How to start a home care agency in Indiana and reach your first client faster
Indiana licenses nonmedical home care as a personal services agency, and the license itself is affordable. The traps sit around it. IDOH must approve your policies before it issues the license, criminal history checks run on a 21 day clock, and Medicaid waiver work needs FSSA certification, IHCP enrollment and PathWays health plan contracts. Since August 1, 2026 a state moratorium has paused most new waiver providers. 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 Indiana rulesIC 16-27-4 and FSSA waiver service definitions
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Indiana requires.
Nonmedical home care for PathWays and Health and Wellness waiver members
- State license
- IDOH personal services agency license (IC 16-27-4) or a home health agency license
- Who you deal with
- IDOH, FSSA Office of Medicaid Policy and Planning (OMPP), the IHCP, and the PathWays health plans (Anthem, Humana, UnitedHealthcare)
- Must haves
- State license, OMPP waiver certification, IHCP waiver enrollment, PathWays plan contracts or placement on the DDARS pick list, EVV. New certifications for attendant care and most other waiver services are paused by a moratorium that began August 1, 2026.
- Realistic time to first client
- On hold until the moratorium ends or an access exception is granted, then several months
Orientation for Indiana only. We confirm your exact path on the free call.
Three places new Indiana agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Policies sent back before the license issues
IDOH will not issue a personal services agency license until every required policy and document is received and approved. Its instructions warn against pasting the statute in as policy or mixing in FSSA waiver documents. Each policy has to match IC 16-27-4: the manager, service plans, client rights, competency evaluations and complaints.
What it costs: Weeks or months of review rounds while rent and insurance are already running.
Planning on Medicaid during a moratorium
Since August 1, 2026 Indiana has paused new OMPP certifications and IHCP enrollments for attendant care, home and community assistance, respite, structured family caregiving and most other waiver services. The pause also blocks adding counties or services and most ownership changes. It runs six months at first and can be extended in six month blocks.
What it costs: A business plan built on PathWays referrals that cannot start until the state reopens or grants an access exception.
The 21 day background check clock
An agency must apply for a national or expanded criminal history check within three business days after a worker starts serving clients, and may not keep the worker on for more than 21 calendar days without the result. Owners, the manager and alternate managers need checks with the license application, dated within the past three months.
What it costs: A caregiver pulled from a client's schedule, or a license packet returned for a stale owner report.
What does a delay cost your agency?
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Home care vs home health vs hospice in Indiana
The three sound alike and are regulated differently. The one you choose decides your regulator, staffing, startup capital and timeline.
| Topic | Nonmedical home care | Home health (skilled) | Hospice |
|---|---|---|---|
| What your staff do | Attendant care (help with bathing, dressing, transfers), homemaker and companion services; nothing that legally needs a health care professional's order | Nursing, physical, occupational and speech therapy, medical social services and home health aide services that must be ordered or performed by a health care professional | Interdisciplinary care for people in the last phase of a terminal illness, and their families |
| State license | IDOH personal services agency license (IC 16-27-4) | IDOH home health agency license (IC 16-27-1; 410 IAC 17) | IDOH hospice license (IC 16-25-3) |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step |
| Main payers | Private pay, PathWays health plans, Health and Wellness and TBI waivers (new providers paused since August 1, 2026) | Medicare, Indiana Medicaid (Medicare enrollment required since July 1, 2026), commercial insurance | Medicare hospice benefit, Indiana Medicaid (Medicare certification required) |
| Medicare | Not covered | Medicare enrollment and certification survey; new enrollment paused by CMS since May 13, 2026 | Medicare enrollment and certification survey; new enrollment paused by CMS since May 13, 2026 |
| Key staff | A manager responsible for daily operations, with written designees; caregivers evaluated as competent for each attendant care task | Administrator, a physician or an RN with two years of nursing including one year supervisory to supervise care, home health aides on the state registry | Physician medical director, registered nurse, social worker and a pastoral or other counselor in the interdisciplinary group |
| Startup capital | Lowest | Higher: clinical payroll before Medicare and Medicaid revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks to months (private pay); on hold for new waiver providers | Longest: licensure, Medicare enrollment, survey | Longest: licensure, Medicare enrollment, survey |
Many Indiana owners start with a personal services agency, build cash flow and a caregiver team with private pay clients, then add home health. A licensed home health agency that also provides personal services does not need a separate personal services agency license (IC 16-27-4-6), so we write policies that can grow into home health instead of being rewritten.
Indiana requirements at a glance
| Nonmedical home care license | Personal services agency license from the Indiana Department of Health (IDOH) under IC 16-27-4; $250 at application and at each yearly renewal |
|---|---|
| How to apply | Online through the IDOH Gateway (Access Indiana) since May 1, 2026: ownership, manager, locations, required documents and payment |
| Home health and hospice licensing | IDOH Division of Home and Community Based Care: home health under IC 16-27-1 and 410 IAC 17; hospice under IC 16-25-3 |
| Medicaid agency | Family and Social Services Administration (FSSA); providers enroll with the Indiana Health Coverage Programs (IHCP) |
| Medicaid home care programs | Indiana PathWays for Aging Waiver (60 and older, through Anthem, Humana and UnitedHealthcare) and the Health and Wellness Waiver (59 and younger). New waiver providers paused since August 1, 2026. |
| Caregiver training | No statewide hour minimum for personal services agencies; the agency evaluates and documents competency for each attendant care task (IC 16-27-4-16). Home health aides need a competency evaluation, the state registry and 12 hours of yearly training. |
| Background screening | National or expanded criminal history check applied for within 3 business days and received within 21 calendar days (IC 16-27-2); nurse aide registry findings bar employment; owners and managers checked with the application |
| Electronic visit verification | Required for Medicaid personal care services since January 1, 2021 and home health since January 1, 2024; Sandata is the state system and other systems must send data to its aggregator |
| Certificate of Need | Only for comprehensive care facilities (nursing homes); none for home care, home health or hospice |
| Medicare (home health, hospice) | CMS paused new Medicare enrollment of home health agencies and hospices nationwide from May 13, 2026 for six months; check its current status |
Summary of Indiana requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Indiana
The order matters. Owner and manager background checks and your policies decide when IDOH issues the license, and the Medicaid steps cannot start until the state moratorium ends or grants your agency an exception.
Form the business with the Indiana Secretary of State
File your LLC or corporation through INBiz, get an EIN from the IRS, and register for state withholding and unemployment insurance. Keep the words health and nursing out of your agency name: IDOH does not allow them for a personal services agency.
You do this; we give you the checklistDecide your payer mix
Private pay, Medicaid waivers or both. New waiver certifications for attendant care and home and community assistance are paused while the August 2026 moratorium lasts, so most new agencies open with private pay. Use the path finder above.
Decided on your free consultationRun owner and manager background checks
IDOH wants a lifetime national or expanded criminal history report, dated within the past three months, for each owner, the manager and alternate managers with the application. Arrange general and professional liability, workers' compensation and auto coverage, plus liability coverage for lift services if you will offer them.
You do this; we specify what is requiredWrite policies to IC 16-27-4
Service plans prepared before care starts and signed by the client within 14 days, a client rights statement within 7 days, competency evaluations for each attendant care task, the manager role, complaints and records. IDOH will not issue the license without them.
We write this for youApply for the license in the IDOH Gateway
Register with Access Indiana, then complete the Personal Service Agency License Registration: agency details, ownership, manager, locations, documents, attestation and the $250 fee. The license lasts one year, and renewal opens 60 days before it expires.
We prepare the applicationBuild the caregiver pipeline
Apply for each worker's criminal history check within three business days of their first client visit and have the result within 21 calendar days. Check the nurse aide registry, then evaluate, train and document competency for every attendant care task before the worker serves clients without direct supervision.
We set up the system and trackerGet certified for Medicaid waivers when the state reopens
Apply through the OMPP Certification Portal for PathWays, Health and Wellness or TBI waiver services, then enroll with the IHCP. While the moratorium lasts, OMPP considers only limited exceptions where members lack access to services.
We prepare and manage itContract with the PathWays plans and set up EVV
PathWays providers contract with each health plan: Anthem, Humana and UnitedHealthcare. Health and Wellness and TBI providers are added to the DDARS pick list. Set up Sandata or an approved alternate EVV system before your first Medicaid visit.
We prepare every plan's packet
Caregiver competency and criminal history checks
Indiana sets no statewide training hour minimum for personal services agency workers. IC 16-27-4-16 makes the agency evaluate each worker on every attendant care task it assigns, train and reevaluate where needed, and document the date and the evaluator's signature. Criminal history checks follow IC 16-27-2.
- Competency evaluations: Required for each attendant care task before the worker performs it without direct agency supervision. Lift services need general lift training plus training on the client's own lift, following the manufacturer's instructions.
- Criminal history check timing: Apply for a national or expanded check within three business days after the worker starts serving clients in their homes, and receive it within 21 calendar days unless the delay is the fault of the state police, the FBI or the screening company.
- Disqualifying convictions: Sex crimes, murder, voluntary manslaughter and exploitation of an endangered adult bar employment. Theft, fraud, identity deception, crimes of violence, felony battery and felony drug offenses bar it within set look back periods, and misdemeanor theft, fraud and identity deception within five years.
- Registry check: A person with a finding of abuse, neglect, mistreatment or misappropriation of property on the state nurse aide registry may not be employed to serve clients at home.
- Owners and managers: Owners, the manager and alternate managers need a lifetime national or expanded report, dated within the past three months, with the license application and with any later ownership or staff change.
- Home health aides: In a licensed home health agency, aides must pass a competency evaluation covering all required subject areas and be on the state aide registry in good standing before patient contact, then complete 12 hours of training each calendar year.
Six mistakes that slow Indiana agencies down
We look for every one of these in the first week of an engagement.
Submitting policies that copy the statute
- What it costs
- IDOH returns the packet and the license waits, since it is issued only after every document is approved.
- How we prevent it
- We write your policy manual to IC 16-27-4, in the order the application asks for.
Counting on PathWays referrals in year one
- What it costs
- New waiver certifications for attendant care and home and community assistance are paused, so a budget built on Medicaid revenue runs short.
- How we prevent it
- We check the moratorium status on your first call and plan a private pay start around it.
Letting the 21 day check window lapse
- What it costs
- A worker who keeps serving clients past day 21 without a result puts the agency out of compliance with IC 16-27-2-5.
- How we prevent it
- A tracker that flags application and result dates for every new hire.
Putting health or nursing in the name
- What it costs
- IDOH does not allow a personal services agency to use those words or advertise as a home health agency, so the name, signage and filings change.
- How we prevent it
- We check your name against IDOH rules before you file with the Secretary of State.
Assuming the license makes you a Medicaid provider
- What it costs
- OMPP certification, IHCP enrollment and each PathWays plan contract are separate steps, and none starts automatically.
- How we prevent it
- We map every Medicaid step and prepare the packets when the state reopens enrollment.
Drifting into ordered care under a personal services license
- What it costs
- Services that need a health care professional's order fall outside IC 16-27-4 and need a home health agency license.
- How we prevent it
- Clear service definitions so caregivers never perform skilled tasks.
In a free 30 minute call we confirm your Indiana path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Indiana 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.
- Indiana path and a dated launch plan
- Policy and procedure manual written to IC 16-27-4 and FSSA waiver service definitions
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
PathWays and Health and Wellness waivers ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to PathWays and Health and Wellness waivers requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for each PathWays health plan (Anthem, Humana and UnitedHealthcare)
- Survey and audit readiness
- Indiana city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to IDOH 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 Indiana 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 IC 16-27-4 and FSSA waiver service definitions |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for each PathWays health plan (Anthem, Humana and UnitedHealthcare) 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 Indiana home care startup checklist
Every Indiana 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 waivers, or both)
- Pick an agency name without the words health or nursing
- Form your LLC or corporation with the Indiana Secretary of State through INBiz
- Get an EIN and register for state withholding and unemployment insurance
- Buy general and professional liability, workers' compensation and auto coverage, plus lift services coverage if needed
- and 16 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 Indiana
- 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 Indiana cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, PathWays and Health and Wellness waivers, 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 Indiana
| Item | Notes |
|---|---|
| Personal services agency license | $250 with the application and $250 at each yearly renewal (IC 16-27-4-6) |
| Home health agency license | $250 nonrefundable application fee (410 IAC 17-10-1) and $250 at each yearly renewal |
| Hospice license | Check the current fee with IDOH before you apply |
| Entity formation | Indiana Secretary of State filing fee through INBiz |
| Criminal history checks | Per owner, manager and worker; national or expanded check fees vary by vendor |
| Insurance | General and professional liability, workers' compensation, auto; liability coverage for lift services is required if you offer them |
| EVV and scheduling software | Sandata is the state system for Medicaid visits; an alternate EVV vendor is at your own cost |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while the license, Medicaid moratorium or Medicare enrollment is pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Indiana
Weeks to a few months: IDOH reviews applications in the order received and issues the license only after every document is approved.
On hold for new providers of most waiver services while the moratorium that began August 1, 2026 lasts; afterward, several months for OMPP certification, IHCP enrollment and plan contracts.
Longest: IDOH licensure and inspection, then Medicare enrollment and a certification survey once the CMS moratorium allows new applications.
Indiana families look for care by city and county: Indianapolis and its surrounding suburbs, Fort Wayne, Evansville, South Bend and the northwest corner that shares a labor market with Chicago. With new Medicaid waiver providers paused and the PathWays and Health and Wellness waivers running waiting lists since 2024, private pay families are the most reachable clients for a new agency. Many are adult children arranging care for a parent, so a complete Google Business Profile and clear pages for each area you serve matter.
Frequently asked questions
Do I need a license to start a home care agency in Indiana?
Yes. An agency that provides attendant care, homemaker or companion services in clients' homes needs a personal services agency license from the Indiana Department of Health under IC 16-27-4. Skilled care that needs a health care professional's order requires a home health agency license under IC 16-27-1.
How much does an Indiana personal services agency license cost?
The state fee is $250 with the application and $250 at each yearly renewal. Insurance, background checks, policies and staff time cost more than the license itself.
Can a personal services agency provide hands on care in Indiana?
Yes. Attendant care, such as help with bathing, dressing and transfers, is part of the license. Services that legally need a health care professional's order are not, and the agency must evaluate each worker's competency for every attendant care task.
Can a new agency get Medicaid waiver clients in Indiana right now?
Usually not. Since August 1, 2026 Indiana has paused new certifications and enrollments for attendant care, home and community assistance and most other waiver services for an initial six months, and it may extend the pause. OMPP considers limited exceptions where members lack access. Check the current status before you plan on Medicaid revenue.
What are PathWays and the Health and Wellness Waiver?
They replaced the Aged and Disabled Waiver in July 2024. Indiana PathWays for Aging serves Medicaid members 60 and older through Anthem, Humana and UnitedHealthcare, and the Health and Wellness Waiver serves members 59 and younger. Providers are certified by FSSA's Office of Medicaid Policy and Planning and enroll with the IHCP.
Do Indiana caregivers need certification?
Not for a personal services agency. The agency evaluates and documents each worker's competency instead. Home health aides in a licensed home health agency must pass a competency evaluation, be on the state aide registry and complete 12 hours of training a year.
Does Indiana require a Certificate of Need for home health or hospice?
No. Indiana's Certificate of Need program, in place since July 1, 2019, covers comprehensive care facilities (nursing homes). Home health agencies and hospices still need IDOH licensure, and Medicare enrollment if they bill Medicare.
Can a new home health agency bill Indiana Medicaid?
Only after Medicare enrollment. Since July 1, 2026 the IHCP requires home health agencies to be enrolled with Medicare, and CMS paused new Medicare enrollment of home health agencies and hospices from May 13, 2026 for six months. CMS may extend or end that pause, so check its status.
Is a franchise a better way to start a home care agency in Indiana?
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 Indiana home care consulting cost?
Lunaria charges one fixed price per engagement, quoted in writing after a free 30 minute consultation. There are no hourly charges, and we work in all 50 states and DC.
Sources checked for this guide (40)
- IDOH Personal Care Services Agency (PSA) Licensing Program, IDOH Gateway process from May 1, 2026 (page updated Apr. 9, 2026; Internet Archive copy of May 18, 2026)
- IDOH Initial Application for License to Operate a Personal Services Agency, instruction letter (updated 08.2022)
- IDOH PSA criminal history checks for employees and owners (updated 08.2022)
- IDOH Home Health Agency Licensing and Certification Program (Internet Archive copy of Apr. 18, 2026)
- IDOH Initial Licensure and Federal Certification Instruction Letter, home health agencies
- IDOH Hospice Agency Licensing and Certification Program (Internet Archive copy of Sept. 21, 2026)
- IDOH Certificate of Need Program, comprehensive care facilities (Internet Archive copy of Oct. 16, 2026)
- IHCP Bulletin BT2026124, HCBS provider certification and enrollment moratorium (July 23, 2026)
- IHCP Bulletin BT202595, home health agencies must enroll with Medicare by July 1, 2026 (June 26, 2025)
- IHCP Bulletin BT202647, home health Medicare enrollment clarification and SEA 222 (March 31, 2026)
- IHCP Bulletin BT202622, PSA license required for waiver attendant care (Feb. 17, 2026, later rescinded)
- IHCP Bulletin BT202666, PSA or home health license accepted again (May 7, 2026)
- IHCP Electronic Visit Verification (Internet Archive copy of Sept. 7, 2026)
- FSSA OMPP Medicaid HCBS Certification process (Internet Archive copy of July 11, 2026)
- FSSA DDARS HCBS Medicaid Waiver Waiting List Information (Internet Archive copy of Apr. 20, 2026)
- FSSA DDARS home page (Internet Archive copy of Oct. 25, 2026)
- Indiana PathWays for Aging home page (Internet Archive copy of June 12, 2026)
- IC 16-27-4-4, personal services definition (FindLaw, current as of Jan. 1, 2026)
- IC 16-27-4-5, personal services agency definition (FindLaw)
- IC 16-27-4-6, license, fee, branches, renewal (FindLaw)
- IC 16-27-4-9, manager (FindLaw)
- IC 16-27-4-10, service plans (FindLaw)
- IC 16-27-4-12, client rights statement (FindLaw)
- IC 16-27-4-16, competency evaluations (FindLaw)
- IC 16-27-2-4, criminal history check within 3 business days (FindLaw)
- IC 16-27-2-5, disqualifying convictions and 21 day rule (FindLaw)
- IC 16-27-1-5, home health services definition (FindLaw)
- IC 16-25-3-1, hospice license required (FindLaw)
- IC 16-25-3-3, hospice license application (FindLaw)
- IC 16-25-3-4, hospice must meet Medicare standards (FindLaw)
- 410 IAC 17-10-1, home health licensure (Cornell LII)
- 410 IAC 17-12-1, home health administration and staffing (Cornell LII)
- 410 IAC 17-14-1, home health aides and services (Cornell LII)
- 405 IAC 5-34-2, Medicaid hospice provider enrollment (Cornell LII)
- CMS Provider Enrollment Moratoria (HHAs and hospices, May 13, 2026; page modified Aug. 27, 2026)
- Federal Register 2026-09717, moratorium on Medicare enrollment of home health agencies
- Federal Register 2026-09718, moratorium on Medicare enrollment of hospices
- 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)
This guide is general information and reflects Indiana requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Indiana Department of Health, FSSA, the Indiana Health Coverage Programs 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.