How to start a home care agency in Minnesota and reach your first client faster
Minnesota licenses nonmedical home care. Helping a client bathe, dress or take medication reminders needs a Minnesota Department of Health license, and that license starts as a temporary one. You earn the full license only after you serve real clients and pass an MDH survey. Meanwhile the Department of Human Services has frozen new Medicaid enrollment for several home and community services, and CMS paused new Medicare home health and hospice enrollment in 2026. 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 Minnesota rulesMinnesota Statutes 144A.43 to 144A.4799 and MSHO and MSC+ provider manuals
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Minnesota requires.
Nonmedical home care for Elderly Waiver members
- State license
- MDH basic or comprehensive home care license (Minn. Stat. 144A.471)
- Who you deal with
- MDH, DHS Minnesota Health Care Programs provider enrollment, and the MSHO and MSC+ health plans in your counties
- Must haves
- MDH license, MHCP enrollment for services still open to new providers, health plan contracts, DHS background studies, EVV for in scope services
- Realistic time to first client
- Several months or more; CFSS and several waiver services are frozen to new providers
Orientation for Minnesota only. We confirm your exact path on the free call.
Three places new Minnesota agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
A license you only finish by opening
MDH issues a temporary license first. You must start serving clients, tell MDH within five days, and pass a survey within 90 days before you get the full basic or comprehensive license. If you serve no clients during the temporary license period, the license expires and you must apply again.
What it costs: A lapsed temporary license costs the nonrefundable $2,100 or $4,200 fee and months of waiting.
Medicaid doors closed to new agencies
In 2026 DHS froze new Medicaid enrollment for a list of high risk services that included Community First Services and Supports (CFSS), adult companion services, individualized home supports and night supervision, and paused new 245D home and community based services licenses through December 31, 2027. Owners who budget on these programs find they cannot enroll.
What it costs: Months of payroll and rent with no Medicaid revenue if the business plan depended on a frozen service.
Applying at the wrong license level
The license level follows the tasks your staff perform. A basic license covers assistive tasks and medication reminders. Hands on help with transfers, medication management and delegated nursing tasks all need the comprehensive license, and basic licensees cannot become Medicare certified.
What it costs: Turned down clients, correction orders at survey, or a second fee to move up a level.
What does a delay cost your agency?
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Home care vs home health vs hospice in Minnesota
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 dressing, bathing, grooming, toileting and eating, standby assistance, medication and treatment reminders, household tasks alongside those services | Nursing, therapies, medication management, delegated tasks, hands on transfer help; Medicare home health under physician or allowed practitioner orders | Palliative and supportive care for people who are terminally ill, and their families |
| State license | MDH basic home care license (Minn. Stat. 144A.471, subd. 6) | MDH comprehensive home care license (Minn. Stat. 144A.471, subd. 7) | MDH hospice license (Minn. Stat. 144A.753; Minn. R. ch. 4664) |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step |
| Main payers | Private pay, long term care insurance, Elderly Waiver through MSHO and MSC+ plans for services still open to new providers | Medicare, Medical Assistance and its health plans (Medicare certified agencies), commercial insurance | Medicare hospice benefit, Medical Assistance |
| Medicare | Not covered | Full comprehensive license, certification survey, then Medicare enrollment | MDH license, certification survey, then Medicare enrollment |
| Key staff | Managerial official in charge of day to day operations; trained and competency evaluated caregivers | Named RN, RN led training and supervision of unlicensed staff; administrator and clinical manager for Medicare | Physician medical director, interdisciplinary team, trained volunteers |
| Startup capital | Lowest, but covers months on a temporary license | Higher: RN payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Months: temporary license, first clients, survey | Longest: full license, certification survey, enrollment | Longest: licensure, survey, enrollment |
Many Minnesota owners start with a basic license, build cash flow with private pay clients, then add skilled services. Moving from basic to comprehensive before your first survey only costs the fee difference, but after that it means more policies, an RN and new training. Only a full comprehensive licensee that has passed its initial survey can apply for Medicare certification. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Minnesota requirements at a glance
| Licensing agency | Minnesota Department of Health (MDH), Health Regulation Division, Home Care Program |
|---|---|
| License | Basic or comprehensive home care license under Minn. Stat. 144A.43 to 144A.4799, issued first as a temporary license for up to one year |
| Home management only | Housekeeping, meal preparation and shopping alone need MDH registration under Minn. Stat. 144A.482, not a license |
| Hospice | Separate MDH hospice license under Minn. Stat. 144A.75 to 144A.755 and Minn. R. ch. 4664 |
| Fees | $2,100 basic or $4,200 comprehensive initial fee, nonrefundable; annual renewal from $231 to $7,651 based on revenue (Minn. Stat. 144A.472, subd. 7) |
| Background studies | DHS background studies with fingerprints and a photo through NETStudy 2.0 for owners, managerial officials and the named RN before licensure, and for staff (Minn. Stat. 144A.476 and 144.057) |
| Caregiver training | Orientation before services, training and competency evaluation, and at least 8 hours of training every 12 months (Minn. Stat. 144A.4795 and 144A.4796) |
| Medicaid route | DHS Minnesota Health Care Programs enrollment; Elderly Waiver through MSHO and MSC+ health plans; CFSS and several waiver services frozen to new providers in 2026 |
| Electronic visit verification | Required for CFSS, PCA and home health services; DHS uses HHAeXchange at no cost, and providers with another EVV system must still enroll with it |
| Certificate of Need | None for home care, home health or hospice; Minnesota repealed its Certificate of Need program in 1984 |
Summary of Minnesota requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Minnesota
The order matters. Staff, policies and workers' compensation must be ready before you apply, because the survey clock starts with your first client and a temporary license that never serves anyone simply expires.
Form the business with the Secretary of State
File your LLC or corporation with the Minnesota Secretary of State, get an EIN, a Minnesota Tax ID for payroll withholding from the Department of Revenue, and an unemployment insurance account with DEED. MDH asks for the legal name exactly as filed and IRS form 147-C.
You do this; we give you the checklistChoose your license level and payer mix
Basic covers assistive tasks and medication reminders. Comprehensive adds nursing, medication management, delegation and hands on transfer help. Decide private pay first or Medical Assistance too, knowing which Medicaid services are frozen. Use the path finder above.
Decided on your free consultationSet up insurance and employment basics
MDH withholds the license until you show active workers' compensation coverage, so buy it before you apply. Add liability and auto coverage, and build Minnesota earned sick and safe time (one hour per 30 hours worked) and Paid Leave premiums, which began January 1, 2026, into payroll.
You do this; we specify what is requiredWrite policies to Minnesota Statutes chapter 144A
The application has you confirm policies on maltreatment reporting, background studies, orientation and training, complaints, client evaluations, the home care bill of rights, infection control, medication reminders and TB screening. A named managerial official attests to understanding the rules.
We write this for youApply for the temporary license
Upload the application and attachments in the MDH licensing portal. MDH requests the fee once the file is complete, then sends background study instructions for owners, managerial officials and the named RN. MDH says it decides within 60 days of a complete application.
We prepare the applicationBuild the caregiver pipeline
Run a DHS background study through NETStudy 2.0 for each hire, give orientation before any visit, complete training and competency evaluation, and track at least 8 hours of training every 12 months.
We set up the system and trackerServe your first clients and pass the survey
Notify MDH within five days of starting services. MDH surveys within 90 days of that notice. Substantial compliance earns the full basic or comprehensive license; problems can mean an extension with conditions or termination.
We get you ready for the surveyAdd Medical Assistance where it is open
Enroll with Minnesota Health Care Programs through the MPSE portal for services still open to new providers, then contract with the MSHO and MSC+ plans serving your counties for Elderly Waiver members. DHS has reported an enrollment backlog in 2026.
We prepare every plan's packetSet up electronic visit verification
DHS requires EVV for in scope services such as CFSS, PCA and home health visits. HHAeXchange is free; if you choose another EVV system, you still enroll with HHAeXchange and connect your system to it.
We walk you through setup
Caregiver training, competency and background studies
Minnesota has no separate state certificate for home care aides. Instead, Minnesota Statutes 144A.4795 and 144A.4796 require every licensed provider to orient, train and test its own staff, and to keep proof in each employee record.
- Orientation before the first visit: Covers the licensing statutes, your policies, emergencies, maltreatment reporting, the home care bill of rights, complaints, advocacy services and the services the worker will provide. It is done once per provider and does not transfer between agencies.
- Basic license training: Unlicensed staff complete a training and competency evaluation, or pass a written or oral test plus a practical skills test, on 15 topics including infection control, personal hygiene, fall prevention, standby assistance and medication reminders. Trainers need home care experience and training.
- Comprehensive license training: An RN, or an instructor working with the RN, trains and tests unlicensed staff who perform delegated tasks, adding vital signs, safe transfers, range of motion and medication administration. Medicare home health aide or nursing assistant training also qualifies.
- Delegated tasks: Staff must show they can perform each delegated task before it is assigned, receive direct supervision within 30 days of starting delegated tasks, and show competency again after 24 months without performing a task.
- Annual training: At least 8 hours for every 12 months of employment, including maltreatment reporting, the home care bill of rights, infection control and your policies. Staff serving clients with Alzheimer's or related disorders need added training on the disease and communication.
- Background studies: DHS runs background studies through NETStudy 2.0, with fingerprints and a photo taken by its vendor. Owners, managerial officials and the named RN must pass before MDH issues the temporary license; after that, every paid or volunteer staff member is studied under Minn. Stat. 144.057.
- Health licensing board exception: Since August 1, 2022, professionals with a valid health licensing board license who had a criminal background check under Minn. Stat. 214.075 do not need a separate NETStudy 2.0 study.
Six mistakes that slow Minnesota agencies down
We look for every one of these in the first week of an engagement.
Applying for basic, then providing comprehensive services
- What it costs
- Medication management, hands on transfers or delegated tasks under a basic license bring correction orders at survey.
- How we prevent it
- Your first call maps every service you plan to offer to the right license level.
Letting the temporary license expire unused
- What it costs
- No clients during the temporary license period means it expires, the fee is gone and you apply again.
- How we prevent it
- A launch plan that lines up staff and first private pay clients before the license arrives.
Missing the five day notice
- What it costs
- MDH can fine $1,000 for failing to notify it within five days of starting services, and the survey clock depends on that notice.
- How we prevent it
- A tracker that flags the notice date the day your first client starts.
Building the budget on frozen Medicaid services
- What it costs
- CFSS and several waiver services were closed to new providers in 2026, and new 245D licenses are paused through 2027.
- How we prevent it
- We check what DHS currently allows on your first call and plan private pay and Elderly Waiver routes around it.
Applying without workers' compensation in force
- What it costs
- MDH will not issue a license on an insurance application; it needs active coverage with you listed as the insured.
- How we prevent it
- A prefiling checklist with every attachment MDH asks for, including IRS form 147-C.
Skipping documented competency testing
- What it costs
- Surveyors look for orientation, training and competency records in each employee file before a caregiver works alone.
- How we prevent it
- Training and competency forms built into your hiring tracker from the first hire.
In a free 30 minute call we confirm your Minnesota path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Minnesota 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.
- Minnesota path and a dated launch plan
- Policy and procedure manual written to Minnesota Statutes 144A.43 to 144A.4799 and MSHO and MSC+ provider manuals
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Elderly Waiver ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Elderly Waiver requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for each MSHO and MSC+ health plan in your counties
- Survey and audit readiness
- Minnesota city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to MDH 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 Minnesota 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 Minnesota Statutes 144A.43 to 144A.4799 and MSHO and MSC+ provider manuals |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for each MSHO and MSC+ health plan in your counties 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 Minnesota home care startup checklist
Every Minnesota 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 license level (basic or comprehensive) and payer mix
- Form your LLC or corporation with the Minnesota Secretary of State
- Get an EIN (keep IRS form 147-C for MDH) and a Minnesota Tax ID for withholding
- Register for an unemployment insurance account with DEED
- Buy workers' compensation before applying, plus liability and auto coverage
- 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 Minnesota
- 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 Minnesota cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Elderly 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 Minnesota
| Item | Notes |
|---|---|
| MDH initial license fee | $2,100 for a temporary basic license or $4,200 for a temporary comprehensive license, nonrefundable (Minn. Stat. 144A.472, subd. 7). Moving from basic to comprehensive before the survey costs the difference. |
| Annual renewal | Based on the prior year's home care revenue, from $231 (up to $25,000) to $7,651 (above $1,500,000). You may pay the top fee instead of reporting revenue. |
| HCBS designation (optional) | $155 initial fee, then $40 to $320 a year based on revenue (Minn. Stat. 144A.484), for home care licensees adding basic support services. |
| Hospice license | Fee based on annual revenue, from $150 to $6,000 (Minn. Stat. 144A.753). Check current fees with MDH. |
| Background studies | A DHS study fee per person in NETStudy 2.0, plus a separate fingerprint and photo fee paid to the vendor |
| Entity formation | Secretary of State filing fee for your LLC or corporation and any assumed name |
| Insurance | Workers' compensation (required before licensure), liability, auto coverage |
| Payroll costs | Minnesota Paid Leave premiums from January 1, 2026, unemployment insurance and earned sick and safe time |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees, if you choose accreditation over the state survey |
| Operating reserve | Covers payroll, rent and insurance through the temporary license, the survey and any Medicaid or Medicare enrollment wait |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Minnesota
Months: MDH says it decides within 60 days of a complete application, then you serve clients on the temporary license and MDH surveys within 90 days of your notice.
Several months or more after licensure: MHCP enrollment, which DHS says is backlogged in 2026, then health plan contracting. Frozen services are not available at all until DHS reopens them.
Longest: full license after the initial survey, a certification survey and Medicare enrollment, which CMS paused for new agencies from May 13, 2026.
The Twin Cities metro holds the most home care agencies and the most competition for private pay clients and health plan referrals. Greater Minnesota, around Rochester, St. Cloud, Duluth, Mankato and smaller towns, covers long distances, so reliable staffing and travel planning become your selling point. Families often search by suburb or city, such as Bloomington, Edina, Woodbury or Maple Grove, and many adult children search for care for a parent from out of town, which makes a complete Google Business Profile and clear city pages matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Minnesota?
Yes, if your staff help clients with tasks such as bathing, dressing, grooming, toileting or medication reminders. MDH issues a basic home care license under Minnesota Statutes 144A.471. Agencies that only provide at least two of housekeeping, meal preparation and shopping register with MDH under section 144A.482 instead.
What is the difference between a basic and a comprehensive home care license?
A basic license covers assistive tasks, standby assistance, medication and treatment reminders and household help alongside those tasks. A comprehensive license adds nursing and therapy services, medication management, delegated tasks, hands on transfer and mobility help and complex care. Only comprehensive licensees can become Medicare certified home health agencies.
How much does a Minnesota home care license cost?
The nonrefundable initial fee is $2,100 for a basic license and $4,200 for a comprehensive license. Annual renewal fees depend on the prior year's home care revenue, from $231 to $7,651.
How long does it take to get a home care license in Minnesota?
MDH says it decides on the temporary license within 60 days of a complete application. You then serve clients, notify MDH within five days, and MDH surveys within 90 days of that notice. The full license follows a survey in substantial compliance, so plan for several months.
Can a new agency bill Medicaid for personal care in Minnesota?
Not through CFSS right now. DHS froze new Medicaid enrollment for high risk services including CFSS in early 2026, and CMS approved extending the freeze for most of those services through January 27, 2027. Elderly Waiver services through MSHO and MSC+ plans may still be an option for services that are not frozen.
Does Minnesota require a Certificate of Need for home health or hospice?
No. Minnesota repealed its Certificate of Need program as of June 30, 1984, and replaced it with a hospital construction moratorium. Home care, home health and hospice need MDH licensure, not a need review.
Can I open a Medicare home health agency in Minnesota right now?
You can get licensed, but new Medicare enrollment was paused. CMS imposed a six month nationwide moratorium on new home health and hospice enrollment from May 13, 2026, set to end around November 13, 2026 unless CMS extends it. It may have ended or been extended, so check before you file. You also need a full comprehensive license first.
Do Minnesota home care aides need a state certificate?
No state aide certificate is required for licensed home care. Unlicensed staff must complete orientation, pass training and competency evaluation, and take at least 8 hours of training every 12 months. On a comprehensive license, an RN leads training for staff who perform delegated tasks.
How much does Minnesota home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Medical Assistance 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 Minnesota?
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 (47)
- MDH State Licensed Home Care Providers (updated 07/15/2026)
- MDH Starting a home care agency: application materials
- MDH Forms for home care providers (licensing portal, HCBS designation, home management registration)
- MDH Application for Licensure: Temporary Comprehensive Home Care (fee, attachments, background studies, workers' compensation)
- MDH Medicare certified home health agencies
- MDH Hospice licensing and certification
- Minn. Stat. 144A.43, definitions
- Minn. Stat. 144A.471, license required, basic and comprehensive, exemptions
- Minn. Stat. 144A.472, application and fees
- Minn. Stat. 144A.473, temporary license and survey
- Minn. Stat. 144A.475, enforcement
- Minn. Stat. 144A.476, background studies of owners and managerial officials
- Minn. Stat. 144A.4791, service plans and client reviews
- Minn. Stat. 144A.4795, training and competency of unlicensed personnel
- Minn. Stat. 144A.4796, orientation and annual training
- Minn. Stat. 144A.4797, supervision of staff
- Minn. Stat. 144A.482, home management registration
- Minn. Stat. 144A.484, integrated license and HCBS designation
- Minn. Stat. 144A.752, regulation of hospice care
- Minn. Stat. 144A.753, hospice licensure and fees
- Minn. Stat. 144.057, background studies for MDH licensed providers
- Minn. Stat. 245C.05, fingerprints and photograph for background studies
- Minn. Stat. 245A.03, licensing moratorium authority (subd. 7a)
- Minn. Stat. 256B.85, Community First Services and Supports
- Minn. Stat. 256B.0653, home health agency services under Medical Assistance
- Minn. Stat. 256B.69, prepaid Medical Assistance and Minnesota Senior Health Options
- Minn. Stat. 256S.02, Elderly Waiver definitions (age 65 and older, managed care organizations)
- Minn. Stat. 256S.20, customized living provider requirements
- Minn. Stat. 181.9446, earned sick and safe time accrual
- Minn. Stat. 268B.14, Paid Leave premiums from January 1, 2026
- Minn. Stat. 268.042, unemployment insurance employer registration
- Minnesota Department of Revenue, Minnesota Tax ID requirements
- DHS news release, freeze on provider enrollment for 13 Medicaid services (January 8, 2026)
- DHS bulletin, temporary moratorium on high risk providers extended through January 27, 2027 (July 10, 2026)
- DHS news release, pause extended for 12 high risk services; HCBS licensing paused through December 31, 2027 (July 15, 2026)
- DHS MHCP Provider Connect, enrollment backlog (September 28, 2026)
- DHS bulletin, EVV compliance enforcement from September 1, 2024 and HHAeXchange enrollment
- DHS bulletin, fingerprint based background studies through NETStudy 2.0 (2020)
- Federal Register, nationwide temporary moratoria on enrollment of home health agencies (CMS-6101-N, 91 FR 27954)
- Federal Register, nationwide temporary moratorium on enrollment of hospices (CMS-6102-N, 91 FR 27946)
- Minnesota House Research, Minnesota's Hospital Construction Moratorium (January 2023), Certificate of Need repeal
- Minnesota House, new law summary 2026 chapter 121 (Medicaid program integrity)
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- CMS-855A Medicare enrollment application, institutional providers
- HHAeXchange Minnesota info hub (vendor page: in scope services, no cost state system)
- HomeCare magazine, Minnesota HCBS licensing pause (secondary, pointer only)
This guide is general information and reflects Minnesota requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Minnesota Department of Health, the Minnesota Department of Human Services 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.