How to start a home care agency in Michigan and reach your first client faster
Michigan has no state license for nonmedical home care, and none for home health either, so new owners think there is nothing to apply for. There is. Medicaid Home Help pays agencies only after MDHHS approves you, and you need at least two employed caregivers enrolled in CHAMPS, criminal history screening, electronic visit verification and a compliance review after your first payments. MI Choice adds separate waiver agency contracts. We put all of it in the right order for you.
- Guides reviewed by Christine Ochimas, RN, LMFT, MBA
- One fixed price, agreed in writing
- You own 100%. No franchise fees or royalties
Get your free Michigan launch plan
A 30 minute call. No obligation.
- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Michigan rulesMDHHS Adult Services Manual ASM 135 and 136, the Medicaid Provider Manual and MI Choice service standards
- Local search marketingGoogle Business Profile and local search
- All 50 states and DCExpand beyond Michigan with us
Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Michigan requires.
Nonmedical home care for Medicaid Home Help clients
- State license
- None for nonmedical care; MDHHS Home Help agency approval instead (ASM 136)
- Who you deal with
- MDHHS Home Help Policy Section, MDHHS local offices, MI Choice waiver agencies, MI Coordinated Health plans in their regions
- Must haves
- EIN, Type 2 NPI, SIGMA vendor account, CHAMPS enrollment, at least two W-2 caregivers, criminal history screening, HASA-2104, EVV
- Realistic time to first client
- Several months
Orientation for Michigan only. We confirm your exact path on the free call.
Three places new Michigan agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Looking for a license that does not exist
Owners search LARA for a home care license application and find nothing, because Michigan licenses neither nonmedical agencies nor home health agencies. Meanwhile the steps that do control Medicaid work, CHAMPS enrollment, caregiver screening and the MDHHS Home Help application, have not started.
What it costs: Weeks of lost time before the real clock even starts.
The Home Help agency rules catch new owners out
MDHHS approves only agencies that directly employ at least two caregivers besides the owner, paid every month. Each caregiver must be enrolled in CHAMPS and pass criminal history screening before working, and three months after your first Home Help payment MDHHS runs a compliance review of your caregiver list and payroll.
What it costs: Months of payroll with no agency rate, or recoupment of payments if caregivers were not properly enrolled.
Medicare and Medicaid home health doors are narrow right now
Michigan Medicaid enrolls only Medicare certified home health agencies and hospices. CMS paused new Medicare enrollment for both nationwide from May 13, 2026 for six months, and LARA says it is not doing initial state certification surveys until higher priority work is done, so most agencies need accreditation.
What it costs: A clinical team on payroll for months with no Medicare or Medicaid revenue.
What does a delay cost your agency?
Enter your own numbers. Nothing is stored or sent.
Home care vs home health vs hospice in Michigan
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 (help with daily activities), homemaking, companionship, respite | Skilled nursing, therapy and home health aide services ordered for an illness or injury | Palliative and supportive care for people who are terminally ill, and their families |
| State license | None | None at the state level; Medicare certification under 42 CFR Part 484 | LARA hospice agency license (Public Health Code Part 214) |
| Certificate of Need | No | No Certificate of Need step | No; LARA lists hospices as excluded from Certificate of Need |
| Main payers | Private pay, Medicaid Home Help, MI Choice waiver agencies, MI Coordinated Health plans in their regions | Medicare, Michigan Medicaid and Medicaid Health Plans (after Medicare certification), commercial insurance | Medicare hospice benefit, Michigan Medicaid (after Medicare certification) |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment | State license, accreditation or state survey, then Medicare enrollment |
| Key staff | Owner or manager plus at least two W-2 caregivers for Home Help; a supervisor for MI Choice work | Administrator, clinical manager, skilled nurses, therapists and trained home health aides | Administrator, medical director, RN coordinator, interdisciplinary team |
| Startup capital | Lowest | Higher: clinical payroll before Medicare revenue | Highest: licensing fees and an interdisciplinary team before revenue |
| Time to first client | Weeks (private pay) to months (Home Help and MI Choice) | Longest: patients, survey, enrollment | Longest: licensure, survey, enrollment |
Many Michigan owners start with nonmedical care, become an approved Home Help agency, build a caregiver team, then add home health. Because Michigan has no home health license, the Medicare certification survey is the real gate, and a state survey readiness letter needs at least 10 skilled patients served first. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Michigan requirements at a glance
| Nonmedical home care license | None at the state level. MDHHS approval as a Home Help agency provider is required for the agency rate. |
|---|---|
| Home health licensing | None. LARA states that state licensing is not required for home health agencies; its Bureau of Survey and Certification surveys them for Medicare under 42 CFR Part 484. |
| Hospice licensing | LARA Bureau of Community and Health Systems, under Part 214 of the Public Health Code; applications through MI-SLS, renewed every year |
| Medicaid agency | Michigan Department of Health and Human Services (MDHHS); providers enroll in CHAMPS |
| Medicaid home care programs | Home Help (fee for service personal care), the MI Choice Waiver through 20 regional waiver agencies, and MI Coordinated Health plans in four regions |
| Caregiver training | No state hour count for Home Help; MI Choice providers give in service training twice each fiscal year; home health aides need 75 hours under federal rules |
| Background screening | Home Help: CHAMPS criminal history screening. MI Choice: Michigan State Police criminal history review. Hospices and Medicare certified home health agencies: Workforce Background Check with fingerprints and registry checks. |
| Electronic visit verification | Required for Home Help, MI Choice, MI Coordinated Health and home health visits. HHAeXchange is the state system at no cost; MDHHS expects 85% of visits without manual edits. |
| Certificate of Need | None for home health or hospice |
| Entity filing and taxes | LARA Corporations Division (or your county clerk), then Michigan Treasury Online registration for state taxes and unemployment |
Summary of Michigan requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Michigan
The order matters. Hire your caregivers and get them through CHAMPS screening early, because MDHHS approves only agencies that already employ at least two caregivers, and each one must be screened before working a single Home Help visit.
Form the business and get your numbers
Register your LLC or corporation with LARA (or your county clerk), get an EIN and a Type 2 organization NPI, and register through Michigan Treasury Online for withholding and an unemployment account.
You do this; we give you the checklistDecide your payer mix
Private pay, Home Help, MI Choice or a combination. In Wayne, Macomb, most of the Upper Peninsula and eight southwest counties, dual eligible members in MI Coordinated Health get personal care from their plan instead of Home Help. Use the path finder above.
Decided on your free consultationSet up insurance and employment basics
Arrange workers' compensation, general and professional liability, auto coverage and a fidelity bond. Put caregivers on W-2 payroll with monthly paychecks, and build Michigan earned sick time into payroll: one hour for every 30 hours worked.
You do this; we specify what is requiredWrite policies to the MDHHS standard
Adopt policies for service agreements, client rights, caregiver identification, criminal history screening, supervision, incident reporting, records kept seven years and EVV, written to ASM 135 and 136, the Home Help chapter of the Medicaid Provider Manual and MI Choice service standards.
We write this for youBuild the caregiver pipeline
Hire at least two caregivers besides the owner, check references, issue photo IDs, and enroll each caregiver in CHAMPS so MDHHS runs the criminal history screening. Associate them to your agency only after the check is complete. No noncompete clauses.
We set up the system and trackerApply for Home Help agency approval
Create a SIGMA vendor account and enroll in CHAMPS, then email the MDHHS Home Help Policy Section your letter of intent, IRS EIN letter, any county registration and the signed HASA-2104. MDHHS answers within 30 calendar days of receiving everything.
We prepare the applicationSet up electronic visit verification
Complete the HHAeXchange provider onboarding form, or connect another system that meets state requirements at your own cost. Train caregivers to clock in and out on every visit, since MDHHS expects 85% of visits each quarter without manual edits.
We walk you through setupContract with MI Choice waiver agencies and plans
Each MI Choice waiver agency subcontracts with its own providers and negotiates rates directly. In MI Coordinated Health regions, apply to each plan's network. Plan in home supervision of each caregiver twice a year for MI Choice work.
We prepare every plan's packet
Caregiver screening, training and supervision
Michigan sets no state training hour count for nonmedical caregivers. The rules come from each payer: MDHHS Home Help policy for screening and employment, MI Choice standards for supervision and in service training, and federal rules for home health and hospice aides.
- Home Help caregiver criteria: At least 18, able to follow instructions and handle emergencies, in adequate health, dependable and willing to take part in available training. Each caregiver carries a state or agency photo ID into every home.
- Home Help criminal history screening: Owners, caregivers and employees with access to clients or their information are screened through CHAMPS enrollment. An agency caregiver with an excludable conviction cannot provide Home Help, and clients cannot waive this for agency staff.
- CHAMPS association: Every agency caregiver enrolls in CHAMPS and is associated to your agency before providing Home Help, never dated earlier than the completed criminal history check. You also track each caregiver's CHAMPS revalidation.
- MI Choice: Waiver agencies and direct providers run a Michigan State Police criminal history review and reference checks before anyone enters a participant's home, give staff in service training at least twice each fiscal year and make supervisory home visits twice each fiscal year.
- Home health aides: At least 75 hours of classroom and supervised practical training (16 of them practical) or a competency evaluation, and 12 hours of in service training every year under 42 CFR 484.80. Hospice aides meet the same standard through 42 CFR 418.76.
- Workforce Background Check: Hospices and Medicare certified home health agencies must use the LARA Workforce Background Check system: state and FBI fingerprints plus OIG, Michigan sanctioned provider, nurse aide and sex offender registry checks. The fee is $68.50 from October 1, 2026 and cannot be charged to the applicant.
- Continuous monitoring: Workforce Background Check results stay linked to Michigan State Police records, and LARA notifies the employer if a worker becomes ineligible. Mark workers as resigned when they leave.
Six mistakes that slow Michigan agencies down
We look for every one of these in the first week of an engagement.
Reading no license as no rules
- What it costs
- MDHHS audits Home Help agencies and can recoup payments or disenroll an agency that misses policy requirements.
- How we prevent it
- We write your policy manual to ASM 135 and 136 and the Home Help chapter of the Medicaid Provider Manual.
Letting a caregiver work before CHAMPS screening
- What it costs
- Payments for visits by caregivers who were not enrolled and associated in CHAMPS can be recouped after a post payment audit.
- How we prevent it
- A tracker that blocks scheduling until enrollment, screening and association are complete for every caregiver.
Placing a client's former caregiver too soon
- What it costs
- An agency caregiver cannot serve a client they cared for as an individual Home Help caregiver for 90 days, and recruiting current Home Help clients or caregivers is not allowed.
- How we prevent it
- We build the 90 day rule and the recruiting and marketing limits into your hiring process.
Using noncompete agreements
- What it costs
- ASM 136 bars agencies from having or enforcing any agreement that stops a caregiver from working for another Home Help client or agency.
- How we prevent it
- Employment documents written to Michigan Home Help policy from the start.
Fixing EVV visits by hand
- What it costs
- Agencies below 85% of visits without manual edits in a quarter face corrective action from MDHHS or the plan.
- How we prevent it
- We set up EVV and train your caregivers before the first visit, then watch the monthly HHAeXchange compliance report.
Counting on Medicaid home health before Medicare
- What it costs
- Michigan Medicaid enrolls only Medicare certified home health agencies and hospices, and new Medicare enrollment has been paused since May 2026.
- How we prevent it
- We check the CMS pause on your first call and plan a nonmedical start that earns revenue meanwhile.
In a free 30 minute call we confirm your Michigan path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Michigan 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.
- Michigan path and a dated launch plan
- Policy and procedure manual written to MDHHS Adult Services Manual ASM 135 and 136, the Medicaid Provider Manual and MI Choice service standards
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Home Help ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Home Help requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for MDHHS Home Help and each MI Choice waiver agency in your area
- Survey and audit readiness
- Michigan city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to LARA 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 Michigan 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 MDHHS Adult Services Manual ASM 135 and 136, the Medicaid Provider Manual and MI Choice service standards |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for MDHHS Home Help and each MI Choice waiver agency 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 Michigan home care startup checklist
Every Michigan 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, Home Help, MI Choice, or a mix)
- Register your entity with LARA or your county clerk and get an EIN
- Register through Michigan Treasury Online for withholding and unemployment
- Get a Type 2 organization NPI and a SIGMA vendor account
- Buy workers' compensation, liability and auto coverage and a fidelity bond
- 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 Michigan
- 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 Michigan cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Home Help, 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 Michigan
| Item | Notes |
|---|---|
| State license | None for nonmedical care or home health. LARA lists hospice fees under MCL 333.20161 as a $2,000 initial application fee and a $500 license fee, with yearly renewal. Check current fees in MI-SLS. |
| Entity formation and tax registration | LARA or county clerk filing fee; Treasury and unemployment registration |
| Home Help caregiver screening | CHAMPS criminal history screening is part of caregiver enrollment |
| Workforce Background Check | $68.50 per fingerprint check from October 1, 2026, paid by the employer; needed for hospices and Medicare certified home health agencies |
| Insurance | Workers' compensation, liability, auto coverage and a fidelity bond |
| EVV and scheduling software | The state HHAeXchange system is free; another EVV system that meets state rules is at your own cost |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll for at least two caregivers, rent and insurance while Home Help approval, waiver contracts or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Michigan
Weeks, once the business, insurance and hiring process are in place.
Several months: hire and screen caregivers, enroll in CHAMPS, then MDHHS decides within 30 calendar days of a complete application. MI Choice contracts depend on each waiver agency.
Longest: hospice licensure, building a patient base, a certification survey and Medicare enrollment, which CMS paused for new agencies in May 2026.
Metro Detroit (Wayne, Oakland and Macomb counties) has the most clients and the most competing agencies. In Wayne and Macomb, and in most of the Upper Peninsula and eight southwest counties, many dual eligible members are in MI Coordinated Health, so their personal care comes through the plan rather than Home Help, which makes plan networks part of your strategy there. MI Choice is run by 20 regional waiver agencies, so the waiver agency in your region decides how many providers it needs. Families search by city: Detroit, Grand Rapids, Lansing, Ann Arbor, Kalamazoo, Flint, Traverse City and Marquette.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Michigan?
No. Michigan has no state license for personal care, companion or homemaker agencies. To be paid the agency rate for Medicaid Home Help clients, you need MDHHS approval as a Home Help agency provider and CHAMPS enrollment, plus business registration and insurance.
Does Michigan license home health agencies?
No. LARA states that state licensing is not required for home health agencies. Agencies that want Medicare or Medicaid become Medicare certified under 42 CFR Part 484, through an accrediting organization or a LARA survey. Nurses and therapists still need Michigan professional licenses.
Who licenses hospices in Michigan?
LARA's Bureau of Community and Health Systems licenses hospice agencies and hospice residences under Part 214 of the Public Health Code. Applications go through the Michigan State Licensing System (MI-SLS), licenses renew every year, and a hospice must be state licensed before Medicare certification is approved.
Does Michigan require a Certificate of Need for home health or hospice?
No. Michigan's Certificate of Need program covers services such as hospital and nursing home beds, surgery and imaging, not home health. LARA's hospice licensing page lists hospices as excluded from Certificate of Need.
How do I become a Home Help agency provider in Michigan?
Get an EIN and a Type 2 NPI, register with LARA or your county clerk, create a SIGMA vendor account and enroll in CHAMPS. Employ at least two W-2 caregivers besides the owner, screened through CHAMPS, then send the letter of intent, EIN letter and signed HASA-2104 to the MDHHS Home Help Policy Section.
How do Michigan agencies get MI Choice Waiver clients?
MDHHS contracts with 20 regional waiver agencies, many of them Area Agencies on Aging, and each one subcontracts with providers and negotiates rates. Contact the waiver agency for your region, meet its service standards, complete criminal history reviews and set up EVV.
Do Michigan caregivers need certification or training hours?
Not for private pay nonmedical care. Home Help requires caregivers who are at least 18, screened and willing to take available training. MI Choice requires in service training twice each fiscal year. Home health aides in Medicare certified agencies need 75 hours of training under federal rules.
Can a new Michigan home health agency or hospice bill Medicare and Medicaid right now?
Not quickly. CMS paused new Medicare enrollment of home health agencies and hospices nationwide from May 13, 2026 for six months, which may have ended or been extended by the time you read this. Michigan Medicaid enrolls only Medicare certified home health agencies and hospices.
Is a franchise a better way to start a home care agency in Michigan?
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 Michigan home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Home Help and MI Choice, or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges. We work in all 50 states and DC.
Sources checked for this guide (27)
- MDHHS Adult Services Manual ASM 136, Home Help Agency Providers (ASB 2026-008, effective 7-1-2026)
- MDHHS Adult Services Manual ASM 135, Home Help Caregivers (ASB 2026-008)
- MDHHS Adult Services Manual ASM 143, Electronic Visit Verification (ASB 2025-004)
- MDHHS Adult Services Manual ASM 126, MI Coordinated Health Program (ASB 2026-001)
- MDHHS Bridges Eligibility Manual BEM 168, MI Coordinated Health (regions and plans)
- Michigan Medicaid Provider Manual, October 1, 2026 (Home Help, Home Health, Hospice, MI Choice Waiver and EVV chapters)
- MDHHS Home Help Agency Providers page
- MDHHS Submit Documents to the Home Help Policy Section (approval within 30 days)
- MDHHS Electronic Visit Verification
- MDHHS EVV Impacted Programs
- MDHHS MI Choice Waiver Program (waiver agencies by region)
- MDHHS Certificate of Need
- MDHHS Certificate of Need Review Standards (covered clinical services)
- LARA Bureau of Survey and Certification, Home Health Agencies
- LARA Bureau of Survey and Certification, Hospice Agencies and Residences
- LARA BCHS Non Long Term Care State Licensing (hospice licensure, fees, CON exclusion, criminal history checks)
- LARA Michigan Workforce Background Check (covered providers)
- LARA Workforce Background Check, Information and Provider Responsibilities (October 2026)
- LARA Workforce Background Check FAQ brochure
- Michigan Treasury New Business Registration
- LEO Earned Sick Time Act FAQ
- CMS Provider Enrollment Moratoria (HHAs and hospices, May 13, 2026)
- Federal Register 2026-09717, moratorium on Medicare enrollment of home health agencies
- Federal Register 2026-09718, moratorium on Medicare enrollment of hospices
- 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)
This guide is general information and reflects Michigan requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Michigan Department of Health and Human Services, the Michigan Department of Licensing and Regulatory Affairs 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.