How to start a home care agency in Delaware and reach your first client faster
Delaware licenses nonmedical home care, and the license comes with a clock. DHCQ issues a 90 day initial license that cannot be renewed, and it surveys you during those 90 days while you are already serving clients. Your office must be in Delaware and its county decides where you may work. Every caregiver goes through the Background Check Center and a drug test before the first shift, and DSHP Plus clients come only through managed care plan contracts. 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
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Delaware rules16 DE Admin. Code 3345 and DSHP Plus health plan provider manuals
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Delaware requires.
Nonmedical home care for DSHP Plus members
- State license
- DHCQ Personal Assistance Services Agency license (16 Del. C. 122(3)(x); 16 DE Admin. Code 3345)
- Who you deal with
- DHCQ, Delaware Medicaid (DMMA) and each DSHP Plus managed care plan
- Must haves
- PASA license, Delaware Medicaid enrollment through the DMAP portal, contracts with AmeriHealth Caritas Delaware, Delaware First Health and Highmark Health Options, EVV registration with HHAeXchange
- Realistic time to first client
- Several months
Orientation for Delaware only. We confirm your exact path on the free call.
Three places new Delaware agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
A 90 day license with no clients
DHCQ grants a 90 day initial license and must survey the agency during those 90 days. Regulation 3345 says the agency must be operating and caring for clients at that survey, or it will not be granted a license, and the initial license cannot be renewed. Owners who wait for the license to start marketing and hiring reach the survey with an empty schedule.
What it costs: A lost license, a new application and months of rent and payroll with nothing to show for them.
An office in the wrong county
Your office must be in Delaware, each office needs its own license, and you may only serve the county where the office sits plus the counties next to it. An office in New Castle County can serve New Castle and Kent, but not Sussex. Many owners sign a lease before they learn this.
What it costs: A second office and a second license, or turning away clients in the county you planned to serve.
DSHP Plus clients only arrive through health plans
Delaware Medicaid long term services and supports run through DSHP Plus, and members receive personal care through their managed care plan. After licensure you enroll with Delaware Medicaid, then contract with and credential with each plan separately. Since November 1, 2025, Medicaid claims for services subject to EVV are denied if they do not match a recorded visit.
What it costs: Months of payroll carried by your reserve while contracts are pending, and denied claims if EVV is not set up before the first visit.
What does a delay cost your agency?
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Home care vs home health vs hospice in Delaware
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 activities of daily living, companion, homemaker and transportation services, medication reminders | Licensed nursing, therapy, social services and home health aide services, supervised by a registered nurse | Palliative and supportive care for people who are terminally ill, and their families, available 24 hours a day |
| State license | DHCQ Personal Assistance Services Agency license (16 DE Admin. Code 3345) | DHCQ skilled home health agency license (16 DE Admin. Code 3350) | DHCQ hospice license (16 DE Admin. Code 3380) |
| Certificate of Need | No | No Certificate of Public Review step | No Certificate of Public Review step |
| Main payers | Private pay, DSHP Plus managed care plans, DDDS Lifespan Waiver for authorized providers | Medicare, Delaware Medicaid managed care plans, commercial insurance | Medicare hospice benefit, Delaware Medicaid |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment; check the CMS moratorium | Accreditation or state survey, then Medicare enrollment; check the CMS moratorium |
| Key staff | Full time director with an associate degree and two years of supervisory experience, a similarly qualified backup, trained and tested caregivers | Full time director, full time RN clinical director with home health and supervisory experience, clinical staff, trained aides | Hospice administrator, governing authority, physician, RN, social worker, director of nurses licensed in Delaware, trained volunteers |
| Startup capital | Lowest | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks to months (private pay); several months (DSHP Plus) | Longest: licensure, survey, enrollment | Longest: licensure, survey, enrollment |
Delaware also has a middle option: an aide only home health agency licensed under 16 DE Admin. Code 3351, where a registered nurse plans and supervises care and aides may perform tasks a nurse delegates. A PASA cannot do that. Many owners start with a PASA, build cash flow and a caregiver team, then add home health. We plan the path from day one so your policies, office and hiring grow with you instead of being rewritten.
Delaware requirements at a glance
| Nonmedical home care license | Personal Assistance Services Agency (PASA) license, one per office, under 16 Del. C. 122(3)(x) and 16 DE Admin. Code 3345 |
|---|---|
| Licensing agency | Delaware Department of Health and Social Services (DHSS), Division of Health Care Quality (DHCQ), Office of Health Facilities Licensing and Certification |
| Home health and hospice | DHCQ licenses skilled home health agencies (16 DE Admin. Code 3350), aide only home health agencies (3351) and hospices (3380) |
| Initial license | 90 days, not renewable, with an on site survey while the agency is caring for clients; then an annual license |
| Office and service area | Office in Delaware; services limited to the office's county and the adjacent Delaware counties |
| Caregiver training | Agency orientation on the topics in Regulation 3345, a competency test before care and every year, and yearly dementia training if you serve people with dementia |
| Background screening | Fingerprint based state and federal criminal history through the DHSS Background Check Center and a drug test before hire (16 Del. C. 1145 and 1146) |
| Medicaid route | Division of Medicaid and Medical Assistance (DMMA); DSHP Plus long term services and supports through AmeriHealth Caritas Delaware, Delaware First Health and Highmark Health Options |
| Electronic visit verification | Required for Medicaid personal care and home health services; HHAeXchange is the state vendor and agencies may use an approved alternate system |
| Business registration | Entity filing with the Delaware Division of Corporations; state business license and employer registration through Delaware One Stop |
Summary of Delaware requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Delaware
The order matters. In Delaware the office lease and the caregiver pipeline come before the application, because the office decides your service area and DHCQ expects you to be caring for clients at the survey inside your 90 day initial license.
Choose your county and form the business
Pick an office location in Delaware that covers the counties you want to serve: an office in Kent County borders both other counties. Form your LLC or corporation with the Division of Corporations, get an EIN, and register for a state business license and as an employer through Delaware One Stop.
Decided on your free consultationSet up insurance and employment basics
Regulation 3345 requires $1 million comprehensive general liability per occurrence and $500,000 single limit coverage at all times. Add workers' compensation and auto coverage. If you will have 10 or more employees, plan for Delaware Paid Leave contributions.
You do this; we specify what is requiredAppoint a qualified director
You need a full time director with at least an associate degree and two years of health care or home care supervisory experience, plus a similarly qualified person named in writing to act in the director's absence.
You do this; we specify what is requiredWrite policies, forms and the competency test
DHCQ reviews your policy manual and the competency test you will give every caregiver with the application. Policies cover intake, service agreements, consumer rights, grievances, incident reporting within 48 hours, infection control, emergency management, records and the insurance disclosure form.
We write this for youApply for the PASA license
Send DHCQ a written statement of intent, then return the Part 1 initial licensure application with the $250 fee and your compliance documents: ownership, governing body, management credentials, policies, the competency test and proof of insurance.
We prepare the applicationBuild the caregiver pipeline
Run every applicant through the Background Check Center, collect a drug test result before hire, get service letters from prior employers, and complete TB screening, a physical exam within 12 months before hire, orientation and the competency test before the first visit.
We set up the system and trackerStart serving clients and pass the initial survey
The initial license lets you hire and build a caseload. Do the director's home visit before services start, write each service plan, and be caring for clients when DHCQ arrives for the on site survey within the 90 days.
We get you ready for the surveyEnroll with Delaware Medicaid and the DSHP Plus plans
Enroll as a Delaware Medicaid provider through the DMAP portal run by Gainwell, then apply to and credential with AmeriHealth Caritas Delaware, Delaware First Health and Highmark Health Options. Plan contracts are what bring DSHP Plus referrals.
We prepare every plan's packetSet up electronic visit verification
Register each Medicaid location ID in the HHAeXchange provider portal and choose the state system or an approved alternate system. Claims for services subject to EVV are denied when no matching visit is recorded.
We walk you through setup
Caregiver training, the Background Check Center and drug testing
Delaware does not set a fixed number of training hours for PASA caregivers. Instead, Regulation 3345 makes the agency responsible: every direct care worker completes your orientation before serving a client and passes your competency test before providing care and every year after. Background checks and drug testing are set by state law, not by the agency.
- Orientation: Before the first assignment, on the topics listed in 16 DE Admin. Code 3345-4.5, including consumer rights, infection control, body mechanics, nutrition, activities of daily living, dementia care and Delaware's rules.
- Competency test: Covers the orientation topics, passed before providing care and every year after. DHCQ reviews a copy of your test with the license application.
- Dementia training: Agencies that serve people with Alzheimer's disease or other dementias give every direct care worker dementia specific training each year.
- Background Check Center: Every applicant is processed through the DHSS Background Check Center for a fingerprint based Delaware and FBI criminal history. You may hire conditionally for up to 60 days, but only after the applicant has been fingerprinted. Certain abuse, neglect and theft convictions disqualify a worker.
- Drug testing: No applicant may start work before you have the result of a mandatory drug screen under 16 Del. C. 1146. There is no conditional start for drug testing.
- Service letters: Delaware law requires you to request service letters from prior employers before hiring and to complete one when an employee leaves, stored in the Background Check Center.
- Health screening: TB testing before hire and every year following CDC recommendations, and a physical exam completed within 12 months before employment.
- Medication administration: Allowed only for an adult in their own home, when a responsible caregiver signs an agreement with the agency and supplies separately packaged, labeled doses, and the worker has completed a Department approved medication training program. Injections, tubes, catheters and some controlled substances are excluded.
Six mistakes that slow Delaware agencies down
We look for every one of these in the first week of an engagement.
Waiting for the license to start hiring and marketing
- What it costs
- The survey arrives inside 90 days, and an agency with no clients is not granted a license.
- How we prevent it
- We plan hiring, referral sources and your first clients so you are serving people before the survey.
Leasing an office that cannot reach your market
- What it costs
- An office in New Castle County cannot serve Sussex County, so you need a second office and license.
- How we prevent it
- Your first call ends with the county and service area that fit your plan.
Starting a caregiver before the drug test result
- What it costs
- State law bars employment before the result, and failing to secure a criminal history carries a civil penalty of $1,000 to $5,000 per violation.
- How we prevent it
- A tracker that blocks scheduling until the Background Check Center and drug screen are complete.
Hiring a director who does not qualify
- What it costs
- The application stalls until you find someone with an associate degree and two years of supervisory experience.
- How we prevent it
- We check every leadership candidate against Regulation 3345 before you make an offer.
Missing 90 day home visits and service plan reviews
- What it costs
- Survey deficiencies, a plan of correction and possibly a provisional license.
- How we prevent it
- A calendar that flags each client's follow up visit, with every other visit in person, and each plan review.
Using "healthcare" in your name or ads
- What it costs
- Regulation 3345 bars a PASA from using the word or anything implying health care services, which means renaming and reprinting.
- How we prevent it
- We review your name, website and marketing against the rule before you launch.
In a free 30 minute call we confirm your Delaware path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Delaware 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.
- Delaware path and a dated launch plan
- Policy and procedure manual written to 16 DE Admin. Code 3345 and DSHP Plus health plan provider manuals
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
DSHP Plus ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to DSHP Plus requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for each DSHP Plus managed care plan
- Survey and audit readiness
- Delaware city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to DHCQ 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 Delaware 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 16 DE Admin. Code 3345 and DSHP Plus health plan provider manuals |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for each DSHP Plus managed care plan 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 Delaware home care startup checklist
Every Delaware 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, DSHP Plus, or both)
- Pick a Delaware office location whose county and adjacent counties cover your market
- Form your LLC or corporation with the Delaware Division of Corporations
- Get an EIN and register for a state business license and as an employer through Delaware One Stop
- Buy $1 million per occurrence general liability, $500,000 single limit coverage, workers' compensation 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 Delaware
- 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 Delaware cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, DSHP Plus, 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 Delaware
| Item | Notes |
|---|---|
| PASA license | $250 nonrefundable application fee and $100 annual license fee, set by 16 Del. C. 122(3)(x). |
| Home health and hospice licenses | Home health agency: $500 nonrefundable application fee and $300 a year (16 Del. C. 122(3)(o)). Hospice: $100 application fee and $50 a year (16 Del. C. 122(3)(m)). |
| Entity formation and business license | Division of Corporations filing fee and the state business license through Delaware One Stop |
| Background Check Center and drug tests | BCC user fee set by DHSS each year, fingerprinting and a drug screen for every applicant |
| TB tests and physical exams | Per new hire; TB screening every year |
| Insurance | $1 million per occurrence general liability and $500,000 single limit minimums for a PASA, plus workers' compensation and auto coverage |
| Office lease | Required in Delaware, in a county that covers your service area |
| Director salary | Full time position from the start |
| EVV and scheduling software | The state HHAeXchange system or an approved alternate system for Medicaid visits |
| Operating reserve | Covers payroll, rent and insurance through the initial license period and while plan contracts or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Delaware
Weeks to a few months to the initial license, then the DHCQ survey within 90 days while you serve your first clients.
Several months: PASA licensure, Delaware Medicaid enrollment, then contracting and credentialing with each managed care plan.
Longest: DHCQ licensure and survey, a certification survey and Medicare enrollment, subject to the CMS moratorium while it lasts.
Delaware has three counties, and your office location decides which of them you can serve. New Castle County, around Wilmington and Newark, is the most populated and the most competitive. Kent County, around Dover, is the only county that borders both of the others, so an office there can serve the whole state. Sussex County's coastal and rural towns are far from Wilmington, and agencies with nearby caregivers win on reliability there. Many families search for care for a parent from Pennsylvania, Maryland or further away, so a complete Google Business Profile and clear pages for Wilmington, Newark, Dover, Lewes and your other towns matter.
Frequently asked questions
Do you need a license to start a home care agency in Delaware?
Yes. Nonmedical home care agencies need a Personal Assistance Services Agency license from DHCQ under 16 Del. C. 122(3)(x) and 16 DE Admin. Code 3345. Agencies that provide skilled nursing or therapy need a home health agency license instead, and hospices need a hospice license.
How much does a Delaware PASA license cost?
State law sets a $250 nonrefundable application fee and a $100 annual license fee. Budget separately for insurance, the Background Check Center, drug tests and your office.
How does the Delaware initial license work?
DHCQ grants a 90 day initial license once your application is complete. It lets you hire caregivers and take clients. DHCQ surveys you during those 90 days, and you must be caring for clients and in substantial compliance to receive a 12 month annual license. The initial license cannot be renewed.
Can one office serve all of Delaware?
Only if it is in Kent County. A PASA may serve the county where its office is and the adjacent Delaware counties. Kent borders both New Castle and Sussex, while an office in New Castle or Sussex cannot reach the county at the other end of the state.
Do Delaware caregivers need certification?
No state certification is required for PASA caregivers. They complete your orientation, pass your competency test before working and every year, clear the Background Check Center and a drug screen, and meet the TB and physical exam rules. Home health aides need 75 hours of training.
Does Delaware require a Certificate of Need for home health or hospice?
No. Delaware's Certificate of Public Review law covers facilities such as hospitals, nursing homes and freestanding surgical centers, not home health agencies or hospices. Licensure, survey and Medicare enrollment still apply.
Can a Delaware PASA bill Medicaid?
Yes, after licensure. Enroll as a Delaware Medicaid provider, then contract with the DSHP Plus managed care plans: AmeriHealth Caritas Delaware, Delaware First Health and Highmark Health Options. Personal care visits must be recorded through electronic visit verification.
Can new home health agencies and hospices enroll in Medicare now?
CMS placed nationwide moratoria on new Medicare enrollment of home health agencies and hospices from May 13, 2026, for six months unless extended, so they may have ended or been extended by the time you read this. Delaware licensure can proceed. Check the CMS moratoria page before you plan around Medicare.
Is a franchise a better way to start a home care agency in Delaware?
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 Delaware home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, DSHP Plus 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 (30)
- 16 Del. C. 122 (powers of DHSS: hospice (3)(m), home health (3)(o), personal assistance services agencies (3)(x), with fees)
- 16 Del. C. 1145 and 1146, criminal background checks and drug screening for home care agencies
- 29 Del. C. 7972, Background Check Center
- 16 Del. C. Chapter 93, Health Resources Board and Certificate of Public Review
- 24 Del. C. 1921, exceptions including medication administration by PASA direct care workers
- 16 DE Admin. Code 3345, Personal Assistance Services Agencies (Cornell LII, sections 1.0 to 10.0)
- 16 DE Admin. Code 3345-2.0, licensing requirements and procedures (Cornell LII)
- 16 DE Admin. Code 3110, Background Checks and Drug Testing for Home Care Agencies (Cornell LII)
- 16 DE Admin. Code 3350, Skilled Home Health Agencies (Cornell LII)
- 16 DE Admin. Code 3351, Home Health Agencies, Aide Only (Cornell LII)
- 16 DE Admin. Code 3380, Delivery of Hospice Services (Cornell LII)
- Division of Health Care Quality chapter list (Cornell LII)
- Final order 27 DE Reg 43 (July 2023), revised Regulation 3345
- DHCQ Part 1 Initial Licensure Application for 3345 PASAs (rev. 10/31/2022; $250 fee)
- DHSS Division of Health Care Quality home page (offices, Background Check Center, registries)
- DMMA Diamond State Health Plan page (three managed care plans)
- CMS approval of the Diamond State Health Plan 1115 demonstration extension, July 1, 2024 to December 31, 2028 (DSHP Plus HCBS benefits, EVV)
- DMMA EVV FAQs (9/29/2025): open model, HHAeXchange, claim denials from November 1, 2025, DMAP location IDs
- DMMA DSHP Plus provider Q&A (2011): providers contract with and bill the managed care plans
- DDDS Provider Application Manual (07/01/2024): Lifespan Waiver personal care and respite, DMMA enrollment through Gainwell
- Delaware Department of Labor, Delaware Paid Leave
- Delaware One Stop business registration and licensing
- Federal Register 2026-09717: nationwide moratorium on Medicare enrollment of home health agencies
- Federal Register 2026-09718: nationwide moratorium on Medicare enrollment of hospices
- CMS Provider Enrollment Moratoria
- 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)
- 42 CFR 489.28, initial reserve operating funds for home health agencies (Cornell LII)
This guide is general information and reflects Delaware requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Delaware Division of Health Care Quality, the Division of Medicaid and Medical Assistance 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.