How to start a home care agency in Arkansas and reach your first client faster
Arkansas splits nonmedical home care into two tracks. Private pay agencies need no state license, but their caregivers still need 40 hours of approved training. Medicaid personal care needs an ADH private care agency license, which replaced the old DHS certification in August 2025. Medicaid enrollment then adds site visits, fingerprint checks and a Medicaid number for every caregiver. Home health and hospice need a Permit of Approval before they can even apply. We put all of it in the right order for you.
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Arkansas rules20 CAR Part 49 and the Arkansas Medicaid Personal Care and ARChoices manuals
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Arkansas requires.
Nonmedical home care for ARChoices and State Plan Personal Care
- State license
- ADH private care agency license (Ark. Code 20-10-2301 et seq.; 20 CAR Part 49)
- Who you deal with
- ADH Health Facility Services, DHS Division of Aging, Adult, and Behavioral Health Services, Arkansas Medicaid Provider Enrollment
- Must haves
- Primary office in Arkansas, $1,000,000 liability coverage, ADH approved 40 hour aide training, background and registry checks, Medicaid enrollment with site visits and fingerprint checks, Freedom of Choice list, EVV
- Realistic time to first client
- Several months
Orientation for Arkansas only. We confirm your exact path on the free call.
Three places new Arkansas agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Following advice that is out of date
For years, Medicaid personal care agencies had to certify with the DHS Division of Provider Services and Quality Assurance before ADH would license them. Act 853 of 2025 ended that. Since August 5, 2025, personal care, ARChoices attendant care and respite providers go straight to ADH for a private care agency license, then enroll with Arkansas Medicaid. Owners who follow older guides fill out the wrong forms first.
What it costs: Weeks spent on a certification step that no longer exists while the real application waits.
Medicaid enrollment that checks everyone
Arkansas Medicaid treats State Plan Personal Care providers as high risk. That means pre enrollment and unannounced site visits, fingerprint based checks, and a Medicaid number for every caregiver who records visits in the EVV system. New providers must also ask to be placed on the DHS Freedom of Choice list for each county they serve.
What it costs: A licensed agency with trained staff and no billable visits until enrollment, caregiver numbers and county listings are done.
A clinical license you cannot apply for yet
Before ADH will take a home health or hospice license application, the Arkansas Health Services Permit Agency must grant a Permit of Approval. Home health need is counted county by county, and the October 2026 Bed Need Book shows no net need in almost every county, so most applicants must prove existing agencies are not meeting local needs. A CMS moratorium on new Medicare home health and hospice enrollment began May 13, 2026.
What it costs: Months of planning and capital tied up in a project that may not get a permit or Medicare billing.
What does a delay cost your agency?
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Home care vs home health vs hospice in Arkansas
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 | Personal care, attendant care, respite, homemaker tasks and companionship | Skilled nursing, therapy, medical social work and home health aide services under a plan of care | Palliative and supportive care for people who are terminally ill, and their families |
| State license | Private pay: none. Medicaid: ADH private care agency license (Ark. Code 20-10-2301; 20 CAR Part 49) | ADH home health license, Class A (Medicare certified) or Class B (Ark. Code 20-10-801; 20 CAR Part 46) | ADH hospice license (Ark. Code 20-7-117; 20 CAR Part 47) |
| Certificate of Need | No | Yes: Permit of Approval from the Health Services Permit Agency | Yes: Permit of Approval from the Health Services Permit Agency |
| Main payers | Private pay; Medicaid State Plan Personal Care, ARChoices attendant care and respite; PASSE plans for their members | Medicare, Arkansas Medicaid, PASSE plans, commercial insurance | Medicare hospice benefit, Arkansas Medicaid, commercial insurance |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment. A CMS moratorium on new enrollment took effect May 13, 2026. | Accreditation or state survey, then Medicare enrollment. A CMS moratorium on new enrollment took effect May 13, 2026. |
| Key staff | Administrator, qualified supervisor, an RN to supervise training and check aide skills, trained aides | Administrator, clinical manager, skilled professionals, home health aides with 75 hours of training | Administrator, physician medical director, RN, social worker, pastoral or other counselor |
| Startup capital | Lowest | Higher: Permit of Approval work and clinical payroll before revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks (private pay) to months (Medicaid) | Longest: permit, licensure, survey, enrollment | Longest: permit, licensure, survey, enrollment |
Many Arkansas owners start with private pay nonmedical care, then add the private care agency license for Medicaid personal care and ARChoices. Home health and hospice are a separate decision, because the Permit of Approval depends on county need and the CMS enrollment moratorium affects Medicare billing. We plan the whole path from day one so your policies, training program and hiring grow with you instead of being rewritten.
Arkansas requirements at a glance
| Nonmedical home care license | Private pay only: no state agency license. Medicaid personal care, ARChoices attendant care and respite: ADH private care agency license. |
|---|---|
| Private care agency rules | Ark. Code 20-10-2301 et seq.; Rules for Private Care Agencies in Arkansas, 20 CAR Part 49. Annual license that expires December 31. |
| Home health and hospice licensing | ADH Health Facility Services: Class A or Class B home health license (Ark. Code 20-10-801 et seq.; 20 CAR Part 46) and hospice license (Ark. Code 20-7-117; 20 CAR Part 47) |
| Certificate of Need | Home health and hospice need a Permit of Approval from the Arkansas Health Services Permit Agency before licensure. Nonmedical care does not. |
| Medicaid | Arkansas Department of Human Services: ARChoices in Homecare waiver and State Plan Personal Care (Division of Aging, Adult, and Behavioral Health Services); PASSE plans for members with developmental disabilities or behavioral health needs |
| Caregiver training | 40 hours of ADH approved, RN supervised training and 12 hours of in service a year for private care agency aides; 40 hours for private pay caregivers serving clients 50 and older; 75 hours for home health aides |
| Background screening | State criminal check through the Arkansas State Police, an FBI fingerprint check when needed, repeated every five years; Medicaid personal care adds registry checks every two years and a drug screen |
| Electronic visit verification | Required for Medicaid personal care, attendant care and respite through Fiserv AuthentiCare or a third party system; home health EVV enforcement began November 1, 2026 |
| Medicare (home health, hospice) | Accreditation or a state survey, then Medicare enrollment, subject to the CMS moratorium that began May 13, 2026 |
| Business registrations | Arkansas Secretary of State (entity), DFA (withholding tax through ATAP), Division of Reemployment (unemployment insurance through Tax21) |
Summary of Arkansas requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Arkansas
The order matters. Your training program and caregiver screening should start while the ADH application is being prepared, because Medicaid enrollment follows the license and every caregiver needs training, checks and a Medicaid number before a billable visit.
Form the business and register with the state
File your LLC or corporation with the Arkansas Secretary of State, get an EIN, register for withholding tax with DFA through ATAP, open an unemployment insurance account with the Division of Reemployment through Tax21, and check your city's business license rules.
You do this; we give you the checklistDecide your payer mix
Private pay only needs no agency license, but caregivers serving clients 50 and older need 40 hours of approved training. To bill Medicaid for personal care, ARChoices attendant care or respite, you need the ADH private care agency license. Use the path finder above.
Decided on your free consultationSet up the office and insurance
A private care agency needs a licensed, fully operational primary office physically located in Arkansas and liability coverage of at least $1,000,000 for employees and contractors while they provide care. Add workers' compensation and auto coverage for caregivers who drive.
You do this; we specify what is requiredWrite policies to 20 CAR Part 49
Name a governing board (it can be the owner), an administrator and a qualified supervisor. Adopt policies for organization, orientation, procedures, infection control and TB prevention, personnel records, quality assurance, complaints, client rights, Aide Service Plans and records kept at least five years after discharge.
We write this for youBuild the training program and caregiver pipeline
Get an ADH approved aide course of at least 40 hours, supervised by an RN, with classroom and clinical instruction, written objectives and an RN skills check for every aide. Run criminal background checks, registry checks and drug screens before anyone meets a client, and plan 12 hours of in service a year.
We set up the system and trackerApply for the ADH private care agency license
Request the new provider packet from Health Facility Services and submit the notarized application. ADH completes a review, an inspection or both before it issues the license, then inspects at least every three years. Renew before December 31 each year.
We prepare the applicationEnroll with Arkansas Medicaid
Apply online through the Medicaid provider portal. Expect pre enrollment and unannounced site visits and fingerprint based checks for owners and staff. Each caregiver enrolls and receives a Medicaid number, and you file the Freedom of Choice form for every county you will serve.
We prepare and manage itSet up electronic visit verification
Personal care, attendant care and respite visits must be verified electronically. Choose the state sponsored Fiserv AuthentiCare system or a third party system, file the Arkansas EVV Declaration Form, and complete the required Fiserv training before your first Medicaid visit.
We walk you through setup
Caregiver training and background checks
Arkansas has three training rules, and which one applies depends on how your agency is licensed. Private care agency aides follow 20 CAR Part 49, home health aides follow 20 CAR Part 46, and caregivers at unlicensed private pay agencies follow the Rules for Home Caregiver Training in Arkansas, effective September 5, 2024.
- Private care agency aides: At least 40 hours of ADH approved training supervised by an RN, with classroom and clinical instruction on the topics in the rule's Table 1. An RN must watch each aide perform the required skills, and the agency documents it.
- In service training: Private care agency and home health aides need at least 12 hours of in service training every 12 months, focused on client care.
- Private pay caregivers: Caregivers who serve clients 50 and older for an in-home services agency need at least 40 hours of approved training, including at least four hours on Alzheimer's disease and other dementias and 16 hours of physical skills with a competent demonstration. They must be 18 or older. The employer may certify the training if it keeps records of who was trained, the topic and the time spent.
- Exemptions: CNAs, LPNs, RNs, physicians, licensed social workers, certain close relatives, court appointed guardians, unpaid helpers, people with a year of verified work in a home health agency, hospital, hospice or long term care facility, and direct care workers in DHS programs are exempt from the private pay training rule. Under Act 643 of 2025, a caregiver who already completed the training and documents it does not have to repeat it.
- Home health aides: At least 75 hours of classroom and supervised practical training under an RN, with at least 16 hours of classroom training before at least 16 hours of supervised practical training.
- Criminal background checks: Home health, hospice and private care agencies run a state criminal check through the Arkansas State Police under Ark. Code 20-38-101 et seq., add an FBI fingerprint check when the person has not lived in Arkansas for the past five years, and repeat checks at least every five years. Certain convictions disqualify a person from employment.
- Medicaid personal care checks: Under the new Personal Care manual, effective January 1, 2027, each employee also needs Arkansas Child Maltreatment, Adult Maltreatment and Sex Offender registry checks at hire and at least every two years, and at least a five panel drug screen at hire.
- Medicaid caregiver credentials: The same manual requires each personal care aide to hold an active CNA, home health aide or certified personal care aide credential and to enroll as an Arkansas Medicaid rendering provider. Caregivers who record visits in EVV already need a Medicaid number.
Six mistakes that slow Arkansas agencies down
We look for every one of these in the first week of an engagement.
Certifying with DPSQA first
- What it costs
- Weeks lost on a step that ended August 5, 2025 for personal care, attendant care and respite providers.
- How we prevent it
- Your first call ends with the current Arkansas path: ADH license, then Medicaid enrollment.
Assuming private pay caregivers need no training
- What it costs
- Caregivers serving clients 50 and older without 40 hours of approved training, and records that do not prove it.
- How we prevent it
- A training plan and records that match the Home Caregiver Training rules from the first hire.
Using a training course ADH has not approved
- What it costs
- Aides who cannot provide private care agency services, and an application that stalls.
- How we prevent it
- We build your 40 hour program to 20 CAR Part 49 and Table 1, with RN supervision and skills checks documented.
Running registry checks only at hire
- What it costs
- Medicaid findings once the new Personal Care manual requires registry checks every two years from January 1, 2027.
- How we prevent it
- A tracker that flags criminal checks, registry checks, drug screens, in service hours and caregiver Medicaid numbers.
Letting the license lapse on December 31
- What it costs
- Every ADH home care license runs on the calendar year, and a lapse stops Medicaid billing.
- How we prevent it
- Renewal dates on your compliance calendar, with the renewal packet prepared in advance.
Planning home health or hospice without checking the permit and moratorium
- What it costs
- Capital spent on a clinical agency that cannot get a Permit of Approval in its county or Medicare enrollment while the CMS moratorium lasts.
- How we prevent it
- We check county need, the Permit of Approval process and the CMS moratorium status before you commit capital.
In a free 30 minute call we confirm your Arkansas path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Arkansas 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.
- Arkansas path and a dated launch plan
- Policy and procedure manual written to 20 CAR Part 49 and the Arkansas Medicaid Personal Care and ARChoices manuals
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
ARChoices ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to ARChoices requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for Arkansas Medicaid and the DHS Freedom of Choice list for your counties
- Survey and audit readiness
- Arkansas city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to ADH 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 Arkansas 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 20 CAR Part 49 and the Arkansas Medicaid Personal Care and ARChoices manuals |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for Arkansas Medicaid and the DHS Freedom of Choice list for your counties 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 Arkansas home care startup checklist
Every Arkansas 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 personal care and ARChoices, or both)
- Form your LLC or corporation with the Arkansas Secretary of State
- Get an EIN, register for withholding with DFA through ATAP and for unemployment insurance through Tax21
- Check your city or county business license rules
- Lease a primary office physically located in Arkansas
- 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 Arkansas
- 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 Arkansas cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, ARChoices, 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 Arkansas
| Item | Notes |
|---|---|
| Private care agency license | Annual ADH license that expires December 31. Confirm the current license fee with Health Facility Services before you apply. |
| Home health and hospice licenses | ADH's June 2026 application instructions list $1,000 per parent home health agency and $500 per hospice facility. A Permit of Approval application comes first; confirm its fee with the Health Services Permit Agency. |
| Entity formation and city license | Secretary of State filing fee, annual franchise tax report, plus any municipal license |
| Liability insurance | At least $1,000,000 for private care agencies, plus workers' compensation and auto coverage |
| Aide training program | RN instructor time, materials and skills checks for the 40 hour course, plus 12 hours of in service a year |
| Background checks and screening | Arkansas State Police and FBI fingerprint fees, registry checks and drug screens for Medicaid staff |
| EVV and scheduling software | AuthentiCare is the state sponsored system; third party systems are a vendor cost |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while licensure, Medicaid enrollment or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Arkansas
Weeks, once the business, insurance, caregiver training and hiring process are in place.
Several months: ADH review or inspection, then Medicaid enrollment with site visits and fingerprint checks. DHS tells new providers to allow 30 to 60 days for the Medicaid provider number.
Longest: Permit of Approval review, ADH licensure, certification survey and Medicare enrollment, subject to the CMS moratorium that began May 13, 2026.
Arkansas demand follows its population centers: Little Rock and central Arkansas, Northwest Arkansas around Fayetteville, Springdale, Rogers and Bentonville, Fort Smith and Jonesboro. Rural counties in the Delta and south Arkansas are spread out, so reliable staffing and travel planning matter as much as marketing there. Medicaid families choose agencies from the DHS Freedom of Choice list by county, so the counties you list decide who can find you. Many families search for care for a parent from out of state, which makes a complete Google Business Profile and clear town pages for each community you serve important.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Arkansas?
Not for private pay only. Arkansas has no agency license for private pay nonmedical care, but caregivers who serve clients 50 and older must complete 40 hours of approved training. To bill Medicaid for personal care, ARChoices attendant care or respite, you need a private care agency license from the Arkansas Department of Health.
What changed for private care agencies in 2025?
Act 853 of 2025 removed the old DHS certification step. Since August 5, 2025, personal care, attendant care and respite providers no longer certify with the DHS Division of Provider Services and Quality Assurance. They get a private care agency license from ADH, then enroll with Arkansas Medicaid.
Who licenses home health and hospice agencies in Arkansas?
The Arkansas Department of Health, Health Facility Services. Home health agencies get a Class A (Medicare certified) or Class B license under Ark. Code 20-10-801 et seq. and 20 CAR Part 46. Hospices are licensed under Ark. Code 20-7-117 and 20 CAR Part 47.
Does Arkansas require a Certificate of Need for home health or hospice?
Yes, in the form of a Permit of Approval from the Arkansas Health Services Permit Agency, which you need before applying for the ADH license. Need is measured by county, and where the Bed Need Book shows no need you must show that existing agencies are not meeting local needs. Nonmedical care needs no permit.
How much training do Arkansas caregivers need?
Private care agency aides need at least 40 hours of ADH approved, RN supervised training and 12 hours of in service a year. Private pay caregivers serving clients 50 and older need 40 hours, including dementia care and 16 hours of physical skills. Home health aides need at least 75 hours. CNAs and nurses are exempt from the private pay rule.
How do Arkansas agencies get ARChoices clients?
By holding a private care agency license, enrolling with Arkansas Medicaid as an attendant care or respite provider, and joining the DHS Freedom of Choice list for each county they serve. A DHS nurse writes the ARChoices person centered service plan, and services must be on that plan before they start.
Does Arkansas require electronic visit verification?
Yes. Medicaid personal care, attendant care and respite visits must be verified electronically, using the state sponsored Fiserv AuthentiCare system or a third party system. Home health EVV enforcement began November 1, 2026, and since December 1, 2026 claims without EVV are denied.
Is the CMS Medicare moratorium still in effect?
CMS paused new Medicare enrollment of home health agencies and hospices nationwide on May 13, 2026, for six months. It was due to end around November 13, 2026 unless CMS extended it in six month steps, and it may have ended or been extended since. Check the CMS moratoria page before you plan Medicare billing.
Is a franchise a better way to start a home care agency in Arkansas?
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 Arkansas home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Medicaid personal care and ARChoices, or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges.
Sources checked for this guide (42)
- ADH Rules for Private Care Agencies in Arkansas (effective June 17, 2024)
- ADH proposed amendments to 20 CAR Part 49, draft markup (Acts 643, 674 and 853 of 2025)
- ADH summary of proposed private care agency rule amendments (October 11, 2025)
- ADH notice of public comment period on 20 CAR Part 49 (July 5 to August 4, 2026)
- ADH Rules for Home Health Agencies in Arkansas (revision effective June 17, 2024)
- ADH summary of proposed home health rule amendments (Acts 144, 643 and 849 of 2025)
- ADH Rules for Hospice in Arkansas (revisions effective June 17, 2024)
- ADH Rules for Home Caregiver Training in Arkansas (effective September 5, 2024)
- ADH Rules for Criminal History Records Checks for Home Health, Hospice and Private Care Agencies
- ADH summary of proposed background check rule amendments (Acts 674 and 853 of 2025)
- ADH Health Facility Services rules page
- ADH Health Facility Services, applications for new providers
- ADH Health Facility Services, criminal background check
- ADH HFS-10A license application instructions and fees (Rev. 06/18/2026)
- ADH HFS-9A license application (Rev. 06/18/2026)
- Arkansas Health Services Permit Agency
- Health Services Permit Agency, Bed Need Book (October 2026, SFY 2027)
- Health Services Permit Agency, home health Permit of Approval application
- Health Services Permit Agency, hospice Permit of Approval application
- DHS Licensure Process Change FAQs for personal care, attendant care and respite (approved 9/19/2025)
- AFMC flyer: DPSQA certification policy change effective August 5, 2025
- DHS new provider resources for personal care, attendant care and respite
- DHS proposed rules and public notices (Personal Care and ARIA manuals, final rule effective 01/01/2027)
- DHS second notice: updates to the Personal Care and ARIA provider manuals (June 11, 2026)
- DHS ARChoices in Homecare
- DHS Agency Provider Certification for ARChoices in Homecare
- DHS ARChoices provider services requirements
- DHS Electronic Visit Verification information (home health EVV phases)
- DHS EVV, Personal Care Services (AuthentiCare, third party option)
- Arkansas Secretary of State, Business and Commercial Services
- Arkansas DFA, withholding tax registration (ATAP)
- Arkansas Division of Reemployment, employer services (Tax21)
- Federal Register 2026-09717, nationwide moratorium on enrollment of home health agencies (govinfo)
- Federal Register 2026-09718, nationwide moratorium on enrollment of hospices (govinfo)
- CMS provider enrollment moratoria page (updated August 27, 2026)
- CMS Home Health and Hospice Nationwide Moratorium Q&As (revised 7/09/26)
- 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)
- Ark. Code 20-10-2304, private care agency rules (FindLaw copy, current through March 2024)
- Ark. Code 20-10-801, home healthcare services definitions (FindLaw copy)
- Ark. Code 20-8-101, Health Services Permit Agency (Justia, 2020 code)
This guide is general information and reflects Arkansas requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Arkansas Department of Health, the Arkansas Department of Human Services, the Arkansas Health Services Permit Agency 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.