How to start a home care agency in Hawaii and reach your first client faster
Hawaii licenses nonmedical home care, so you cannot serve a single client until the Office of Health Care Assurance issues your home care agency license. Around that license sit background checks and TB clearance for every caregiver, nurse aide training for personal care aides, QUEST Integration health plan contracts, and employer costs most mainland guides miss: Prepaid Health Care, Temporary Disability Insurance and the general excise tax. Home health and hospice add a Certificate of Need. 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 Hawaii rulesHAR Chapter 11-700 and QUEST Integration health plan provider manuals
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Hawaii requires.
Nonmedical home care for QUEST Integration members
- State license
- OHCA home care agency license (HRS 321-14.8; HAR Chapter 11-700)
- Who you deal with
- OHCA, the Med-QUEST Division and each QUEST Integration health plan you contract with
- Must haves
- OHCA license, Medicaid provider enrollment with Med-QUEST, health plan contracts and credentialing, Level II aides with skills competency, background checks and TB clearance, EVV
- Realistic time to first client
- Several months or more
Orientation for Hawaii only. We confirm your exact path on the free call.
Three places new Hawaii agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Hiring and marketing before the license
Hawaii law makes it unlawful to operate a home care agency without an OHCA license, and that covers companion and homemaker work as well as personal care. Owners who line up clients first have to turn them away while the application, background checks and policies catch up. The license is issued to one named agency and cannot be transferred, so buying a shortcut does not work either.
What it costs: Months of rent and recruiting with no billable hours, and families who hire someone else while you wait.
Hawaii employer costs priced in too late
Hawaii employers must provide Prepaid Health Care coverage to regular employees who work at least 20 hours a week, carry Temporary Disability Insurance and workers' compensation, and pay general excise tax on gross receipts. The state minimum wage rose to $16.00 an hour on January 1, 2026 and goes to $18.00 in 2028. A rate copied from a mainland agency rarely covers all of it.
What it costs: Thin or negative margins on every hour, discovered after you have signed your first clients.
Caregivers who cannot do personal care
Under HAR 11-700, a personal care aide must have completed a basic nurse aide course in a state approved program, an equivalent course, or training as a licensed or certified health professional. Homemakers need only experience or training in homemaker tasks. Agencies that hire everyone as one job title find that half the team cannot bathe, dress or transfer a client.
What it costs: Clients you cannot staff for personal care, and survey findings for aides working outside their scope.
What does a delay cost your agency?
Enter your own numbers. Nothing is stored or sent.
Home care vs home health vs hospice in Hawaii
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, homemaker services and respite in the client's home | Skilled nursing plus at least one other therapeutic service, ordered by a physician, APRN or physician assistant | Palliative and supportive care for people who are terminally ill, and their families |
| State license | OHCA home care agency license (HRS 321-14.8; HAR Chapter 11-700) | OHCA home health agency license (HAR Chapter 11-97.1) | Permissive under HRS 321-15.63; confirm current state licensure with OHCA |
| Certificate of Need | No | Yes: SHPDA Certificate of Need (HRS 323D-43; HAR 11-186-5) | Yes: hospice is a standard category in HAR 11-186-5 |
| Main payers | Private pay, QUEST Integration health plans, Kupuna Care contracts through Area Agencies on Aging | Medicare, QUEST Integration health plans, commercial insurance | Medicare hospice benefit, Med-QUEST |
| Medicare | Not covered | Accreditation or OHCA survey, then Medicare enrollment | Accreditation or OHCA survey, then Medicare enrollment |
| Key staff | Administrator, supervisor (two years of home care experience or a professional license), personal care aides and homemakers | Governing body, administrator, licensed clinical manager, advisory committee with a physician or APRN or PA and an RN | Administrator, physician medical director, RN, interdisciplinary team |
| Startup capital | Lowest, but Hawaii employer costs start with the first hire | Higher: Certificate of Need, clinical payroll before Medicare revenue | Highest: Certificate of Need and an interdisciplinary team before revenue |
| Time to first client | Months: OHCA license first | Longest: Certificate of Need, licensure, survey, enrollment | Longest: Certificate of Need, survey, enrollment |
Since 2025, HRS 321-14.8 says a home care agency may not provide nursing services unless a registered nurse, licensed practical nurse or APRN provides them. If you want skilled care, that points to a home health agency, which in Hawaii means a Certificate of Need before the license. Many owners start with a licensed home care agency, build cash flow and a caregiver team, then add home health. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Hawaii requirements at a glance
| Nonmedical home care license | Required. Home care agency license from the Department of Health, Office of Health Care Assurance (HRS 321-14.8; HAR Chapter 11-700), valid two years |
|---|---|
| Home health licensing | OHCA home health agency license under HAR Chapter 11-97.1, effective 9/16/2022 |
| Hospice | HRS 321-15.63 lets the department license hospice service agencies; confirm current requirements with OHCA |
| Certificate of Need | Required from the State Health Planning and Development Agency for a new home health agency or hospice (HRS 323D-43; HAR 11-186-5) |
| Medicaid | Med-QUEST Division; home and community based services run through QUEST Integration health plans (Section 1115 demonstration approved through December 31, 2029) |
| Caregiver qualifications | Personal care aides: basic nurse aide course or equivalent. Homemakers: experience or training. Orientation and ongoing in service education for all |
| Background screening | Criminal history, abuse and neglect registries, sex offender and nurse aide registry checks under HRS 321-15.2 and HAR Chapter 11-106 |
| TB clearance | Before first client contact (HAR 11-700-9), and yearly under HAR 11-164.2-24 |
| Electronic visit verification | Required for Medicaid personal care and home health services under the federal 21st Century Cures Act |
| Employer obligations | GET license, Prepaid Health Care, Temporary Disability Insurance, workers' compensation, unemployment insurance, $16.00 minimum wage in 2026 |
Summary of Hawaii requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Hawaii
The order matters. Steps 4 and 5 must be finished before step 6, because the OHCA application asks for your policies, your administrator and supervisor, and background check results for owners, managers and staff.
Form the business and register for Hawaii taxes
File your LLC or corporation, get an EIN, get a general excise tax license from the Department of Taxation (a one time $20 fee), and register for state withholding and unemployment insurance.
You do this; we give you the checklistDecide your services and payer mix
Personal care, homemaker services, respite or all three, and private pay, QUEST Integration, Kupuna Care or a mix. Your choice decides which job titles you hire and which contracts you pursue. Use the path finder above.
Decided on your free consultationPrice in Hawaii employer costs
Arrange workers' compensation and Temporary Disability Insurance, choose a Prepaid Health Care plan for employees who work 20 or more hours a week, and build the $16.00 minimum wage and general excise tax into your rates before you quote a family.
You do this; we specify what is requiredName your administrator and supervisor and write policies
HAR 11-700 requires a supervisor with two years of home care experience or a license such as RN, LPN, social worker, PT or OT. Policies must cover services and service area, nondiscrimination, service plans, client records, job descriptions, human resources, and orientation and in service education.
We write this for youBuild the caregiver pipeline
Run background checks under HRS 321-15.2 within five working days of hire, collect TB clearance before first client contact, confirm nurse aide training for every personal care aide, and run orientation. Track yearly TB clearance, name inquiries and supervisory visits.
We set up the system and trackerApply for the OHCA home care agency license
Submit the application on department forms with your owners and governing body, administrator and supervisor qualifications, services, service area, policies and background check results, plus the $1,500 initial fee. OHCA may inspect without notice.
We prepare the applicationEnroll with Med-QUEST and contract with QUEST Integration plans
Medicaid managed care network providers must be enrolled with the state. Enroll with the Med-QUEST Division, then apply to each QUEST Integration health plan for personal assistance Level I and Level II and respite, and complete its credentialing.
We prepare every plan's packetSet up electronic visit verification
EVV is required for Medicaid personal care and home health services. Confirm the EVV system and data requirements with Med-QUEST and each health plan, and set it up before your first QUEST Integration visit.
We walk you through setup
Caregiver qualifications, background checks and TB clearance
HAR Chapter 11-700 sets two caregiver roles for licensed home care agencies: personal care aides, who help with bathing, dressing, toileting, transfers and other personal care, and homemakers, who handle housecleaning, laundry, shopping, meals, errands and escorts. Hawaii sets no fixed number of hours for agency orientation, but it does set who may give personal care.
- Personal care aides: Must have completed a basic nurse aide course in a state approved nurse aide training program, an equivalent course the department accepts, or coursework that qualifies them as a certified or licensed health professional.
- Homemakers: Need experience or training in homemaker services. Homemakers may not provide personal care.
- QUEST Integration Level II: Personal assistance Level II must be provided by a home health aide, personal care aide, certified nurse aide or nurse aide with the right skills competency.
- Orientation and supervision: Orientation to agency policies for everyone who serves clients, then continuing in service education. A supervisor visits each caregiver at a client's home at least once a year.
- Background checks: Owners, operators, staff with client access and adult volunteers are checked for criminal history, adult and child abuse records, sex offender records, nurse aide registry findings and records from other states where they lived (HRS 321-15.2). Checks are due within five working days of hire.
- Ongoing name inquiries: A state criminal history name inquiry every year for the first two years, then every two years, unless the person is enrolled in the state's rap back program (HAR 11-106-5).
- TB clearance: Documented before first client contact (HAR 11-700-9). Workers in department licensed settings working more than ten hours a week get clearance within 12 months before starting and every year after (HAR 11-164.2-24).
- Home health aides: Medicare certified agencies need aides trained in a program of at least 75 hours of classroom and supervised practical training (42 CFR 484.80).
Six mistakes that slow Hawaii agencies down
We look for every one of these in the first week of an engagement.
Serving clients before the OHCA license is issued
- What it costs
- Operating without a license is unlawful under HRS 321-14.8 and can lead to penalties and a denied application.
- How we prevent it
- Your first call ends with your exact Hawaii path and the order to do it in, so your launch date follows the license.
Copying mainland rates
- What it costs
- Prepaid Health Care, TDI, general excise tax and a rising minimum wage eat the margin on every hour.
- How we prevent it
- We list every Hawaii employer cost on your checklist before you set rates.
Sending homemakers on personal care visits
- What it costs
- Aides working outside their scope is a licensing finding, and QUEST Integration Level II needs qualified aides.
- How we prevent it
- Clear job descriptions and a tracker that shows each caregiver's training and what they may do.
Letting nonmedical staff perform nursing tasks
- What it costs
- Since 2025, HRS 321-14.8 bars home care agencies from nursing services unless an RN, LPN or APRN provides them.
- How we prevent it
- Service definitions and policies that keep skilled tasks with licensed nurses.
Confusing a home care agency with a residential license
- What it costs
- Adult residential care homes and community care foster family homes are separate licenses with separate rules; the wrong application wastes months.
- How we prevent it
- We confirm on your first call that a home care agency license fits your plan.
Planning home health without a Certificate of Need
- What it costs
- SHPDA review comes before OHCA licensure, so a plan without it stalls before it starts.
- How we prevent it
- We build the Certificate of Need into your timeline and budget from day one.
In a free 30 minute call we confirm your Hawaii path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Hawaii 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.
- Hawaii path and a dated launch plan
- Policy and procedure manual written to HAR Chapter 11-700 and QUEST Integration health plan provider manuals
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
QUEST Integration ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to QUEST Integration requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for each QUEST Integration health plan
- Survey and audit readiness
- Hawaii city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to OHCA 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 Hawaii 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 HAR Chapter 11-700 and QUEST Integration health plan provider manuals |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for each QUEST Integration health 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 Hawaii home care startup checklist
Every Hawaii 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 services (personal care, homemaker, respite) and payer mix
- Form your LLC or corporation and get an EIN
- Get a general excise tax license and register for withholding and unemployment insurance
- Buy workers' compensation and Temporary Disability Insurance coverage
- Choose a Prepaid Health Care plan for employees working 20 or more hours a week
- and 15 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 Hawaii
- 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 Hawaii cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, QUEST Integration, 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 Hawaii
| Item | Notes |
|---|---|
| OHCA license | Home care agency: $1,500 initial and $1,000 renewal. Home health agency: $2,750 initial and $2,000 renewal (HAR Chapter 11-103.1 fee schedules). Check current fees with OHCA. |
| Certificate of Need (home health, hospice) | $200 filing fee plus a share of the project's capital expenditure (HAR 11-186-25) |
| Entity formation and GET license | State business filing fee plus a one time $20 general excise tax license |
| Background checks and TB clearance | FBI and Hawaii criminal history fees may be passed on to applicants and employees (HRS 321-15.2); TB clearance per worker |
| Prepaid Health Care | Employer pays at least half the premium; the employee's share is capped at 1.5% of wages (HRS 393-13) |
| TDI, workers' compensation and liability insurance | Premiums based on payroll and coverage |
| EVV and scheduling software | Paid by the agency; needed for QUEST Integration personal care visits |
| Inter island supervision | Airfare and staff time if you serve clients on more than one island |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while the license, plan contracts or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Hawaii
Months: the OHCA license must be issued before your first client, so policies, leadership and background checks come first.
Several months or more: OHCA license, Medicaid enrollment, then contracting and credentialing with each health plan.
Longest: Certificate of Need review, OHCA licensure, certification survey and Medicare enrollment.
Most of Hawaii's people live on Oahu, so Honolulu, Kapolei, Ewa Beach, Pearl City and Kaneohe are where agencies compete hardest for families and health plan referrals. On Maui, Hawaii Island and Kauai, distances and island travel make dependable staffing your selling point, and HAR 11-700 still requires a supervisor to visit each caregiver in a client's home every year, island by island. Many families search for kupuna care for a parent, often from the mainland, which makes a strong Google Business Profile and clear pages for each community you serve matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Hawaii?
Yes. HRS 321-14.8 requires every home care agency that provides personal care or homemaker services in a client's home to be licensed by the Department of Health, Office of Health Care Assurance. The rules are in HAR Chapter 11-700. Individuals working on their own, including those incorporated as a business, are not home care agencies under the law.
Are any agencies exempt from the Hawaii home care license?
HRS 321-14.8 exempts agencies serving clients under contract with the City and County of Honolulu Elderly Affairs Division, and agencies approved by Med-QUEST that serve only participants in a Section 1915(c) Medicaid waiver. Agencies serving private pay or QUEST Integration clients need the license.
How much is the Hawaii home care agency license fee?
The HAR Chapter 11-103.1 fee schedule lists $1,500 for an initial home care agency license and $1,000 for renewal. Licenses last two years, and the renewal application is due at least 30 days before expiration. Check current fees with OHCA before you file.
Who licenses home health agencies and hospices in Hawaii?
OHCA licenses home health agencies under HAR Chapter 11-97.1. For hospice, HRS 321-15.63 allows the department to license hospice service agencies, so ask OHCA what applies today. Both home health and hospice need a Certificate of Need from SHPDA, and Medicare certification for Medicare billing.
Does Hawaii require a Certificate of Need for home health or hospice?
Yes. Home health agency and hospice are standard categories of health care service under HAR 11-186-5, and adding one requires a Certificate of Need from the State Health Planning and Development Agency under HRS 323D-43. Nonmedical home care agencies do not need one.
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, but Med-QUEST requires Medicare certification for Medicaid hospice providers, so the pause holds up that route too. Each state decides whether to pause its own Medicaid enrollment, so check with Med-QUEST.
What training do Hawaii home care aides need?
Personal care aides must have completed a basic nurse aide course in a state approved program or an equivalent course. Homemakers need experience or training in homemaker tasks. Every caregiver needs orientation, ongoing in service education, a background check under HRS 321-15.2 and TB clearance before first client contact.
How do Hawaii home care agencies get Medicaid clients?
Medicaid home and community based services in Hawaii run through QUEST Integration health plans, including personal assistance Level I (companion and homemaker) and Level II (hands on personal care). Agencies hold the OHCA license, enroll with the Med-QUEST Division, then contract with and get credentialed by each health plan.
Does Hawaii's Prepaid Health Care Act apply to home care agencies?
Yes. Employers must cover regular employees who work at least 20 hours a week and earn at least 86.67 times the state minimum wage in a month. The employer pays at least half the premium, and the employee's share cannot exceed 1.5% of wages. Many caregivers qualify.
How much does Hawaii home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, QUEST Integration or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges, you own 100% of your agency with no franchise fees or royalties, and we work in all 50 states and DC.
Sources checked for this guide (46)
- HRS 321-14.8, home care agencies; licensing (amended 2025)
- HRS 321-15.2, background checks
- HRS 321-15.63, hospice services
- HRS 323D-2, health planning definitions (home health agencies, hospices)
- HRS 323D-43, certificates of need
- HRS 323D-54, exemptions from certificate of need
- HRS 349-17, Kupuna Care program
- HRS 393-3, Prepaid Health Care definitions (regular employee)
- HRS 393-11, mandatory Prepaid Health Care coverage
- HRS 393-13, Prepaid Health Care premium shares
- HRS 392-41, Temporary Disability Insurance
- HRS 386-121, workers' compensation security
- HRS 383-61, unemployment insurance contributions
- HRS 387-2, minimum wage ($16.00 from January 1, 2026)
- HRS 237-9, general excise tax license
- HRS 237-13, general excise tax imposition
- HRS 237-24.3, amounts not taxable (Medicare, Medicaid, TRICARE)
- HAR Chapter 11-700, home care agencies (Cornell LII)
- HAR 11-700-2, definitions (Cornell LII)
- HAR 11-700-4, license (Cornell LII)
- HAR 11-700-6, scope of services (Cornell LII)
- HAR 11-700-8, policies and procedures (Cornell LII)
- HAR 11-700-9, administration and standards (Cornell LII)
- HAR Chapter 11-97.1, home health agencies (Cornell LII)
- HAR 11-97.1-1, -3, -5 and -6, home health definitions, license, governance, policies (Cornell LII)
- HAR Chapter 11-103.1 Exhibit A, initial licensure fees (Cornell LII)
- HAR Chapter 11-103.1 Exhibit B, renewal fees (Cornell LII)
- HAR Chapter 11-106, background checks (Cornell LII)
- HAR 11-164.2-24, TB clearance for health care settings (Cornell LII)
- HAR 11-186-5, standard categories of health care services (Cornell LII)
- HAR 11-186-6, change of service requiring a certificate of need (Cornell LII)
- HAR 11-186-25, certificate of need filing fee (Cornell LII)
- HAR 11-186-99.1, administrative review (Cornell LII)
- HAR 17-1720-18, QUEST Integration home and community based services (Cornell LII)
- HAR 17-1737-108, providers of hospice service (Cornell LII)
- Medicaid.gov, Hawaii QUEST Integration Section 1115 demonstration (expires 12/31/2029)
- CMS, Hawaii QUEST Integration special terms and conditions, approval period January 8, 2025 to December 31, 2029
- CMS state survey agency contact, Hawaii
- CMS accreditation and approved accrediting organizations
- 42 CFR 438.602, state enrollment of managed care network providers (Cornell LII)
- 42 CFR 484.80, home health aide training (Cornell LII)
- 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)
- CMS-855A Medicare enrollment application, institutional providers
This guide is general information and reflects Hawaii requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Hawaii Department of Health Office of Health Care Assurance, the State Health Planning and Development Agency, the Med-QUEST Division 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.