How to start a home care agency in Idaho and reach your first client faster
Idaho has no state license for nonmedical home care, and since July 1, 2025 it no longer licenses home health agencies either. That does not mean there are no rules. To serve Medicaid clients you enroll as a Personal Assistance Agency, finish quality assurance training before approval, hire an RN supervisor, run fingerprint checks through the DHW Background Check Unit and set up electronic visit verification. Home health and hospice go through Medicare certification instead. 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 Idaho rulesIDAPA 16.03.26 and the A&D Waiver provider training matrix
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Idaho requires.
Nonmedical home care for Idaho Medicaid members
- State license
- None for nonmedical care; Idaho Medicaid Personal Assistance Agency enrollment instead (IDAPA 16.03.26)
- Who you deal with
- DHW Division of Medicaid, Bureau of Long Term Care, the Medicaid enrollment contractor, and IMPlus or MMCP health plans for members with Medicare too
- Must haves
- Medicaid enrollment with the Prospective HCBS Provider Toolkit, signed provider agreement, QA training before approval, RN supervisor, Background Check Unit clearances, trained caregivers, liability insurance, EVV
- Realistic time to first client
- Several months
Orientation for Idaho only. We confirm your exact path on the free call.
Three places new Idaho 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 look for a DHW application for nonmedical home care and find none. Since July 1, 2025 there is no state home health license either. Meanwhile the steps that really decide your start date, Medicaid enrollment, QA training, RN supervision and fingerprint checks, have not begun.
What it costs: Weeks of lost time before the real clock even starts.
The Medicaid approval sequence
A new Personal Assistance Agency completes the Prospective HCBS Provider Toolkit with its Medicaid application, signs a provider agreement and must be trained by a DHW Quality Assurance Specialist before the application is approved. No Aged and Disabled Waiver or personal care service can be provided before that training. Members who have both Medicare and Medicaid may also be enrolled in an IMPlus or MMCP health plan.
What it costs: Months of rent, insurance and payroll with caregivers hired and no Medicaid clients to serve.
Rules that moved in 2025 and 2026
Idaho folded its Medicaid benefit rules into one chapter, IDAPA 16.03.26 Medicaid Plan Benefits, and ended state home health licensing. Many older guides and templates still cite IDAPA 16.03.10 or a state home health license. A policy manual written to the old rules looks out of date to reviewers on day one.
What it costs: A manual you pay to write twice, and review findings you could have avoided.
What does a delay cost your agency?
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Home care vs home health vs hospice in Idaho
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, homemaker, companion and respite services | Skilled nursing, home health aide services and therapy under a home health plan of care | Palliative and supportive care for people who are terminally ill, and their families |
| State license | None | None since July 1, 2025; Medicare certification instead | None for a Medicare certified hospice |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step |
| Main payers | Private pay, Idaho Medicaid State Plan PCS and A&D Waiver, IMPlus and MMCP plans for members with Medicare too | Medicare, Idaho Medicaid, health plans, commercial insurance | Medicare hospice benefit, Idaho Medicaid |
| Medicare | Not covered | Medicare enrollment, then a state or accreditation survey; paused while the CMS moratorium lasts | Medicare enrollment, then a state or accreditation survey; paused while the CMS moratorium lasts |
| Key staff | RN supervisor (or a QIDP for participants with developmental disabilities); trained personal assistants | Administrator, clinical manager, nurses, therapists and aides under 42 CFR Part 484 | Administrator, medical director, RN coordination, interdisciplinary team under 42 CFR Part 418 |
| Startup capital | Lowest | Higher: clinical payroll and Medicare initial reserve operating funds before revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks (private pay) to months (Medicaid) | Longest: Medicare enrollment and survey | Longest: Medicare enrollment and survey |
Many Idaho owners start with nonmedical care, build cash flow and a caregiver team, then add home health. With no state home health license, Medicare certification is the main gate for skilled care, and Idaho Medicaid only pays home health agencies that meet Medicare's conditions. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Idaho requirements at a glance
| Nonmedical home care license | None at the state level. Medicaid Personal Assistance Agency enrollment is required to serve Idaho Medicaid members. |
|---|---|
| Home health and hospice | No state license for Medicare certified home health agencies since July 1, 2025, or for Medicare certified hospices. Certification runs through the DHW Bureau of Facility Standards or an accrediting organization. |
| Medicaid agency | Idaho Department of Health and Welfare (DHW), Division of Medicaid, Bureau of Long Term Care |
| Medicaid home care programs | State Plan Personal Care Services (PCS) and the Aged and Disabled (A&D) Waiver: attendant care, homemaker, companion, respite and more |
| Governing rule | IDAPA 16.03.26, Medicaid Plan Benefits (Sections 530 to 556 for HCBS, the A&D Waiver and PCS) |
| Caregiver training | Department provider training matrix, met by formal training or demonstrated competency; free Idaho Care online training; CNA when DHW requires it |
| Background screening | Fingerprint based check through the DHW Background Check Unit under IDAPA 16.05.06 |
| Electronic visit verification | Required for State Plan PCS, A&D Waiver attendant care, homemaker and respite, and home health visits |
| Managed care | Dual eligible adults: Idaho Medicaid Plus (IMPlus) or MMCP plans from Molina Healthcare of Idaho and UnitedHealthcare Community Plan of Idaho |
| Entity filing | Idaho Secretary of State; tax permits through Idaho Business Registration |
Summary of Idaho requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Idaho
The order matters. Steps 4 to 6 should start long before step 7, because DHW will not approve a new agency until QA training is done, and every caregiver needs a Background Check Unit application on file before they work.
Form the business with the Idaho Secretary of State
File your LLC or corporation, get an EIN, register for income tax withholding through Idaho Business Registration, set up unemployment insurance with the Idaho Department of Labor, and check your city's business license rules.
You do this; we give you the checklistDecide your payer mix
Private pay, Idaho Medicaid or both. Medicaid means State Plan Personal Care Services, A&D Waiver services, or both. 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. IDAPA 16.03.26 requires a Personal Assistance Agency to keep liability insurance.
You do this; we specify what is requiredLine up your RN supervisor
A Medicaid agency must staff an RN, or a QIDP for participants with developmental disabilities, to develop service plans and supervise service delivery, including on site visits and reviews of visit records.
You do this; we specify what is requiredWrite policies to IDAPA 16.03.26
Adopt policies for service plans, visit records signed by the participant, supervision, HCBS setting requirements, EVV and participant privacy, health screens, background checks, incident reporting and annual quality reviews.
We write this for youBuild the caregiver pipeline
Give each applicant your agency's payment code for a Background Check Unit application, collect a health questionnaire, and train them to the department's provider training matrix. Fingerprints must reach DHW within 21 days of the application.
We set up the system and trackerEnroll with Idaho Medicaid
Apply through the Medicaid enrollment contractor, complete the Prospective HCBS Provider Toolkit, sign the provider agreement, and schedule training with a Bureau of Long Term Care Quality Assurance Specialist, which must happen before approval.
We prepare and manage itSet up electronic visit verification
Choose an EVV system certified as compliant with the DHW aggregator, record participant consent, and send EVV data to the aggregator before you bill PCS, attendant care, homemaker or respite claims.
We walk you through setupContract with IMPlus and MMCP plans
Many members who have both Medicare and Medicaid receive their Medicaid services through Molina Healthcare of Idaho or UnitedHealthcare Community Plan of Idaho, depending on county. Credential with the plans that serve your area.
We prepare every plan's packet
Personal assistant training and background checks
IDAPA 16.03.26 sets the standards for direct care workers who provide personal care and A&D Waiver services through a Personal Assistance Agency. Idaho has no single state test for personal assistants. Instead, each worker must meet the department's training requirements and clear a fingerprint based check.
- Who can provide PCS: An RN, an LPN, or a worker who meets the personal assistant standards. All staff must receive training for service quality, and DHW may require a CNA when a participant's medical condition warrants it.
- A&D Waiver training matrix: Providers of attendant care, homemaker, companion, respite and other waiver services must meet the provider training matrix and the Standards for Direct Care Staff, either by formal training or demonstrated competency.
- Free online training: The Bureau of Long Term Care offers free online training through the Idaho Care site that DHW describes as compliant with the provider training matrix.
- Developmental disabilities: When care needs more than physical help for a participant with developmental disabilities, the worker needs a Department approved DD training course or experience, unless they qualify as a QIDP.
- Health screen: Every direct care worker completes a health questionnaire kept in their personnel file, with a medical provider's statement if they report a medical issue.
- Background Check Unit: A fingerprint based check under IDAPA 16.05.06 for agency staff. Sources include the FBI, Idaho State Police, child and adult protection registries, sex offender registries, the OIG exclusion list and the Nurse Aide Registry.
- Working while the check is pending: An agency may let a worker start on a provisional basis once the application is submitted and reviewed and no disqualifying crimes are disclosed. Fingerprints must reach DHW within 21 days, or the worker must be removed from direct access.
- Spouses: A&D Waiver direct care workers cannot be the participant's spouse.
Six mistakes that slow Idaho agencies down
We look for every one of these in the first week of an engagement.
Assuming no license means no rules
- What it costs
- Medicaid enrollment, QA reviews and health plans all hold you to IDAPA 16.03.26. Missing policies or records lead to findings.
- How we prevent it
- Your first call ends with your exact Idaho path and the order to do it in.
Writing policies to the old IDAPA 16.03.10
- What it costs
- A manual that cites repealed rules and has to be rewritten before review.
- How we prevent it
- We write your policy manual to IDAPA 16.03.26, the A&D Waiver training matrix and each plan's provider manual.
Serving Medicaid clients before QA training and approval
- What it costs
- Services provided before approval are not eligible for Medicaid payment.
- How we prevent it
- We schedule QA training as soon as your application is in and track every approval step.
Missing the 21 day fingerprint window
- What it costs
- A caregiver whose fingerprints do not reach DHW in time must be removed from direct access to clients.
- How we prevent it
- A tracker that flags background check, health screen and training dates for every caregiver.
Relying on EVV alone for visit records
- What it costs
- EVV does not replace the signed visit record Idaho requires, so claims can fail review.
- How we prevent it
- Visit records that capture date, time, services and the participant's signature alongside EVV.
Planning a Medicare agency without checking the moratorium
- What it costs
- New Medicare home health and hospice applications filed during the CMS moratorium are denied.
- How we prevent it
- We check the moratorium's current status on your first call and plan the order of steps around it.
In a free 30 minute call we confirm your Idaho path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Idaho 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.
- Idaho path and a dated launch plan
- Policy and procedure manual written to IDAPA 16.03.26 and the A&D Waiver provider training matrix
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Idaho Medicaid PCS and A&D Waiver ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Idaho Medicaid PCS and A&D Waiver requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for Idaho Medicaid (DHW) and the IMPlus and MMCP plans in your area
- Survey and audit readiness
- Idaho city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to DHW Bureau of Facility Standards 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 Idaho 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 IDAPA 16.03.26 and the A&D Waiver provider training matrix |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for Idaho Medicaid (DHW) and the IMPlus and MMCP plans 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 Idaho home care startup checklist
Every Idaho 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, Idaho Medicaid, or both)
- Form your LLC or corporation with the Idaho Secretary of State
- Get an EIN and register for withholding through Idaho Business Registration
- Set up unemployment insurance with the Idaho Department of Labor
- Check your city or county business license rules
- 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 Idaho
- 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 Idaho cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Idaho Medicaid PCS and A&D Waiver, 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 Idaho
| Item | Notes |
|---|---|
| State license | None for nonmedical care, and no state home health license since July 1, 2025. |
| Entity formation and city license | Idaho Secretary of State filing fee plus any city license. Check current fees with each office. |
| Background checks | The DHW Background Check Unit lists a standard check at $70, plus $1 and 2.5% when paid by card. Out of state registry fees can add to enhanced checks. |
| RN supervisor | Salaried or contracted RN time for service plans and supervisory visits |
| Caregiver training | Idaho Care online training is free; other approved courses, CPR or CNA training cost extra |
| Insurance | Workers' compensation, liability and auto coverage |
| EVV and scheduling software | Paid by the agency; must be certified with the DHW aggregator for Medicaid visits |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees, if you choose accreditation over a state survey |
| Operating reserve | Covers payroll, rent and insurance while Medicaid approval or Medicare enrollment is pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Idaho
Weeks, once the business, insurance and hiring process are in place.
Several months: enrollment application and toolkit, QA training before approval, then plan credentialing for members with Medicare too.
Longest: Medicare enrollment, certification survey and Medicaid enrollment. New Medicare enrollment is paused while the CMS moratorium lasts.
The Treasure Valley around Boise, Meridian and Nampa is Idaho's largest market, so agencies there compete for caregivers and referrals. Eastern Idaho, the Magic Valley and the rural north cover long distances, where reliable staffing and a caregiver who lives nearby become your selling point. Agencies in Coeur d'Alene and Post Falls often get calls from families near Spokane, but Washington licenses in home services agencies, so serving clients across the state line is a separate license. Families search by city, which makes a strong Google Business Profile and clear pages for Boise, Idaho Falls, Twin Falls, Pocatello and your other communities matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Idaho?
No. Idaho does not license nonmedical home care agencies. You still need business registration, tax accounts and insurance, and to serve Medicaid clients you must enroll with Idaho Medicaid as a Personal Assistance Agency and meet IDAPA 16.03.26.
Does Idaho still license home health agencies?
No. DHW says that under the Streamlined Facilities Licensing and Inspection Act, Medicare certified home health agencies are no longer required to be licensed in Idaho, and no new licenses have been issued since July 1, 2025. Agencies go through Medicare certification with the DHW Bureau of Facility Standards or an accrediting organization.
Does Idaho license hospices?
Not when the hospice is Medicare certified. A Medicare certified hospice goes through federal certification with the Bureau of Facility Standards or an accrediting organization. A hospice that is not Medicare certified should confirm its status with DHW first.
Does Idaho require a Certificate of Need for home health or hospice?
No. Idaho has no Certificate of Need step for home health or hospice. Medicare certification, enrollment and Idaho Medicaid enrollment still apply.
How do you become an Idaho Medicaid Personal Assistance Agency?
Apply through the Medicaid enrollment contractor, complete the Prospective HCBS Provider Toolkit, sign the provider agreement, and finish training with a Bureau of Long Term Care Quality Assurance Specialist before approval. You also need an RN supervisor, liability insurance and background checks for your staff.
Do Idaho caregivers need certification?
Not usually. Personal assistants must meet the department's personal assistant standards and the provider training matrix, by formal training or demonstrated competency, complete a health questionnaire and clear a Background Check Unit check. DHW may require a CNA when a participant's medical condition warrants it.
How do Idaho background checks work for home care?
The applicant gets a payment code from your agency, applies online with the DHW Background Check Unit and is fingerprinted within 21 days. A standard check is $70. Your agency may let the worker start provisionally while the check is pending if no disqualifying crimes are disclosed.
Is electronic visit verification required in Idaho?
Yes, for State Plan Personal Care Services, A&D Waiver attendant care, homemaker and respite, and home health visits. Agencies choose an EVV system certified with the DHW aggregator, and EVV does not replace signed visit records.
Can a new Idaho home health agency or hospice enroll in Medicare right now?
CMS put a nationwide moratorium on new Medicare enrollment of home health agencies and hospices in effect on May 13, 2026, for six months. It may have ended or been extended since. We check its current status on your free consultation.
How much does Idaho home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Idaho Medicaid or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges, and you own 100% of your agency with no franchise fees or royalties.
Sources checked for this guide (20)
- IDAPA 16.03.26, Medicaid Plan Benefits (current rule, sections effective 7-1-26)
- IDAPA 16.05.06, Criminal History and Background Checks
- DHW Home Health Agencies (no state license after July 1, 2025; page updated 4-16-2026)
- DHW Hospice Agencies (page updated 11-19-2025)
- DHW Long Term Care Provider Enrollment and General (toolkit, QA training)
- DHW Long Term Care Provider Training (training matrix, Idaho Care; updated 2-10-2026)
- DHW Background Check Unit (fees, process; updated 3-6-2026)
- DHW Managed Care Providers (IMPlus and MMCP plans; updated 6-24-2026)
- DHW The Future of Idaho Medicaid is Managed Care (transition delayed)
- DHW Information for Medicaid Providers (Gainwell; updated 4-16-2026)
- Idaho State Tax Commission, Idaho Business Registration
- Federal Register 2026-09717, nationwide moratorium on Medicare enrollment of home health agencies (effective May 13, 2026)
- Federal Register 2026-09718, nationwide moratorium on Medicare enrollment of hospices (effective May 13, 2026)
- CMS Provider Enrollment Moratoria page (last modified 08/27/2026)
- 42 CFR 440.70, Medicaid home health services (Cornell LII)
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- Cornell LII, IDAPA 16.03.26.003 background check requirements and IDAPA 16.03.10 (prior rule)
- Idaho Code Title 39, Chapter 13 as amended by 2025 ch. 122 (unofficial mirror, secondary)
- FindLaw, Idaho Code 39-5603 repeal note (secondary, pointer only)
This guide is general information and reflects Idaho requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Idaho Department of Health and Welfare, Idaho Medicaid and CMS before filing. Lunaria Care Consulting provides professional consulting services and does not provide legal advice.
Other states: see all state guides. What we do: licensing, compliance, Medicaid enrollment and local search marketing.