How to start a home care agency in Arizona and reach your first client faster
Arizona has no state license for nonmedical home care, so new owners assume the hard part is over. It is not. AHCCCS registration, a separate contract with each ALTCS health plan in your area, DCW training and testing, background and registry checks, and electronic visit verification decide when your first Medicaid client arrives. Home health and hospice add ADHS licensure and Medicare on top. We put all of it in the right order for you.
- Guides reviewed by Christine Ochimas, RN, LMFT, MBA
- One fixed price, agreed in writing
- You own 100%. No franchise fees or royalties
Get your free Arizona launch plan
A 30 minute call. No obligation.
- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Arizona rulesAHCCCS Medical Policy Manual 1240-A and ALTCS health plan provider manuals
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- All 50 states and DCExpand beyond Arizona with us
Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Arizona requires.
Nonmedical home care for ALTCS members
- State license
- None for nonmedical care; AHCCCS provider registration instead
- Who you deal with
- AHCCCS and each ALTCS E/PD health plan in your geographic service area
- Must haves
- AHCCCS registration (Provider Type 40, Attendant Care), health plan contracts, DCW trained and tested caregivers, background and APS and DCS registry checks, CPR and first aid, EVV
- Realistic time to first client
- Several months
Orientation for Arizona only. We confirm your exact path on the free call.
Three places new Arizona agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Searching for a license that does not exist
Owners call ADHS, look for an application form and ask other agencies before learning that nonmedical care has no state license. AHCCCS policy states it plainly: direct care agencies are not certified by a state board or agency. Meanwhile, the steps that do matter have not started.
What it costs: Weeks of lost time before the real clock even starts.
The ALTCS health plan wall
ALTCS members for the elderly and physically disabled program are served through contracted health plans, and each plan contracts with and credentials you separately after AHCCCS registration. Which plans you need depends on your geographic service area: the North area has one plan, the Central area has three. Agencies that start this after opening face a long stretch with staff and no Medicaid clients.
What it costs: Months of rent, insurance and payroll carried by your operating reserve while plan contracts are pending.
Caregivers you cannot keep scheduling
AHCCCS gives an agency 90 days from hire to train and test each Direct Care Worker. If the worker has not passed the knowledge and skills tests by then, they must stop providing care until they do. Background checks, APS and DCS registry searches, and current CPR and first aid all have to be on file too.
What it costs: A client you suddenly cannot staff, and a caregiver who may take another offer while they wait.
What does a delay cost your agency?
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Home care vs home health vs hospice in Arizona
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 | Attendant care, personal care, homemaker tasks, companionship, respite | Skilled nursing and therapy ordered by a physician, nurse practitioner, physician assistant or podiatrist | Palliative and supportive care for people who are terminally ill, and their families |
| State license | None | ADHS home health agency license (A.R.S. 36-425.01; A.A.C. R9-10 Article 12) | ADHS hospice license (A.A.C. R9-10 Article 6) |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step |
| Main payers | Private pay, ALTCS E/PD health plans; DDD only for services it is currently contracting | Medicare, AHCCCS health plans, commercial insurance | Medicare hospice benefit, AHCCCS |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment | Accreditation or state survey, then Medicare enrollment |
| Key staff | Supervisor for required monitoring visits; DCW trained and tested caregivers | Administrator, home health services director (physician or experienced RN), clinical staff, advisory group | Administrator, physician medical director, RN director of nursing, interdisciplinary team |
| Startup capital | Lowest | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks (private pay) to months (ALTCS) | Longest: licensure, survey, enrollment | Longest: licensure, survey, enrollment |
Many Arizona owners start with nonmedical care, build cash flow and a caregiver team, then add home health. Once a home health agency is Medicare certified and has held its ADHS license for at least a year, A.R.S. 36-425.01 lets ADHS issue its license without a state licensure survey. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Arizona requirements at a glance
| Nonmedical home care license | None at the state level. AHCCCS registration is required to serve ALTCS members. |
|---|---|
| Home health and hospice licensing | Arizona Department of Health Services (ADHS), Bureau of Medical Facilities Licensing, under A.R.S. Title 36, Chapter 4 and A.A.C. R9-10 (Article 12 home health, Article 6 hospices) |
| Medicaid agency | Arizona Health Care Cost Containment System (AHCCCS) |
| Long term care program | Arizona Long Term Care System (ALTCS); the elderly and physically disabled program (E/PD) runs through contracted health plans |
| Caregiver training | AHCCCS Direct Care Worker (DCW) training and testing within 90 days of hire, CPR and first aid, six hours of continuing education a year |
| Background screening | Nationwide criminal background check, APS and DCS registry searches and a notarized attestation (AHCCCS); Level One Fingerprint Clearance Card for DDD work; fingerprint clearance card for home health staff |
| Electronic visit verification | Required for personal care and home health services; AHCCCS runs its own EVV aggregator and agencies choose and pay for a tested EVV system |
| Developmental disabilities | DES Division of Developmental Disabilities Qualified Vendor contract (RFQVA DDD-2024); attendant care, homemaker and respite are not open to new vendors |
| Medicare (home health, hospice) | Accreditation by a CMS approved organization or a state survey, then Medicare enrollment |
| Entity filing | Arizona Corporation Commission, Corporations Division |
Summary of Arizona requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Arizona
The order matters. Steps 5 and 6 should start long before step 7, because health plan contracts follow AHCCCS registration and every caregiver needs checks and DCW testing on file.
Form the business with the Arizona Corporation Commission
File your LLC or corporation, get an EIN, register for state payroll withholding and unemployment insurance, and check your city's business license rules.
You do this; we give you the checklistDecide your payer mix
Private pay, ALTCS or both. DDD is currently not accepting new Qualified Vendors for attendant care, homemaker, respite or hourly habilitation, so check its open services before you plan on it. Use the path finder above.
Decided on your free consultationSet up insurance and employment basics
Arrange workers' compensation, general and professional liability, and auto coverage for caregivers who drive. Build Arizona earned paid sick time into payroll from the first hire: one hour for every 30 hours worked.
You do this; we specify what is requiredWrite policies to the AHCCCS standard
Even with no state license, adopt policies for service agreements, member rights, care plans, supervisory visits, background checks, incident and abuse reporting, infection control and records, written to AHCCCS Medical Policy Manual 1240-A and each health plan's provider manual.
We write this for youBuild the caregiver pipeline
Check three references, run a nationwide criminal background check and APS and DCS registry searches, collect the notarized attestation, confirm CPR and first aid, and send each new caregiver through an approved DCW training and testing program within 90 days of hire. Track continuing education every year.
We set up the system and trackerRegister with AHCCCS
Apply through the AHCCCS Provider Enrollment Portal (APEP). Nonmedical companies register as Provider Type 40, Attendant Care, sign the Provider Participation Agreement, and list every employee in APEP.
We prepare and manage itContract with ALTCS health plans
ALTCS E/PD members are served by UnitedHealthcare Community Plan, Banner-University Family Care and Mercy Care, depending on county. Apply to each plan in your area and complete its credentialing. Plan contracts, not the state, are what bring referrals.
We prepare every plan's packetSet up electronic visit verification
AHCCCS requires EVV for personal care services. Since October 1, 2025 AHCCCS runs its own data aggregator, so you choose and pay for an EVV system that has passed AHCCCS testing, and set it up before your first ALTCS visit.
We walk you through setup
Direct Care Worker training and background checks
AHCCCS Medical Policy Manual 1240-A sets the standards for direct care workers who provide attendant care, personal care and homemaker services to ALTCS members through an agency. Training is based on the Principles of Caregiving curriculum. Knowledge tests need a score of 80% and every skills demonstration must be passed.
- Level I: Fundamentals of Caregiving: Required for every DCW, including family caregivers. Must be passed within 90 days of hire, or the worker stops providing care until they pass.
- Level II: Specialized modules: Aging and Physical Disabilities, or Developmental Disabilities, matched to the people the worker serves. Workers who serve both groups take both. Not required for workers who care only for a family member.
- Exemptions: RNs, LPNs, certified or licensed nursing assistants and licensed health aides are exempt from DCW training and testing, though the agency may still require it.
- CPR and first aid: Current certification with an in person skills demonstration, before the first ALTCS visit and kept current.
- Continuing education: Six hours every year. CPR and first aid do not count toward the six hours.
- Background and registry checks: A nationwide criminal background check at hire and every three years, APS and DCS registry searches at hire and every year, and a notarized attestation at hire and every year.
- Fingerprint clearance cards: Required by statute for DDD direct care staff (a Level One card under A.R.S. 36-594.01) and for direct care staff of licensed home health agencies (A.R.S. 36-411). Workers apply through the DPS Public Services Portal; the card is valid for six years.
- Portability: Testing records are kept in the AHCCCS DCW testing records database so qualified workers can move between agencies. Check it before retraining someone.
Six mistakes that slow Arizona agencies down
We look for every one of these in the first week of an engagement.
Looking for a license application that does not exist
- What it costs
- Weeks of searching while caregiver screening, policies and AHCCCS registration sit untouched.
- How we prevent it
- Your first call ends with your exact Arizona path and the order to do it in.
Assuming no license means no standards
- What it costs
- ALTCS plans hold you to AHCCCS policy at credentialing and audit. Missing policies send the packet back.
- How we prevent it
- We write your policy manual to AHCCCS Medical Policy Manual 1240-A and each plan's provider manual.
Letting the 90 day DCW window run out
- What it costs
- A caregiver who has not passed DCW testing by day 90 must stop working ALTCS cases.
- How we prevent it
- A tracker that flags testing, registry checks, CPR and continuing education dates for every caregiver.
Contracting with only one ALTCS plan
- What it costs
- Referrals from only a slice of the ALTCS members in your area, since Maricopa, Pinal, Gila and Pima members can choose between plans.
- How we prevent it
- We prepare packets for every plan serving your geographic service area at once.
Counting on DDD attendant care
- What it costs
- DDD has not accepted new Qualified Vendors for attendant care, homemaker or respite since 2023, so a plan built on DDD referrals stalls.
- How we prevent it
- We check DDD's open services on your first call and plan around what is actually available.
Drifting into skilled care without an ADHS license
- What it costs
- Exposure to enforcement under A.R.S. Title 36 and problems with every payer.
- How we prevent it
- Clear service definitions so nonmedical caregivers never perform skilled tasks.
In a free 30 minute call we confirm your Arizona path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Arizona 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.
- Arizona path and a dated launch plan
- Policy and procedure manual written to AHCCCS Medical Policy Manual 1240-A and ALTCS health plan provider manuals
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
ALTCS ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to ALTCS requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for each ALTCS E/PD health plan in your area
- Survey and audit readiness
- Arizona city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to ADHS 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 Arizona 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 AHCCCS Medical Policy Manual 1240-A and ALTCS health plan provider manuals |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for each ALTCS E/PD health plan in your area 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 Arizona home care startup checklist
Every Arizona 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, ALTCS, or both)
- Form your LLC or corporation with the Arizona Corporation Commission
- Get an EIN and register for state payroll withholding and unemployment insurance
- Check your city or county business license rules
- Buy workers' compensation, general and professional liability, and auto coverage
- 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 Arizona
- 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 Arizona cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, ALTCS, 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 Arizona
| Item | Notes |
|---|---|
| State license | None for nonmedical care. ADHS charges home health agencies and hospice service agencies a $50 application fee and a licensing fee under A.A.C. R9-10-106 ($365 for an agency with no licensed capacity). Check current fees with ADHS. |
| Entity formation and city license | Arizona Corporation Commission filing fee plus any municipal license |
| Fingerprint clearance cards | DPS fee is currently $67 per card, plus any fingerprinting vendor fee. Needed for DDD and home health staff. |
| Background and registry checks | Nationwide criminal background check vendor fees for ALTCS caregivers |
| DCW training and testing | Approved training program tuition or testing fees per caregiver, plus CPR and first aid |
| Insurance | Workers' compensation, liability, auto coverage |
| EVV and scheduling software | Paid by the agency; required for ALTCS personal care visits |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while health plan contracts or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Arizona
Weeks, once the business, insurance and hiring process are in place.
Several months: AHCCCS registration, then contracting and credentialing with each health plan in your area.
Longest: ADHS application at least 60 days before opening, licensing inspection, certification survey and Medicare enrollment.
Most Arizonans live in Maricopa and Pima counties, and that is where ALTCS members have a choice of health plans, so agencies there compete for plan contracts and referrals. In the North geographic service area (Apache, Coconino, Mohave, Navajo and Yavapai counties) one ALTCS E/PD plan serves members, so a single strong contract matters more there, and rural distances make reliable staffing your selling point. Many families search for care for a parent from out of state, which makes a strong Google Business Profile and clear city pages for Phoenix, Mesa, Scottsdale, Tucson and your other communities matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Arizona?
No. Arizona does not license nonmedical home care agencies, and AHCCCS policy states that direct care agencies are not certified by a state board or agency. Agencies still need business registration and insurance, and must register with AHCCCS and meet its standards to serve ALTCS members.
Who licenses home health and hospice agencies in Arizona?
The Arizona Department of Health Services, through its Bureau of Medical Facilities Licensing, under A.R.S. Title 36, Chapter 4. Home health agency rules are in A.A.C. R9-10 Article 12 and hospice rules are in Article 6. Applications are filed online through the ADHS Licensing Management System.
What is the difference between a state license and Medicare certification?
The ADHS license lets a home health or hospice agency operate in Arizona. Medicare certification, through an accreditation or state survey and Medicare enrollment, lets it bill Medicare. Most agencies need both.
Does Arizona require a Certificate of Need for home health or hospice?
No. Arizona's health care institution licensing law and the ADHS home health application contain no Certificate of Need or need review. Licensure, survey and Medicare enrollment still apply.
Can a new home health agency or hospice enroll in Medicare right now?
Not while the federal pause lasts. On May 13, 2026, CMS began a six month nationwide moratorium on new Medicare enrollment of home health agencies and hospices, including new branches and practice locations. It is set to end around November 13, 2026, but CMS can extend it in six month increments, so it may have ended or been extended by the time you read this. Agencies already enrolled are not affected. It covers Medicare only. Each state decides whether to pause its own Medicaid enrollment, so check with AHCCCS before you plan around it.
What is a DCW in Arizona?
A Direct Care Worker provides attendant care, personal care or homemaker services to ALTCS members. Through an agency, a DCW must pass Level I Fundamentals and at least one Level II module (Aging and Physical Disabilities or Developmental Disabilities) within 90 days of hire, hold CPR and first aid, and complete six hours of continuing education a year.
Do Arizona caregivers need a fingerprint clearance card?
It depends on the program. DDD direct care staff need a Level One Fingerprint Clearance Card, and direct care staff of licensed home health agencies need a fingerprint clearance card. For ALTCS E/PD work, AHCCCS requires a nationwide criminal background check, APS and DCS registry searches and a notarized attestation. Cards cost $67 from DPS and last six years.
How do Arizona home care agencies get ALTCS clients?
By registering with AHCCCS as an attendant care provider and contracting with the ALTCS E/PD health plans that serve their counties: UnitedHealthcare Community Plan, Banner-University Family Care and Mercy Care, depending on the area. Services are authorized by the plans' case managers.
Is a franchise a better way to start a home care agency in Arizona?
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 Arizona home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, ALTCS or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges. We work in all 50 states and DC.
Sources checked for this guide (32)
- AHCCCS Medical Policy Manual 1240-A, Direct Care Services (effective 10/01/25)
- AHCCCS Medical Policy Manual 540, Electronic Visit Verification
- AHCCCS Provider Type Profile 40, Attendant Care (Companies Only)
- AHCCCS ALTCS-EPD contracts FAQ (health plans by geographic service area)
- AHCCCS notice via DES: Important EVV Updates, June 2025 (AHCCCS aggregator from October 1, 2025)
- DES DDD vendor announcements (EVV 2.0 go live, background checks)
- DES DDD Contract Information for Qualified Vendors (RFQVA DDD-2024, open and closed services)
- DES DDD Become a Qualified Vendor
- ADHS Bureau of Medical Facilities Licensing
- ADHS Home Health Agency License Application
- A.R.S. 36-401, health care institution definitions
- A.R.S. 36-151, home health agency definition
- A.R.S. 36-422, license application (60 to 120 days before operation)
- A.R.S. 36-425.01, home health agency licensing
- A.R.S. 36-411, fingerprint clearance cards in home health agencies
- A.R.S. 36-594.01, fingerprinting for DDD providers
- A.R.S. 41-1758.07, Level I fingerprint clearance cards
- A.R.S. 46-459, Adult Protective Services registry
- A.R.S. 23-372, earned paid sick time accrual
- A.A.C. Title 9, Chapter 10 article list (Cornell LII)
- A.A.C. R9-10-106, fees (Cornell LII)
- A.A.C. R9-10-1203, home health agency administration (Cornell LII)
- A.A.C. R9-10-603, hospice administration (Cornell LII)
- Arizona DPS Fingerprint Clearance Card
- Arizona Corporation Commission, Arizona Business Center
- CMS accreditation and approved accrediting organizations
- CMS-855A Medicare enrollment application, institutional providers
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- Federal Register 2026-09717, CMS nationwide temporary moratoria on Medicare enrollment of home health agencies (published May 15, 2026)
- Federal Register 2026-09718, CMS nationwide temporary moratorium on Medicare enrollment of hospices (published May 15, 2026)
- NCSL Certificate of Need state laws (secondary, pointer only)
This guide is general information and reflects Arizona requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Arizona Department of Health Services, AHCCCS, DES 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.