How to start a home care agency in Oklahoma and reach your first client faster
Oklahoma licenses almost everything in home care. Personal care, skilled care and even companion or sitter services need an OSDH license, and it is unlawful to advertise those services first. The application needs a certified home care administrator, a supervising RN and an alternate, insurance, proof of funds and a real office, and then you wait for an initial survey. ADvantage clients add OHCA and ADvantage certification on top. 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 Oklahoma rulesOAC 310:662, the Home Care Act and ADvantage service standards
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Oklahoma requires.
Personal care for ADvantage members
- State license
- OSDH home care agency license (OAC 310:662), then ADvantage provider certification and a SoonerCare provider agreement
- Who you deal with
- OSDH, the Oklahoma Health Care Authority (OHCA), and the ADvantage Administration at Oklahoma Human Services
- Must haves
- OSDH license, SoonerCare provider agreement with OHCA, ADvantage certification, certified home health aides, OKSCREEN background checks, the statewide EVV system
- Realistic time to first client
- Several months
Orientation for Oklahoma only. We confirm your exact path on the free call.
Three places new Oklahoma agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
No certified administrator, no license
The Home Care Act makes it a misdemeanor to serve as a home care agency administrator without OSDH certification, and the license application asks for proof of it. The usual route is a 160 hour preparedness course and the OHCAPA exam. Owners who leave this until the paperwork is done find the whole application waiting on one person.
What it costs: Weeks or months added to your start date before OSDH will even queue your survey.
An office, a nurse and money in the bank before the survey
OSDH says an agency cannot be located in a home, and the rules require a place of business in Oklahoma that is open to the public. The application also needs a supervising RN or physician and an alternate, liability insurance of at least $100,000 per occurrence, workers' compensation and proof of funds in the agency's own name. Your agency must be ready for business on the day of the initial survey.
What it costs: Rent, insurance and nurse time paid for months before your first client.
Aides who age out at four months
Oklahoma counts anyone giving personal care for a fee as a home health aide. No agency may keep someone in that role for more than four months unless they are certified and listed on the OSDH registry, which takes a 75 hour training program and a competency exam. Background checks through OKSCREEN have to clear before they start.
What it costs: A client you suddenly cannot staff, and a caregiver who may take another offer while they finish training.
What does a delay cost your agency?
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Home care vs home health vs hospice in Oklahoma
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 (dressing, bathing, walking, exercise), homemaker help; companion or sitter services with no hands on care | Skilled nursing and therapy ordered by a physician, plus home health aide services | Palliative and supportive care for people who are terminally ill, and their families |
| State license | OSDH home care agency license (OAC 310:662); sitter or companion service license for companion only care | OSDH home care agency license with skilled services (OAC 310:662) | OSDH hospice license (OAC 310:661) |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step |
| Main payers | Private pay, ADvantage and SoonerCare State Plan personal care, long term care insurance | Medicare, SoonerCare, commercial insurance | Medicare hospice benefit, SoonerCare |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment | Accreditation or state survey, then Medicare enrollment |
| Key staff | Certified home care administrator, supervising RN or physician and an alternate (can be on call for personal care only), certified home health aides | Certified home care administrator, supervising RN or physician and an alternate, licensed clinical staff | Administrator, physician medical advisor, RN patient care coordinator, interdisciplinary team |
| Startup capital | Moderate: office, insurance and nurse time before the survey | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Months: administrator, license and survey first | Longest: licensure, survey, enrollment | Longest: licensure, survey, enrollment |
In Oklahoma one OSDH home care agency license covers both personal care and skilled home health, so many owners start with personal care, then add skilled services and Medicare later under the same license. The administrator, supervising nurse and office you set up on day one carry over. We plan both from the start so your policies and hiring grow with you instead of being rewritten.
Oklahoma requirements at a glance
| Home care license | Required for skilled or personal care in the home: OSDH home care agency license under the Home Care Act (63 O.S. § 1-1960 et seq.) and OAC 310:662 |
|---|---|
| Companion and sitter services | Licensed too: a sitter or companion service license (63 O.S. § 1-1972; OAC 310:662 Subchapter 8), or added to a home care agency license |
| Licensing office | OSDH Medical Facilities Service, Home Services Division, which also licenses hospices (OAC 310:661) |
| Administrator | Must hold OSDH home care administrator certification (63 O.S. § 1-1962a; OAC 310:664), renewed every July 31 |
| Medicaid | Oklahoma Health Care Authority (OHCA) runs SoonerCare; the ADvantage waiver is certified by the ADvantage Administration at Oklahoma Human Services |
| Caregiver training | Home health aides certified and on the OSDH registry within four months of hire; training programs are at least 75 hours; 12 hours of in service training a year |
| Background screening | Fingerprint based checks and registry screening through OKSCREEN, the Oklahoma National Background Check Program, under the criteria in 63 O.S. § 1-1950.1 |
| Electronic visit verification | Required for SoonerCare personal care through the statewide EVV system or a third party system; the state system is moving from AuthentiCare to Acumen DCI |
| Certificate of Need | None for home care, home health or hospice; Oklahoma's program covers nursing facilities and psychiatric and chemical dependency facilities |
| Entity filing | Oklahoma Secretary of State, plus a trade name report for any DBA |
Summary of Oklahoma requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Oklahoma
The order matters. Start the administrator certification and caregiver training first, because the OSDH application needs proof of a certified administrator and the agency must be fully ready on the day of the initial survey. ADvantage certification comes after the license.
Decide your license and payer mix
A home care agency license covers personal care and skilled care; a sitter or companion service license covers only care with no hands on help. Private pay, ADvantage or both. Use the path finder above.
Decided on your free consultationGet your administrator certified
Complete an OSDH approved 160 hour preparedness program and pass the OHCAPA exam, or qualify through the deeming criteria (for example an Oklahoma RN with one year of full time home care experience in the last two years). Apply for the certificate within six months of passing.
You do this; we specify what is requiredForm the business and secure an office
Register your LLC or corporation with the Oklahoma Secretary of State, file a trade name report for any DBA, get an EIN and register for state withholding and unemployment insurance. Lease an office in Oklahoma that is open to the public; OSDH does not license agencies located in a home.
You do this; we give you the checklistName your nurses, insure and fund the agency
Engage a supervising RN or physician and a written alternate. Buy liability insurance of at least $100,000 per occurrence and $300,000 aggregate plus workers' compensation, and open a bank account or line of credit in the agency's name as proof of funds.
You do this; we specify what is requiredWrite policies to OAC 310:662
Client rights, standards of practice, in home assessments, plans of care, supervisory visits (at least every six months for personal care only, every 60 days with skilled care), personnel and health screening, clinical records and quality improvement.
We write this for youApply to OSDH and pass the initial survey
Mail ODH Form 757 with the $1,000 fee, ownership disclosures, six month staffing and visit projections and every attachment at least 30 days before you plan to open. Complete applications are queued for an initial survey, and you cannot serve clients until the license is issued.
We prepare the applicationBuild the caregiver pipeline
Run every new hire through OKSCREEN for fingerprint and registry checks, confirm registry status, and get each aide certified as a home health aide within four months of hire. Schedule 12 hours of in service training a year.
We set up the system and trackerEnroll with SoonerCare and get ADvantage certified
Sign a SoonerCare provider agreement with OHCA and start ADvantage certification through the online intake form on the Oklahoma Human Services ADvantage page. Certification is by county, and each member's case manager authorizes your services.
We prepare and manage itSet up electronic visit verification
OHCA requires personal care visits to be recorded in the statewide EVV system or an approved third party system. The state system is moving from AuthentiCare to Acumen's DCI, so set up on the current platform before your first ADvantage visit.
We walk you through setup
Home health aide certification and background checks
The Home Care Act treats anyone who gives personal care for a fee as a home health aide. OAC 310:662-5-3 lets an agency use an uncertified aide for no more than four months; after that the aide must be certified and listed on the OSDH Nurse Aide and Nontechnical Services Worker Registry, unless they are a licensed health professional.
- Training program: OAC 310:677-9-4 requires a home health aide training program of at least 75 hours, including at least 16 hours of classroom training before at least 16 hours of supervised practical training, followed by a competency exam.
- Four month window: An aide can work while finishing training and testing, but no longer than four months from hire without certification and registry placement.
- In service training: At least 12 hours every calendar year plus an annual performance review for each aide (OAC 310:677-9-1).
- Transfers and reciprocity: Aides on another state's home care aide registry can apply for the Oklahoma registry. A long term care aide can move to home care after passing an OSDH approved home care skills exam and 16 hours of orientation.
- Background checks: Fingerprint based criminal history checks and registry screening through OKSCREEN, using the disqualifying offenses in 63 O.S. § 1-1950.1. The provider pays $19 and the applicant $10 for fingerprinting.
- Registries: Screen every hire against the OSDH nurse aide registry. The Home Care Act also bars agencies from employing supportive home assistants listed on the Oklahoma Human Services Community Services Worker Registry.
- Supervision: A physician or licensed nurse visits personal care only clients at least every six months; with skilled care an RN visits at least every 60 days.
- Companion and sitter staff: Need criminal background checks that meet the certified nurse aide criteria and a designated supervisor, but no hands on care is allowed under that license.
Six mistakes that slow Oklahoma agencies down
We look for every one of these in the first week of an engagement.
Serving clients before the license is issued
- What it costs
- OSDH says it is a violation that carries an administrative penalty of up to $10,000.
- How we prevent it
- A step by step plan that keeps marketing and client intake behind the license date.
Leaving the administrator certification until last
- What it costs
- The application cannot be completed without proof of a certified administrator, so the survey queue never starts.
- How we prevent it
- Your first call ends with the fastest route to certification for your administrator.
Running the agency from a home office
- What it costs
- OSDH does not license agencies located in a home, so the application comes back.
- How we prevent it
- We confirm your office meets the place of business rule before you sign a lease.
Assuming companion care needs no license
- What it costs
- Advertising or providing companion or sitter services without a license is a misdemeanor under 63 O.S. § 1-1972.
- How we prevent it
- We match your services to the right license, or add companion services to your home care license.
Keeping an uncertified aide past four months
- What it costs
- An aide who is not on the registry by month four must stop giving personal care.
- How we prevent it
- A tracker that flags training, testing, registry status and in service hours for every aide.
Missing the July 31 renewals
- What it costs
- The agency license and the administrator certificate both expire every July 31, and OSDH asks for renewals by June 30.
- How we prevent it
- We set renewal and continuing education reminders from day one.
In a free 30 minute call we confirm your Oklahoma path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Oklahoma 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.
- Oklahoma path and a dated launch plan
- Policy and procedure manual written to OAC 310:662, the Home Care Act and ADvantage service standards
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
ADvantage ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to ADvantage requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for OHCA (SoonerCare provider agreement) and the ADvantage Administration
- Survey and audit readiness
- Oklahoma city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to OSDH 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 Oklahoma 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 OAC 310:662, the Home Care Act and ADvantage service standards |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for OHCA (SoonerCare provider agreement) and the ADvantage Administration 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 Oklahoma home care startup checklist
Every Oklahoma 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 (home care agency or sitter or companion) and payer mix
- Start administrator certification: OHCAPA course and exam, or the deeming route
- Form your LLC or corporation with the Oklahoma Secretary of State and file any trade name report
- Get an EIN and register for state withholding and unemployment insurance
- Lease an office in Oklahoma that is open to the public (not in a home)
- 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 Oklahoma
- 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 Oklahoma cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, ADvantage, 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 Oklahoma
| Item | Notes |
|---|---|
| OSDH home care agency license | $1,000 initial license and application fee, nonrefundable (ODH Form 757 and OAC 310:662-2-1). $500 annual renewal; $25 per branch. Renewals are prorated at $125 a quarter to expire July 31. |
| Sitter or companion service license | $1,000 initial and $500 renewal (63 O.S. § 1-1972; ODH Form 1273). |
| Hospice license | $2,000 initial and $2,000 renewal, $500 per alternate administrative office (ODH Form 924). Check current fees with OSDH. |
| Administrator certification | OHCAPA course tuition set by each approved provider, then $140 for initial certification ($80 for a deeming or provisional application) and $55 a year to renew. |
| Background checks | OKSCREEN fingerprinting: $19 paid by the provider and $10 paid by the applicant. |
| Aide training and testing | Training program tuition and competency exam fees per aide, plus yearly in service training |
| Office and insurance | A public place of business in Oklahoma, liability insurance at or above the $100,000 and $300,000 minimums, workers' compensation |
| Supervising nurses | Salaried or contracted RN or physician time for the supervisor and alternate |
| EVV and scheduling software | The state system or a third party system for SoonerCare personal care visits |
| Operating reserve | Covers rent, insurance and payroll while the OSDH survey, ADvantage certification or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Oklahoma
Months: administrator certification, the OSDH application, and the initial survey, which is scheduled in the order complete applications are received.
Several months: the OSDH license first, then a SoonerCare provider agreement and ADvantage certification by county.
Longest: OSDH licensure, a certification survey and Medicare enrollment, which CMS has paused for new home health agencies and hospices since May 13, 2026.
Oklahoma's demand is split between the Oklahoma City and Tulsa metro areas and a large rural map of small towns. The OSDH application lets you choose your service area county by county, so many owners start with the counties near their office and add more later through a change of information. ADvantage certification is also by county, which lets you grow Medicaid referrals one area at a time. Families often search by city or suburb, such as Edmond, Norman, Broken Arrow or Lawton, so a complete Google Business Profile and clear city pages matter.
Frequently asked questions
Do you need a license to start a home care agency in Oklahoma?
Yes. Any agency providing skilled or personal care in the client's home needs an OSDH home care agency license under the Home Care Act and OAC 310:662. Companion and sitter services also need an OSDH license, either their own or added to a home care agency license.
How much is an Oklahoma home care agency license?
OSDH charges a nonrefundable $1,000 initial license and application fee, $500 a year to renew and $25 per branch. A sitter or companion service license is $1,000, then $500 to renew. Budget separately for administrator certification, insurance, an office and nurse supervision.
Does the administrator need to be certified?
Yes. Under 63 O.S. § 1-1962a it is a misdemeanor to serve as a home care agency administrator without OSDH certification. Most candidates complete a 160 hour preparedness program and pass the OHCAPA exam; some, such as Oklahoma RNs with recent home care experience, qualify to go straight to the exam.
Can I run an Oklahoma home care agency from my house?
No. OSDH's application instructions say an agency cannot be located in a home, and OAC 310:662-2-1 requires a place of business in Oklahoma that is accessible to the public.
Do caregivers need certification in Oklahoma?
Caregivers who give personal care count as home health aides and must be certified and on the OSDH registry within four months of hire. Training programs are at least 75 hours, followed by a competency exam. Every worker also needs background and registry checks through OKSCREEN.
How do Oklahoma home care agencies get ADvantage clients?
After the OSDH license, the agency signs a SoonerCare provider agreement with the Oklahoma Health Care Authority and becomes certified by the ADvantage Administration at Oklahoma Human Services for the counties it serves. ADvantage members are not in SoonerSelect managed care, so there are no health plan contracts; each member's case manager authorizes services.
Does Oklahoma require a Certificate of Need for home health or hospice?
No. Oklahoma's Certificate of Need program covers nursing facilities and psychiatric and chemical dependency facilities. Home health and hospice still need OSDH licensure, and Medicare certification if you plan to bill Medicare.
Can a new Oklahoma home health agency or hospice enroll in Medicare right now?
CMS imposed a six month nationwide moratorium on new Medicare enrollment of home health agencies and hospices starting May 13, 2026. It was due to end around November 13, 2026 unless CMS extends it, so it may have ended or been extended. You can still get your OSDH license in the meantime.
Is a franchise a better way to start a home care agency in Oklahoma?
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.
Do you only work in Oklahoma?
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 (33)
- OSDH Home Services Division (statutes, rules, contacts, 2026 Chapter 662 rule consultation)
- OSDH Home Services licensure applications and forms
- OSDH Home Care Application Guidance letter ($1,000 fee, attachments, survey, Medicare steps)
- ODH Form 757, Application for License to Operate a Home Care Agency (12/2020)
- OSDH Companion Sitter Application Guidance letter
- ODH Form 1273, Sitter or Companion Service Agency application (12/2020)
- ODH Form 924, Application for License to Operate a Hospice (12/2020)
- OSDH Home Care License Renewal letter
- Home Care Act, 63 O.S. § 1-1960 et seq. (OSDH unofficial version, as amended in 2013)
- OSDH Home Care Administrator Registry (OHCAPA, deeming, fees, CE)
- OSDH Nurse Aide Registry (aide types, HHA training program forms)
- OSDH HHA Curriculum Checklist (OAC 310:677-9-4, 75 hours)
- OSDH Oklahoma National Background Check Program (OKSCREEN, fees)
- OSDH Health Resources Development Service (Certificate of Need scope)
- OAC 310:662-2-1, licensure (Cornell LII)
- OAC 310:662-3-4, organization (Cornell LII)
- OAC 310:662-5-3, services provided and supervision (Cornell LII)
- OAC 310:662-5-1, initiation of services (Cornell LII)
- OAC 310:677-9-1 and 9-2, home health aides (Cornell LII)
- OAC 310:661-2-2 and 3-2, hospice applications and organization (Cornell LII)
- OAC 310:2-29-3, background check implementation (Cornell LII)
- OHCA OAC 317:30-5-950, agency personal care eligible providers (revised 09-01-25)
- OHCA OAC 317:30-5-761, ADvantage eligible providers (revised 09-01-24)
- OHCA OAC 317:35-17-21.1, ADvantage provider certification
- OHCA OAC 317:35-17-3, ADvantage program services (revised 09-01-26)
- OHCA OAC 317:55-3-1, SoonerSelect mandatory, voluntary and excluded populations (revised 09-01-2026)
- OHCA Electronic Visit Verification page
- OHCA Provider Newsletter, June 2026 (EVV transition to Acumen DCI)
- Oklahoma Human Services ADvantage Administration
- Federal Register 2026-09717, nationwide moratorium on HHA enrollment (effective May 13, 2026)
- Federal Register 2026-09718, nationwide moratorium on hospice enrollment
- 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 Oklahoma requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Oklahoma State Department of Health, the Oklahoma Health Care Authority, Oklahoma 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.