How to start a home care agency in Massachusetts and reach your first client faster
Massachusetts just created its first home care agency license, but EOHHS has not written the rules yet. New owners are caught in between: free to open for private pay today, yet building toward background check, training, insurance and contract standards that will soon be mandatory. Public clients come through ASAP contracts that require AGE's Homemaker Notice of Intent, SCO and One Care plans, DPH registry checks and electronic visit verification. 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 Massachusetts rulesM.G.L. c. 6A, § 16II, 105 CMR 155.000 and AGE homemaker and personal care standards
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Massachusetts requires.
Nonmedical home care for MassHealth and Home Care Program clients
- State license
- EOHHS home care agency license; a temporary license goes first to agencies already contracted with an ASAP or MassHealth
- Who you deal with
- Executive Office of Aging & Independence (AGE), your regional ASAPs, SCO and One Care plans, MassHealth
- Must haves
- Accepted AGE Homemaker Notice of Intent application, ASAP contracts, SCO or One Care plan contracts, DPH registry checks, CORI, Home Care Worker Registry reporting, EVV
- Realistic time to first client
- Several months
Orientation for Massachusetts only. We confirm your exact path on the free call.
Three places new Massachusetts agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Opening in the gap before licensure
The new law makes a home care agency license mandatory, but EOHHS still has to write the rules and set the date by which every agency must be licensed. Owners either wait for rules that may take a year or more, or open without building to the standards the law already lists: background checks, training topics, insurance minimums, written service plans and safe working conditions.
What it costs: Months lost waiting, or policies and personnel files that must be rebuilt when the license application opens.
The ASAP contracting gate
State Home Care Program and Frail Elder Waiver clients are served through Aging Services Access Points. To provide homemaker or personal care, an agency must first have its Homemaker Notice of Intent application accepted by AGE, and then each ASAP decides whether to contract. An ASAP or MassHealth contract is also what qualifies an agency for a temporary license under the new law.
What it costs: Months with staff and no public clients, and a later start on licensure than competitors who already hold contracts.
Hiring before the checks are done
DPH rules require homemaker agencies, home health agencies and hospices to check the DPH registry before hiring anyone who will provide direct care or have access to clients' property, and never to employ someone with a finding of abuse, neglect or misappropriation. CORI checks, out of state history and exclusion list reviews are coming under the new law too.
What it costs: A caregiver you have to take off a case, or an ASAP contract review that finds missing records.
What does a delay cost your agency?
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Home care vs home health vs hospice in Massachusetts
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 bathing, dressing, eating, toileting, transfers, housekeeping, laundry and companionship | Skilled nursing or therapy in the home, supervised by a physician or registered nurse | Palliative and supportive care for people who are terminally ill, and their families |
| State license | EOHHS home care agency license (M.G.L. c. 6A, § 16II), rules pending | None issued today; Medicare certification is the working standard | DPH hospice program license (105 CMR 141.000) |
| Certificate of Need | No | No Determination of Need step | No Determination of Need step for a hospice program |
| Main payers | Private pay, ASAP contracts (Home Care Program and Frail Elder Waiver), SCO and One Care plans | Medicare, MassHealth and its health plans, commercial insurance | Medicare hospice benefit, MassHealth |
| Medicare | Not covered | Accreditation, DPH certification packet, then Medicare enrollment | Accreditation or state survey, then Medicare enrollment |
| Key staff | Owner or manager, supervisor, trained homemakers and personal care workers | Administrator, supervising registered nurses, home health aides, therapists | Administrator with two years of experience, clinical services coordinator, interdisciplinary team |
| Startup capital | Lowest | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks (private pay) to months (ASAP and plans) | Longest: accreditation, certification, enrollment | Longest: licensure, survey, enrollment |
The new license covers nonmedical home care only. The law excludes hospice programs licensed under M.G.L. c. 111, § 57D, home health agencies under § 51K, ASAPs, house cleaning only businesses, and the MassHealth PCA and Adult Foster Care programs. It also covers businesses that match families with caregivers, not just employers. Many owners start with nonmedical care, then add home health once they have cash flow and a clinical team. We plan both from day one so your policies grow with you.
Massachusetts requirements at a glance
| Nonmedical home care license | Required under M.G.L. c. 6A, § 16II, added by An Act to improve Massachusetts home care (signed August 7, 2026). EOHHS is writing the rules; there is no application yet. |
|---|---|
| License timeline | Temporary licenses within 180 days of the effective date for agencies contracted with an ASAP or MassHealth; full rules within one year; mandatory licensure by a date EOHHS sets, no later than one year after its rules |
| License terms | Three year, non transferable license; EOHHS may fine up to $500 a day for noncompliance; fees not yet set |
| Home health | No DPH license issued today, although M.G.L. c. 111, § 51K provides for one. Medicare certification is required to enroll in MassHealth (130 CMR 403.405). |
| Hospice | DPH hospice program license under M.G.L. c. 111, § 57D and 105 CMR 141.000, issued for two years |
| Public funding routes | ASAP contracts for the State Home Care Program and Frail Elder Waiver (after AGE's Homemaker Notice of Intent), plus Senior Care Options (SCO) and One Care plans |
| Background screening | DPH registry check before hire (105 CMR 155.010) and CORI today; the new law adds out of state checks, the OIG exclusion list, the nurse aide registry and driving records |
| Electronic visit verification | Required for MassHealth funded personal care, homemaker and home health visits; state system from Sandata or a registered Alt-EVV system |
| Employment agency license | Needed from the Department of Labor Standards only if you place or refer caregivers whom families pay directly; not for agencies that employ their caregivers |
| Entity filing | Secretary of the Commonwealth, Corporations Division |
Summary of Massachusetts requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Massachusetts
The order matters. Start the AGE Homemaker Notice of Intent and your screening system early, because ASAP contracts follow an accepted application, and an ASAP or MassHealth contract is the path to a temporary license.
Form the business
File your LLC or corporation with the Secretary of the Commonwealth, get an EIN, and register for state tax withholding, unemployment insurance and Paid Family and Medical Leave. Avoid the words "home care" in a business name you cannot license later without planning for it.
You do this; we give you the checklistChoose your model and payer mix
Employ your caregivers, or place them with families who pay them directly. A placement model needs an employment agency license from the Department of Labor Standards, and matching services are also covered by the new home care license. Then choose private pay, ASAP and plan work, or both.
Decided on your free consultationSet up insurance and payroll
Buy workers' compensation, general and professional liability, and auto coverage for caregivers who drive. Build earned sick time into payroll from the first hire: at least one hour for every 30 hours worked, up to 40 hours a year, paid once you have 11 or more employees.
You do this; we specify what is requiredWrite policies to the new law and DPH rules
Adopt policies for client service plans and contracts with unit rates and total cost, background checks, worker training, abuse prevention and reporting under 105 CMR 155.000, complaints, emergency preparedness, infection control and worker safety. These are the topics M.G.L. c. 6A, § 16II tells EOHHS to regulate.
We write this for youBuild the caregiver screening pipeline
Check the DPH registry before every direct care hire, run CORI through DCJIS, review the OIG exclusion list, and check driving records for anyone who will transport clients. Train every worker on the law's required topics, including dementia care and abuse reporting.
We set up the system and trackerApply through AGE's Homemaker Notice of Intent
To provide homemaker or personal care to ASAP clients, submit the electronic Homemaker Notice of Intent application. AGE accepts or rejects it, and each ASAP you selected then decides whether to contract. ASAP contracts bring Home Care Worker Registry reporting under 651 CMR 16.00.
We prepare the applicationContract with ASAPs and SCO or One Care plans
Complete each ASAP's provider packet, and apply to the Senior Care Options and One Care plans in your area, which contract with providers directly. Contracts, not the license, are what bring referrals.
We prepare every plan's packetSet up electronic visit verification
MassHealth funded personal care and homemaker visits need EVV. Use the state's Sandata system or register your own Alt-EVV system that sends all six federal data elements to the state aggregator.
We walk you through setupApply for your EOHHS license when it opens
Watch for EOHHS rules. Agencies with an ASAP or MassHealth contract can get a temporary license first; every other agency must be licensed by the deadline EOHHS sets. Expect a suitability review of every owner with 5% or more and a check of financial capacity.
We prepare the application
Caregiver training and background checks
Massachusetts is moving from contract based standards to a licensing standard. Today, DPH rules, ASAP contracts and MassHealth waiver rules set the requirements. The new law tells EOHHS to require specific background checks and training topics for every licensed agency, so build to both now.
- DPH registry check: Homemaker agencies, home health agencies and hospices must contact the DPH registry before hiring anyone who will give direct care or have access to clients or their property, and may not employ someone with a finding of abuse, neglect, mistreatment or misappropriation (105 CMR 155.010).
- Abuse prevention and reporting: Written policies on preventing and reporting abuse, neglect and misappropriation, reviewed at least yearly, with every staff member trained on them. Suspected cases are reported to DPH.
- Background checks under the new law: Massachusetts CORI, criminal history checks in every state where the worker lived or worked in the past 5 years, the OIG List of Excluded Individuals/Entities, the nurse aide registry, credentials where relevant, and license, insurance and 5 years of driving records for anyone who transports clients.
- Training topics under the new law: Client privacy, infection control, emergencies and falls prevention, observing and reporting changes, recognizing and reporting abuse, Alzheimer's disease and dementia care, and workers' wage and hour rights, delivered in a culturally and linguistically competent way. EOHHS will set the hours.
- ASAP and waiver standards: ASAP clients' homemaker and personal care follow AGE's homemaker standards and Personal Care Guidelines. In the ABI and MFP waivers, homemakers need a home health aide or nurse aide certificate, a 40 hour homemaker certificate or a 60 hour personal care certificate (130 CMR 630.404).
- Home Care Worker Registry: Agencies that employ workers for the State Home Care Program under an ASAP contract submit worker data to AGE's Home Care Worker Registry (651 CMR 16.00) and tell workers their rights.
- Home health and hospice aides: Medicare requires home health aides to complete at least 75 hours of training, including 16 hours of supervised practical training, or a competency evaluation (42 CFR 484.80). Waiver home health aides also need CPR.
Six mistakes that slow Massachusetts agencies down
We look for every one of these in the first week of an engagement.
Waiting for EOHHS rules before building anything
- What it costs
- When applications open, agencies with policies, training records and screening files ready move first, and the rest start over.
- How we prevent it
- We build your policies and personnel files to the topics the law already lists.
Assuming no license yet means no rules
- What it costs
- DPH abuse reporting and registry checks, earned sick time, wage and hour law and ASAP contract standards all apply now.
- How we prevent it
- Your first call maps every rule that applies to you today.
Hiring before the DPH registry check
- What it costs
- A worker with a finding cannot be employed, and a missing check shows up in ASAP and DPH reviews.
- How we prevent it
- A tracker that blocks scheduling until the registry check, CORI and training are on file.
Running a placement service without the right credential
- What it costs
- Placing caregivers whom families pay directly needs a Department of Labor Standards license, and matching services fall under the new home care license too.
- How we prevent it
- We settle your business model on the free consultation, before you sign families.
Skipping the Homemaker Notice of Intent
- What it costs
- ASAPs can contract only with homemaker agencies whose NOI application AGE has accepted, and an ASAP contract is the route to a temporary license.
- How we prevent it
- We prepare your NOI application and each ASAP's packet together.
Offering skilled care without Medicare certification
- What it costs
- Skilled nursing falls outside the nonmedical license, and MassHealth pays only Medicare certified home health agencies.
- How we prevent it
- Clear service definitions so nonmedical caregivers never perform skilled tasks.
In a free 30 minute call we confirm your Massachusetts path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Massachusetts 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.
- Massachusetts path and a dated launch plan
- Policy and procedure manual written to M.G.L. c. 6A, § 16II, 105 CMR 155.000 and AGE homemaker and personal care standards
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
MassHealth ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to MassHealth requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for your regional ASAPs (after AGE accepts your Homemaker NOI) and each SCO or One Care plan
- Survey and audit readiness
- Massachusetts city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to DPH 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 Massachusetts 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 M.G.L. c. 6A, § 16II, 105 CMR 155.000 and AGE homemaker and personal care standards |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for your regional ASAPs (after AGE accepts your Homemaker NOI) and each SCO or One 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 Massachusetts home care startup checklist
Every Massachusetts 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 model (employer or placement) and payer mix
- Form your LLC or corporation with the Secretary of the Commonwealth
- Get an EIN and register for withholding, unemployment insurance and Paid Family and Medical Leave
- Buy workers' compensation, general and professional liability, and auto coverage
- Set up payroll with earned sick time (one hour per 30 hours worked)
- 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 Massachusetts
- 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 Massachusetts cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, MassHealth, 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 Massachusetts
| Item | Notes |
|---|---|
| State license | EOHHS has not set home care license fees yet; they will be set under M.G.L. c. 7, § 3B. DPH hospice license fees are set by the Executive Office for Administration and Finance. Check current fees with each agency. |
| Employment agency license (placement models only) | Department of Labor Standards: $300 application fee for the main office and $180 for each additional office, renewed every year |
| Entity formation | Secretary of the Commonwealth filing and annual report fees |
| Background checks | CORI, out of state criminal history and driving record checks per worker |
| Training | Homemaker and personal care training, dementia training, CPR where required, and aide training for home health |
| Insurance | Workers' compensation, general and professional liability, auto coverage |
| EVV and scheduling software | The state Sandata system is available; an Alt-EVV system is your cost |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while ASAP contracts, plan credentialing or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Massachusetts
Weeks today, once the business, insurance and screening are in place. The EOHHS license follows the law's schedule: temporary licenses first, full rules within a year of the effective date, then a mandatory licensing date up to a year later.
Several months: AGE's Homemaker Notice of Intent review, then each ASAP's contracting decision and plan credentialing.
Longest: DPH hospice licensure where it applies, accreditation, certification and Medicare enrollment, which CMS paused for new agencies in May 2026.
Massachusetts families usually search by town and region, such as Worcester, the North Shore, the South Shore, the Pioneer Valley and Cape Cod, and many adult children arrange care for a parent from another town or state. Public funding is organized by ASAP service areas, so the ASAPs and SCO plans that cover your towns shape where referrals come from. When EOHHS posts its public list of licensed agencies, families will be able to check it, which makes an early license and a complete Google Business Profile worth more. Town pages that match how people search help you get found in each community you serve.
Frequently asked questions
Do you need a license to start a home care agency in Massachusetts?
Yes, soon. An Act to improve Massachusetts home care, signed August 7, 2026, requires a home care agency license from EOHHS. EOHHS must first adopt rules, then set a date, no more than a year after those rules, by which every agency must be licensed. Until applications open, agencies still follow DPH abuse reporting rules, labor law and any ASAP or plan contract.
When will Massachusetts home care licensing start?
The law took effect in early November 2026. EOHHS must issue temporary licenses within 180 days to agencies already contracted with an ASAP or MassHealth, adopt full rules within one year, and then set the mandatory licensing date no later than one year after its rules. Check EOHHS announcements for the actual dates.
Who needs the new home care agency license?
Businesses that provide nonmedical home care in clients' homes for pay, that present themselves as a home care agency, or that match families with caregivers. The law excludes state and federal programs, house cleaning only businesses, ASAPs, licensed hospices, home health agencies, the MassHealth PCA program and Adult Foster Care.
Does Massachusetts license home health agencies?
Not in practice today. M.G.L. c. 111, § 51K provides for a DPH home health license, but DPH says you do not have to apply to it to open a home health business. To bill Medicare or MassHealth, an agency must be Medicare certified, and DPH processes the certification paperwork.
Who licenses hospices in Massachusetts?
The Department of Public Health, under M.G.L. c. 111, § 57D and 105 CMR 141.000. Licenses run for two years, and no one may use the word "hospice" without one. MassHealth requires both the DPH license and Medicare certification.
Does Massachusetts require a Determination of Need for home health or hospice?
No. Massachusetts calls its Certificate of Need program Determination of Need, and 105 CMR 100.000 applies it to hospitals, clinics, long term care facilities and similar facilities, not to home health agencies or hospice programs. Hospice inpatient facilities are handled separately by DPH.
How do Massachusetts home care agencies get MassHealth clients?
Mainly through Aging Services Access Points, which serve State Home Care Program and Frail Elder Waiver clients, and through Senior Care Options and One Care plans. For homemaker and personal care, AGE must accept your Homemaker Notice of Intent application before an ASAP can contract with you.
Can I open a Medicare home health agency or hospice in Massachusetts right now?
Not quickly. CMS paused new Medicare enrollment of home health agencies and hospices nationwide on May 13, 2026, for six months. It may have ended or been extended since, so check CMS before you file. MassHealth enrolls only Medicare certified home health agencies and hospices, and it has separately paused enrollment of new Adult Foster Care providers.
How much does Massachusetts home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, ASAP and MassHealth plans, 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.
Do you only work in Massachusetts?
No. Lunaria works with owners in all 50 states and DC, so you can expand into a second state with the same team.
Sources checked for this guide (32)
- House Bill 5627, An Act to improve Massachusetts home care (conference committee report, July 30, 2026; Internet Archive copy of malegislature.gov PDF)
- Mass.gov press release: Governor Healey Signs Bill Strengthening Safety, Quality and Oversight of Home Care (8/07/2026)
- M.G.L. c. 111, § 51K, home health agency licensure
- DPH: Apply for Home Health Agency Medicare Certification
- 105 CMR 141.000, Licensure of Hospice Programs (Cornell LII)
- 105 CMR 141.121, period of license (Cornell LII)
- 105 CMR 141.201, hospice administration (Cornell LII)
- 105 CMR 100.100, Determination of Need definitions (Cornell LII)
- 105 CMR 155.010, responsibilities of home health agencies, homemaker agencies and hospices (Cornell LII)
- 105 CMR 155.003, definitions of homemaker and homemaker agency (Cornell LII)
- AGE: Frail Elder Waiver information for providers (Homemaker Notice of Intent)
- 651 CMR 3.02, Home Care Program definitions (Cornell LII)
- 651 CMR 16.04, Home Care Worker Registry agency duties (Cornell LII)
- 130 CMR 630.404, HCBS waiver provider eligibility (Cornell LII)
- 130 CMR 403.405, MassHealth home health provider eligibility (Cornell LII)
- 130 CMR 437.404, MassHealth hospice provider eligibility (Cornell LII)
- MassHealth: ACA program integrity provisions (moratoria, risk levels, fingerprinting)
- MassHealth: Agency-based providers and services required to use EVV
- MassHealth Home Health Agency Bulletin 94, EVV registration and compliance (May 2025)
- MassHealth HCBS Waiver Provider Bulletin 24, EVV for waiver services (July 2025)
- MassHealth: One Care
- 101 CMR 15.03, EOHHS CORI rules scope (Cornell LII)
- Department of Labor Standards: registering an employment, placement or staffing agency
- Attorney General: Earned sick time
- Federal Register 2026-09717: nationwide moratorium on Medicare enrollment of home health agencies
- Federal Register 2026-09718: nationwide moratorium on Medicare enrollment of hospices
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR 484.80, home health aide training (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- CMS-855A Medicare enrollment application, institutional providers
- Elder Care Network Southeast (ASAP) homemaker provider application checklist (example ASAP packet, secondary)
- Polsinelli: Massachusetts home care licensing law effective this fall (secondary, pointer only)
This guide is general information and reflects Massachusetts requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with EOHHS, the Executive Office of Aging & Independence, the Department of Public Health, MassHealth 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.