How to start a home care agency in Oregon and reach your first client faster
Oregon licenses nonmedical home care. Any agency that schedules or places caregivers needs an in-home care agency license from the Oregon Health Authority, in one of four classifications, and OHA said in 2025 that initial applications were taking six to nine months. Choose the wrong class and Medicaid stays closed, because ODHS enrolls only Comprehensive agencies. Policies, training records and a fully trained caregiver must be ready for the survey. 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 Oregon launch plan
A 30 minute call. No obligation.
- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Oregon rulesOAR 333-536 and the ODHS in-home care agency rules in OAR 411-033
- Local search marketingGoogle Business Profile and local search
- All 50 states and DCExpand beyond Oregon with us
Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Oregon requires.
Nonmedical home care for APD Medicaid clients
- State license
- OHA in-home care agency license, Comprehensive classification only (OAR 333-536-0007; OAR 411-033-0030)
- Who you deal with
- Oregon Health Authority, ODHS Aging and People with Disabilities, local APD and Area Agency on Aging offices
- Must haves
- Comprehensive license with an RN, ODHS Medicaid provider enrollment and agreement, Background Check Unit checks, EVV with monthly attestation, MMIS billing
- Realistic time to first client
- Longest nonmedical path: license, then enrollment
Orientation for Oregon only. We confirm your exact path on the free call.
Three places new Oregon agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Choosing a classification you cannot grow out of
Oregon licenses in-home care agencies as Limited, Basic, Intermediate or Comprehensive, based on the medication and nursing services they offer. ODHS enrolls only Comprehensive agencies as Medicaid providers. Owners who start at Limited or Basic to save on fees or staffing later need a change of classification before a single Medicaid referral.
What it costs: Months of Medicaid revenue lost while a change of classification survey is scheduled.
A long queue with no room for an incomplete packet
OHA's In-Home Care program told applicants in 2025 that initial applications were taking six to nine months and are reviewed in the order received. The online portal will not accept an incomplete application, and OHA reported 48 initial applications pending at the end of 2025. Every missing policy or resume detail pushes your place in line back.
What it costs: Rent, an administrator's salary and software paid for months before the first client.
Caregiver files that fail the survey
The 2023 rules set a four hour orientation, at least eight hours of initial training and four hours of medication training, each documented separately. OHA's top survey citations for 2025 included caregiver orientation and caregiver training, often for missing topics or missing hour documentation. The initial survey requires at least one caregiver who is fully hired, trained and found competent.
What it costs: A failed survey means corrections and a second survey, or a new application and fee.
What does a delay cost your agency?
Enter your own numbers. Nothing is stored or sent.
Home care vs home health vs hospice in Oregon
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 such as bathing, dressing, toileting, mobility and feeding, plus housekeeping, errands and, by classification, medication and nursing services | Skilled nursing, therapy and home health aide services in the patient's home | Palliative and supportive care for people who are terminally ill, and their families |
| State license | OHA in-home care agency license (ORS 443.305 to 443.350; OAR 333-536) | OHA home health agency license (ORS 443.014 to 443.095; OAR 333-027) | OHA hospice program license (ORS 443.860; OAR 333-035); new licenses paused |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step, but a state moratorium on new licenses |
| Main payers | Private pay; APD Medicaid in-home services for Comprehensive agencies | Medicare, Oregon Health Plan (fee for service and CCOs), commercial insurance | Medicare hospice benefit, Oregon Health Plan, commercial insurance |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment (new enrollments paused from May 13, 2026) | Accreditation, then Medicare enrollment (new enrollments paused from May 13, 2026) |
| Key staff | Administrator with two years of health related professional or management experience; an RN for Intermediate and Comprehensive; trained caregivers | Administrator (Oregon licensed physician or RN, or an experienced community health administrator), nurses, therapists, home health aides | Administrator, medical director, interdisciplinary team |
| Startup capital | Lowest, but carry costs through a long OHA review | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Several months (OHA licensing) before any client | Longest: licensure, survey, enrollment | Paused for most new applicants until rules are adopted or January 2, 2029 |
Many Oregon owners start with an in-home care agency, build a caregiver team and private pay revenue, then add home health. A licensed home health agency can also provide in-home care services under its home health license by filing OHA's in-home care attestation. If you plan to serve Medicaid clients at any point, apply for Comprehensive from the start so your policies, nurse and training are built once.
Oregon requirements at a glance
| Nonmedical home care license | In-home care agency license from the Oregon Health Authority (OHA), Public Health Division, under ORS 443.305 to 443.350 and OAR 333-536 (revised October 23, 2023) |
|---|---|
| Classifications | Limited (medication reminding), Basic (adds medication assistance), Intermediate (adds medication administration), Comprehensive (adds nursing services) |
| Home health and hospice licensing | OHA Health Care Regulation and Quality Improvement: home health under OAR 333-027, hospice under OAR 333-035. New hospice licenses are paused under SB 1575 (2026). |
| Medicaid agency | Oregon Department of Human Services (ODHS), Aging and People with Disabilities (APD), for in-home services; OHA runs the Oregon Health Plan |
| Medicaid in-home route | APD in-home services under Community First Choice (1915(k)) and related authorities; agencies enroll under OAR 411-033 with a Comprehensive license, and APD or Area Agency on Aging case managers authorize hours |
| Caregiver training | Four hour orientation, at least eight hours of initial training, a documented competency evaluation, four hours of medication training for medication services, six hours of yearly education (OAR 333-536-0070) |
| Background checks | Nationwide criminal records check before client contact and every three years, plus an LEIE search; Medicaid agencies use the ODHS Background Check Unit (OAR 333-536-0093; OAR 407-007) |
| Electronic visit verification | Required for APD Medicaid personal care visits, with a monthly report and attestation (OAR 411-033-0030), and for Oregon Health Plan home health visits since January 1, 2024 (OAR 410-127-0046) |
| Certificate of Need | Applies to new hospitals and nursing facilities, not to in-home care, home health or hospice |
| Entity filing | Oregon Secretary of State, Corporation Division (Oregon Business Registry) |
Summary of Oregon requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Oregon
The order matters. OHA will not accept an incomplete application and expects a trained caregiver at the initial survey, so policies, the administrator and the caregiver pipeline (steps 3 to 6) must be finished before step 7. Medicaid enrollment (step 9) only starts once the Comprehensive license is in hand.
Form the business and register for payroll taxes
Register your LLC or corporation with the Oregon Secretary of State, get an EIN, then get a Business Identification Number through Revenue Online before the first paycheck. Payroll covers state withholding, the statewide transit tax, Paid Leave Oregon contributions, the Workers' Benefit Fund and unemployment insurance. Check your city's business license rules.
You do this; we give you the checklistChoose your classification and payer mix
Limited, Basic, Intermediate or Comprehensive, private pay or APD Medicaid. Medicaid enrollment requires Comprehensive, which also means an RN on staff and nursing policies. Your classification sets your fee, your policies and what you may advertise.
Decided on your free consultationHire a qualified administrator and, if needed, an RN
The administrator needs a high school diploma and at least two years of professional or management experience in a health related field, must be reachable whenever clients are served and must be onsite more than one day a week. Intermediate and Comprehensive agencies must employ an Oregon licensed RN for medication administration and the 90 day medication reviews.
You do this; we specify what is requiredWrite policies, procedures and forms to OAR 333-536
OHA's Initial Checklist lists every required policy, procedure and form, from abuse reporting and service plans to quarterly monitoring visits, QAPI and criminal records checks. OHA rejects policies that only restate rule language or contradict each other.
We write this for youSet up insurance and employment basics
Oregon requires most employers to carry workers' compensation. Add general and professional liability and auto coverage for caregivers who drive. Build Oregon sick time (one hour per 30 hours worked) and Paid Leave Oregon into payroll from the first hire.
You do this; we specify what is requiredBuild the caregiver pipeline
Run a nationwide criminal records check and LEIE search before any client contact, then deliver the four hour orientation, at least two hours of initial training before the first service, a competency evaluation and, for medication services, four hours of medication training with a return demonstration. Have at least one caregiver fully trained and documented before the survey.
We set up the system and trackerApply in the OHA licensing portal
Since May 12, 2025, initial applications go through hflclicensing.oregon.gov. Include the administrator's resume and diploma, a background check request for owners and administrators with client contact, your policies and forms, the completed Initial Checklist and the fee.
We prepare the applicationPass the initial onsite survey
The surveyor reviews your policies, quality improvement plan, a mock client record and at least one caregiver record. If you pass, OHA issues the license within ten business days. You may not accept clients before the license arrives.
We get you ready for the surveyEnroll with ODHS for Medicaid in-home services
With a Comprehensive license, enroll with ODHS Aging and People with Disabilities, get a Medicaid provider number and sign the Provider Enrollment Agreement. Run caregiver checks through the ODHS Background Check Unit, set up EVV with a monthly attestation, and bill authorized hours through MMIS.
We prepare and manage it
Caregiver training and background checks
OAR 333-536-0070, revised in October 2023, sets minimum hours for caregiver orientation and training at every classification. Orientation, initial training and medication training must each be documented separately, with topics, dates, length and the trainer's name and signature.
- Basic requirements: Caregivers must be at least 18 and have the communication and language skills to do the job.
- Orientation: four hours: Agency specific, online or in person, before the caregiver works alone. Run by the administrator, a designee or a delegate, covering the topics listed in rule.
- Initial training: eight hours: Two hours before the first service; the rest before services or within 120 days of hire, which can include on the job training. Up to one hour of competency evaluation counts toward the eight.
- Competency evaluation: Before independent work, the administrator or designee evaluates each caregiver through direct observation plus written or oral testing, and documents it.
- Medication training: four hours: Required before any medication services at the Basic, Intermediate and Comprehensive levels, with a return demonstration evaluated by a qualified individual such as an RN, LPN or pharmacist.
- Yearly education: Six hours a year on caregiver duties, plus one more hour for caregivers who provide medication services. CPR is recommended but not required.
- Exemptions: Caregivers with a current Oregon health care license or certificate are exempt from caregiver training, but medication training is still required for medication services.
- Criminal records checks: Before client contact and every three years: identity and address trace, local and nationwide searches, the sex offender registry, plus an LEIE search. Anyone convicted of a crime listed in ORS 443.004 may not work for the agency. OHA itself checks owners and administrators.
- Medicaid background checks: Agencies paid by Medicaid must run checks through the ODHS Background Check Unit under OAR 407-007, which makes the fitness determination.
Six mistakes that slow Oregon agencies down
We look for every one of these in the first week of an engagement.
Picking Limited or Basic, then wanting Medicaid
- What it costs
- ODHS enrolls only Comprehensive agencies, so Medicaid waits for a change of classification and a new survey.
- How we prevent it
- Your first call settles your classification against the clients you actually plan to serve.
Filing an incomplete application
- What it costs
- The portal will not accept it, and in a queue of six to nine months every resubmission costs you time.
- How we prevent it
- We complete OHA's Initial Checklist line by line before anything is filed.
Using old or out of state policy templates
- What it costs
- Policies written to the pre 2023 rules or another state's rules are cited at survey or sent back.
- How we prevent it
- We write your manual to the current OAR 333-536 and your classification.
Training records that miss topics or hours
- What it costs
- Orientation and training were among OHA's most cited survey tags in 2025.
- How we prevent it
- A tracker for orientation, eight hour training, medication training, competency and yearly education for every caregiver.
Accepting a client before the license arrives
- What it costs
- OHA says agencies may not accept clients until the license is received, which puts the whole application at risk.
- How we prevent it
- A written opening plan that starts marketing to families only once the license is issued.
Missing the 30 day change notice
- What it costs
- Ownership, address and administrator changes must be reported to OHA in writing within 30 days, and some carry a fee.
- How we prevent it
- A compliance calendar for notices, renewals, monitoring visits and the survey every two years.
In a free 30 minute call we confirm your Oregon path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Oregon 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.
- Oregon path and a dated launch plan
- Policy and procedure manual written to OAR 333-536 and the ODHS in-home care agency rules in OAR 411-033
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
APD Medicaid in-home services ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to APD Medicaid in-home services requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for ODHS Aging and People with Disabilities
- Survey and audit readiness
- Oregon city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to OHA 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 Oregon 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 OAR 333-536 and the ODHS in-home care agency rules in OAR 411-033 |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for ODHS Aging and People with Disabilities 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 Oregon home care startup checklist
Every Oregon 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 classification and payer mix (Comprehensive if you will serve Medicaid)
- Register your LLC or corporation with the Oregon Secretary of State
- Get an EIN and a Business Identification Number through Revenue Online before the first paycheck
- Set up withholding, statewide transit tax, Paid Leave Oregon, Workers' Benefit Fund and unemployment insurance
- Buy workers' compensation, general and professional liability, and auto coverage
- 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 Oregon
- 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 Oregon cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, APD Medicaid in-home services, 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 Oregon
| Item | Notes |
|---|---|
| In-home care agency license | Initial fee by classification: Limited $2,000, Basic $2,250, Intermediate $2,500, Comprehensive $3,000; $1,250 per subunit (OHA, ORS 443.315). Yearly renewal: $1,000 Limited or Basic, $1,250 Intermediate, $1,500 Comprehensive, $1,000 per subunit. Change of ownership $350. |
| Home health agency license | $4,000 initial, $2,125 yearly renewal, $1,250 change of ownership (ORS 443.035). |
| Hospice license | $1,140 for a new license, renewal or change of ownership on OHA's current application, but new licenses are paused for most applicants. |
| Entity formation and city license | Oregon Secretary of State filing fee plus any city business license |
| Criminal records checks | Vendor fees per caregiver, or ODHS Background Check Unit processing for Medicaid agencies |
| Caregiver and medication training | Approved training entity or qualified individual fees, plus paid training hours |
| Administrator and RN | Salaries during the OHA review; an RN is required for Intermediate and Comprehensive |
| Insurance | Workers' compensation, liability, auto coverage; Medicaid amounts are set in the ODHS enrollment agreement |
| Scheduling and EVV software | Paid by the agency; EVV is required for Medicaid visits |
| Operating reserve | Covers rent, salaries and software while OHA reviews the application and while Medicaid enrollment is pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Oregon
Several months: OHA said in 2025 that initial in-home care applications were taking six to nine months, plus the onsite survey. No clients before the license.
Longer: the Comprehensive license first, then ODHS enrollment, background checks through the Background Check Unit and EVV setup before referrals.
Longest: OHA licensure, a certification survey and Medicare enrollment, with Medicare enrollment paused from May 13, 2026 and new hospice licenses paused in Oregon.
OHA counted 217 licensed in-home care agencies in Oregon on January 1, 2026, and new initial licenses are issued slowly, so a well prepared agency can enter a market that is not growing quickly. Most families search by city: Portland, Beaverton, Gresham, Salem, Eugene, Bend and Medford, plus many who search for a parent from out of state. For Medicaid, local APD and Area Agency on Aging offices rotate referrals among enrolled agencies when a client has no preference, so being enrolled and known to your local office matters. Rural counties cover long distances, which makes reliable staffing your selling point there. If you also plan to serve Clark County across the Columbia River, Washington licenses home care separately.
Frequently asked questions
Do you need a license to start a home care agency in Oregon?
Yes, if you provide personal care for pay and schedule, place, pay or set working conditions for caregivers. You need an in-home care agency license from the Oregon Health Authority under OAR 333-536. A business that provides only housekeeping and supportive services, such as laundry, shopping and errands, does not need one.
What are the four in-home care agency classifications?
Limited agencies may remind clients about medication. Basic agencies add medication assistance. Intermediate agencies add medication administration and must employ an RN. Comprehensive agencies add nursing services. You may not advertise or provide services above your classification.
How much does an Oregon in-home care agency license cost?
Initial fees are $2,000 for Limited, $2,250 for Basic, $2,500 for Intermediate and $3,000 for Comprehensive, plus $1,250 per subunit. Yearly renewals run $1,000 to $1,500. Check current fees with OHA before filing.
How long does Oregon licensing take?
OHA told applicants in 2025 that initial applications were taking six to nine months, reviewed in the order received, and it does not promise a fixed time. After you pass the onsite survey, the license is issued within ten business days.
Can an Oregon in-home care agency bill Medicaid?
Only with the Comprehensive classification. OAR 411-033-0030 requires a Comprehensive license, Secretary of State registration, a Medicaid provider number and a signed Medicaid Provider Enrollment Agreement with ODHS. APD or Area Agency on Aging case managers authorize the hours, and agencies bill through MMIS.
How many training hours do Oregon caregivers need?
At least four hours of agency orientation, at least eight hours of initial training (two before the first service, the rest within 120 days of hire), a documented competency evaluation, four hours of medication training for medication services, and six hours of education every year.
Does Oregon require a Certificate of Need for home health or hospice?
No. Oregon's Certificate of Need program covers new hospitals and nursing facilities. Hospice has a different barrier: SB 1575 (2026) pauses most new hospice licenses until OHA adopts new rules or January 2, 2029, with limited exemptions such as an underserved area.
Can I open a Medicare home health agency or hospice in Oregon now?
CMS placed a six month nationwide pause on new Medicare enrollment of home health agencies and hospices, effective May 13, 2026. It may have ended or been extended, so check its status. In Oregon, new hospice licenses are also paused under SB 1575.
How much does Oregon home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, APD Medicaid 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 Oregon?
No. Lunaria works with owners in all 50 states and DC, so you can expand into Washington or another state with the same team.
Sources checked for this guide (39)
- OHA In-Home Care Initial Application FAQs and IHC Initial Checklist (updated 08/01/2025)
- OHA In-Home Care Update, January 2026 (licensed agencies, pending applications, top citations)
- OHA IHC Caregiver Orientation, Training and Competency memo (rev. 06/2024)
- OHA IHC Qualified Individual, Qualified Entity and Qualified Trainer memo (updated 09/16/2026)
- OHA online licensing portal (in-home care, licensed agency list)
- OHA Home Health Agency License Application (rev. 08/2024)
- OHA initial home health agency licensure letter (fee, administrator qualifications)
- OHA Hospice License Application (rev. 08/17/2026, fee schedule)
- OHA Hospice Licensing Update webinar, August 2026 (SB 1575 moratorium and exemptions)
- OHA Hospice Licensure FAQs (last updated 12/05/2017)
- OHA Certificate of Need program
- ODHS APD OAR chapter 411, division 033, In-Home Care Agencies Providing Medicaid In-Home Services (effective 03/28/2024)
- ODHS APD Payment Processing for In-Home Care Agencies (updated 03/27/2026)
- ODHS APD Agency with Choice comparison of in-home service options (04/07/2026)
- ODHS news release: Agency with Choice launch (10/05/2026)
- ODHS APD public notice: 1915(k) Community First Choice and 1915(b)(4) amendments (2025)
- ODDS Director's message: provider moratorium is over (12/01/2025)
- OHA CCO and long term services and supports (LTSS outside CCO budgets)
- OHA Oregon Health Plan provider enrollment
- OAR 410-127-0046, home health EVV (Cornell LII)
- OAR 333-536-0070, caregiver requirements (Cornell LII, amended 10/23/2023)
- OAR 333-536-0075, medication services (Cornell LII)
- OAR 333-536-0093, criminal records checks (Cornell LII)
- OAR 333-536-0041, surveys (Cornell LII)
- OAR 333-536-0052, administrator (Cornell LII)
- OAR 333-536-0066, initial and monitoring visits (Cornell LII)
- OAR 333-536-0007, classifications (Oregon Public Law)
- OAR 333-027-0010, home health agency licensing (Cornell LII)
- ORS 443.035, home health agency fees (Oregon Public Law)
- ORS 443.315, in-home care agency license and fees (Oregon Public Law)
- Oregon Department of Revenue, starting payroll taxes
- Paid Leave Oregon, employers
- Oregon BOLI, sick time
- Oregon Workers' Compensation Division, employers
- Federal Register 2026-09717, nationwide moratorium on Medicare enrollment of HHAs (effective 05/13/2026)
- Federal Register 2026-09718, nationwide moratorium on Medicare enrollment of hospices (effective 05/13/2026)
- CMS-855A Medicare enrollment application, institutional providers
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
This guide is general information and reflects Oregon requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Oregon Health Authority, the Oregon 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.