationary certification, then standard certification of two to four years.
Who licenses home health and hospice agencies in Alaska?
Health Facilities Licensing and Certification in the Department of Health's Division of Health Care Services, under AS 47.32. Home health rules are in 7 AAC 12.500 to 12.590 and hospice rules in 7 AAC 12.310 to 12.349. New agencies receive a provisional license after an onsite inspection.
Does Alaska require a Certificate of Need for home health or hospice?
No. Alaska's Certificate of Need law covers the health care facilities listed in AS 18.07.111, such as hospitals, nursing facilities and ambulatory surgical facilities. Home health agencies and hospices are not on that list. State licensure, survey and Medicare enrollment still apply.
What training do Alaska personal care assistants need?
At least 40 hours of department approved training taught by a licensed nurse, plus a standardized competency test, unless the PCA is an RN, a certified nurse aide or a certified community health aide or practitioner. Every PCA also needs CPR and first aid every two years, medication assistance and restrictive intervention training, and critical incident reporting training.
How do background checks work for Alaska caregivers?
Agencies certified or paid by the Department of Health use the Alaska Background Check Program through NABCS under AS 47.05.300 to 47.05.390. Individuals cannot apply on their own. A PCA needs at least a provisional clearance and a clean exclusion list check before working with clients, and Medicaid will not pay for a PCA without a valid check.
Is electronic visit verification required in Alaska?
Yes, for Medicaid personal care since January 1, 2021 and for Medicaid home health care since January 1, 2023. Alaska uses an open choice model: agencies can use the state's Therap system at no cost or an approved third party system, and claims need matching EVV data.
Can I open a Medicare certified home health agency or hospice in Alaska right now?
CMS imposed a nationwide moratorium on new Medicare enrollment of home health agencies and hospices starting May 13, 2026, for six months, which would end around November 13, 2026 unless CMS extends it. You can still pursue the state license, but check the CMS moratoria page for the current status before planning Medicare revenue.
Is a franchise a better way to start a home care agency in Alaska?
A franchise gives you a brand and playbook in exchange for fees and ongoing royalties. Starting independently with Lunaria costs one fixed price, and you own 100% of your agency with no franchise fees or royalties.
How much does Alaska home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Medicaid personal care or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges, and we work in all 50 states and DC.
Sources checked for this guide (38)
- 7 AAC 125.060, PCS agency certification (Cornell LII)
- 7 AAC 125.070, electronic visit verification (Cornell LII)
- 7 AAC 125.090, personal care assistant qualifications (Cornell LII)
- 7 AAC 125.160, PCA training (Cornell LII)
- 7 AAC 125.170, supervising registered nurse (Cornell LII)
- SDS PCS and CFC PCS Provider Conditions of Participation (rev. 9/1/22)
- SDS Personal Care Services Provider Certification Application Content Guidance
- SDS Provider Certification and Compliance Unit
- Alaska Department of Health, Personal Care Services (PCS) Program
- Alaska Department of Health, Community First Choice
- Alaska Department of Health, HCBS Waivers
- Alaska Department of Health, Electronic Visit Verification
- Alaska Department of Health, Background Check Program
- Health Facilities Licensing and Certification, Home Health Agencies
- Health Facilities Licensing and Certification, Hospice Agencies
- Alaska Department of Health, Certificate of Need program
- Alaska Medicaid Provider Enrollment Resources (application fee, 2026 notices)
- Alaska Department of Health, Medicaid Provider Assistance
- 7 AAC 12 chapter index, hospice (Article 7) and home health (Article 11) (Cornell LII)
- 7 AAC 12.312, hospice licensure (Cornell LII)
- 7 AAC 12.327, hospice interdisciplinary team (Cornell LII)
- 7 AAC 12.508, home health professional advisory committee (Cornell LII)
- 7 AAC 12.510, home health administration (Cornell LII)
- 7 AAC 12.516, director of clinical services (Cornell LII)
- 7 AAC 12.519, home health aide services (Cornell LII)
- 7 AAC 12.610, license application and provisional license (Cornell LII)
- 7 AAC 12.615, license fees (Cornell LII)
- 7 AAC 07.001, health care facilities considered for Certificate of Need (Cornell LII)
- AS 47.32.010, centralized licensing, covered entities (FindLaw copy, current as of 1/1/2025)
- AS 18.07.111, Certificate of Need definitions (FindLaw copy, current as of 1/1/2025)
- Alaska Division of Corporations, Business and Professional Licensing, business licensing
- Alaska Department of Labor and Workforce Development, Employment Security Tax
- CMS Provider Enrollment Moratoria (page modified 8/27/2026)
- Federal Register, nationwide temporary moratorium on hospice enrollment (CMS-6102-N, May 15, 2026)
- Federal Register, nationwide temporary moratorium on home health agency enrollment (CMS-6101-N, May 15, 2026)
- CMS accreditation and approved accrediting organizations
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
This guide is general information and reflects Alaska requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Alaska Department of Health, Senior and Disabilities Services, Health Facilities Licensing and Certification, Alaska Medicaid and CMS before filing. Lunaria Care Consulting provides professional consulting services and does not provide legal advice.
Other states: see all state guides. What we do: licensing, compliance, Medicaid enrollment and local search marketing.