How to start a home care agency in Pennsylvania and reach your first client faster
Pennsylvania licenses nonmedical home care, so you cannot take a single private pay client until the Department of Health issues your Chapter 611 license for a physical office. Criminal history checks, competency and TB screening must be on file for every caregiver, owner and office worker. Medicaid adds OLTL enrollment and a separate contract with each Community HealthChoices plan. Home health and hospice add Medicare, which CMS has paused for new agencies. 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 Pennsylvania rules28 Pa. Code Chapter 611 and 55 Pa. Code Chapter 52
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Pennsylvania requires.
Nonmedical home care for Community HealthChoices members
- State license
- DOH home care agency license (28 Pa. Code Chapter 611), then OLTL enrollment
- Who you deal with
- DOH, the DHS Office of Long-Term Living and each Community HealthChoices managed care organization
- Must haves
- DOH license, OLTL enrollment as provider type 59 for Personal Assistance Services, 55 Pa. Code Chapter 52 policies, general and professional liability and workers' compensation, CHC plan contracts, EVV
- Realistic time to first client
- Several months
Orientation for Pennsylvania only. We confirm your exact path on the free call.
Three places new Pennsylvania agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
An application the Division sends back
The Department of Health expects every form and every supporting document in the first submission, and incomplete packets are returned. You also need a real physical office, because the address goes on the license and inspections happen there. Since March 31, 2026, initial applications go through the DOH online system only.
What it costs: Weeks or months before your first private pay client, because you cannot serve anyone until the license is issued.
The Community HealthChoices plan wall
Medicaid home care for older adults and adults with physical disabilities runs through Community HealthChoices plans. After your DOH license, you enroll with the Office of Long-Term Living, but the Department of Health itself warns that state Medicaid enrollment does not guarantee a place in any plan network, and some networks may be closed. Each plan contracts and credentials you separately.
What it costs: Months of rent, insurance and payroll carried by your operating reserve while plan contracts are pending.
Clearances that stall the first shift
Every caregiver, office worker and owner needs a criminal history report. Workers who have lived in Pennsylvania less than two years also need an FBI fingerprint check and a Department of Aging determination. Provisional hiring is allowed only for 30 or 90 days, and only after the worker meets the Chapter 611 competency rule.
What it costs: A client you cannot staff, and a caregiver who may take another offer while they wait.
What does a delay cost your agency?
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Home care vs home health vs hospice in Pennsylvania
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 instrumental activities of daily living, companionship, respite, specialized care | Part time or intermittent skilled nursing plus at least one other therapeutic service, under a plan of treatment | Palliative and supportive care for people who are terminally ill, and their families |
| State license | DOH home care agency or home care registry license (28 Pa. Code Chapter 611) | DOH home health care agency license (28 Pa. Code Chapter 601) | DOH hospice license (35 P.S. § 448.806) |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step |
| Main payers | Private pay, Community HealthChoices plans, OBRA waiver and Act 150 program; ODP waivers for some services | Medicare, Medical Assistance and CHC plans once Medicare certified, commercial insurance | Medicare hospice benefit; Medical Assistance once Medicare certified and the DHS moratorium ends |
| Medicare | Not covered | Accreditation or DOH survey, then Medicare enrollment; paused for new agencies since May 2026 | Accreditation or DOH survey, then Medicare enrollment; paused for new hospices since May 2026 |
| Key staff | Owner or administrator with a clean criminal history report; competent, screened direct care workers | Administrator, supervising physician or RN with at least one year of nursing experience, professional advisory group, clinical staff | Administrator, medical director, RN coordination, interdisciplinary group |
| Startup capital | Lowest | Higher: clinical payroll and Medicare reserve funds before revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks to months (private pay) to several months (CHC) | Longest: licensure, survey, Medicare enrollment | Longest: licensure, survey, Medicare enrollment |
Many Pennsylvania owners start with a Chapter 611 home care agency, build cash flow and a caregiver team, then add home health. Chapter 611 does not apply to licensed home health agencies, and a nurse on staff does not turn a home care agency into one: skilled care needs its own Chapter 601 license. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Pennsylvania requirements at a glance
| Nonmedical home care license | Department of Health home care agency or home care registry license under 28 Pa. Code Chapter 611 and the Health Care Facilities Act (Act 69 of 2006). One license per physical location, renewed every year. |
|---|---|
| Home health and hospice licensing | DOH Division of Home Health: home health care agencies under 28 Pa. Code Chapter 601; hospices under Chapter 8 of the Health Care Facilities Act, reviewed against 42 CFR Part 418 |
| Certificate of Need | None. The certificate of need provisions of the Health Care Facilities Act sunset four years after December 18, 1992. |
| Medicaid agency | Department of Human Services (DHS); the Office of Long-Term Living (OLTL) runs home and community based services |
| Long term care program | Community HealthChoices (CHC) managed care, plus the OBRA waiver and Act 150 program; the Office of Developmental Programs runs separate waivers |
| Caregiver competency | Pennsylvania nurse license, a passed competency exam or an approved training program before assignment (§ 611.55), reviewed at least yearly; TB screening before consumer contact (§ 611.56) |
| Background screening | State Police criminal history report, or an FBI fingerprint report and Department of Aging determination for residents of less than two years; ChildLine clearance when serving minors |
| Electronic visit verification | Required for Medicaid personal assistance and home health visits. Open vendor model; CHC plans use HHAeXchange. |
| Medicare (home health, hospice) | Accreditation or a DOH survey, then Medicare enrollment. CMS paused new enrollments nationwide on May 13, 2026 for six months, with possible extensions. |
| Entity filing | Department of State, Business Filing Services; tax accounts through myPATH |
Summary of Pennsylvania requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Pennsylvania
The order matters. Your office, policies and caregiver files must be ready before step 6, because the Department of Health inspects before it licenses and you cannot serve anyone until then. OLTL enrollment and plan contracts only start once the license is issued.
Form the business with the Department of State
File your LLC or corporation through Business Filing Services, get an EIN, and register for employer withholding and unemployment compensation through myPATH. Register for unemployment compensation within 30 days of first covered employment, and plan to withhold local earned income tax and local services tax.
You do this; we give you the checklistChoose agency or registry, and your payer mix
A home care agency employs its caregivers; a registry refers independent contractors and must tell consumers who is responsible for taxes and insurance. Medicaid programs expect the agency model. Then decide on private pay, Community HealthChoices or both. Use the path finder above.
Decided on your free consultationSecure an office and insurance
DOH does not accept a virtual office. A home office is allowed, but inspections will happen there. Choose the counties you will serve. Arrange workers' compensation, general and professional liability, and auto coverage for caregivers who drive.
You do this; we specify what is requiredWrite policies to Chapter 611
Cover hiring, criminal history and ChildLine checks, provisional hiring, competency, TB screening, consumer rights, the consumer information packet, the direct care worker status notice and termination notice. Agencies planning Medicaid also need the policies 55 Pa. Code Chapter 52 requires.
We write this for youBuild the caregiver pipeline
Interview each applicant (Act 96 of 2024 allows two way video), check two references, obtain criminal history reports, confirm competency and TB screening, and keep it all in the worker's file. Owners and office staff need criminal history reports too.
We set up the system and trackerApply for the DOH license
Submit the home care agency or registry application through the DOH online system with every required form and the license fee. The Department inspects before it issues the license. Each physical location is licensed separately.
We prepare the applicationEnroll with the Office of Long-Term Living
Apply online as provider type 59 (OLTL programs) with the Provider Enrollment Information Form, choosing Personal Assistance Services and Respite and your counties. Attach your DOH license, insurance, business plan and Chapter 52 policies. New providers attend Department training within 180 days of enrollment.
We prepare and manage itContract with Community HealthChoices plans
CHC plans authorize and pay for services, so apply to and credential with each plan that serves your counties. OLTL enrollment alone does not put you in a plan network.
We prepare every plan's packetSet up electronic visit verification
Medicaid personal assistance claims without a matching EVV visit are denied. CHC plans use HHAeXchange; if you choose another EVV system, connect it to each plan. The free DHS EVV system covers fee for service visits only.
We walk you through setup
Caregiver competency and background checks
28 Pa. Code Chapter 611 sets the rules for every direct care worker a home care agency employs or a registry refers. It does not set a number of training hours. Instead, each worker must show competency before assignment, and the agency must document it in the worker's file.
- Competency before assignment: A valid Pennsylvania nurse license, a passed competency exam, or completion of an approved program such as nurse aide or home health aide training (§ 611.55).
- Required subjects: Exams and agency training cover ten areas, including confidentiality, consumer control, infection control, emergencies, documentation and reporting abuse. Workers giving personal care also cover bathing, transfers, feeding, toileting and help with self administered medications.
- Yearly review: Competency is reviewed at least once a year, and sooner after a quality of care problem. Documentation transfers between agencies if the break in employment is 12 months or less.
- TB screening: Active TB screening consistent with CDC guidelines before consumer contact, no more than a year before the start date, updated every 12 months (§ 611.56).
- Criminal history: A Pennsylvania State Police report for residents of two years or more. Others need an FBI fingerprint report and a Department of Aging determination letter. Reports must be no more than a year old, and owners and office staff need them too (§ 611.52).
- Hiring decisions: After the 2015 Peake decision, the Department of Aging recommends a case by case review of any record, looking at the offense, time passed, rehabilitation and the job, and suggests consulting an attorney.
- Provisional hiring: Allowed while checks are pending for up to 30 days (residents of two years or more) or 90 days (others), only after competency is met and with documented monitoring (§ 611.54).
- Children and minors: Agencies serving anyone under 18 need ChildLine clearances (§ 611.53). In Community HealthChoices, workers in homes where children live need State Police, FBI and child abuse certifications before services, renewed every 60 months.
- Medicaid annual training: OLTL providers train staff every year on abuse prevention, critical incidents, complaints, DHS policies, the quality management plan and fraud prevention (55 Pa. Code § 52.21).
Six mistakes that slow Pennsylvania agencies down
We look for every one of these in the first week of an engagement.
Taking a client before the license arrives
- What it costs
- Operating without a Chapter 611 license can bring penalties and an order to stop, and it puts Medicaid enrollment out of reach.
- How we prevent it
- Your first call ends with your exact Pennsylvania path and the order to do it in.
Using a policy manual that never mentions Chapter 611
- What it costs
- Generic manuals miss the consumer information packet, worker status notice and provisional hiring rules DOH checks at inspection.
- How we prevent it
- We write your policy manual to 28 Pa. Code Chapter 611, and to 55 Pa. Code Chapter 52 if you plan on Medicaid.
Letting provisional hires run past the limit
- What it costs
- A worker without results after 30 or 90 days must be let go, and a client loses their caregiver.
- How we prevent it
- A tracker that flags clearance, competency and TB dates for every caregiver.
Assuming OLTL enrollment brings referrals
- What it costs
- Enrollment does not guarantee a place in any Community HealthChoices plan network, so staff wait with no Medicaid clients.
- How we prevent it
- We prepare packets for every CHC plan serving your counties as soon as your license is issued.
Planning home health or hospice Medicaid before Medicare
- What it costs
- DHS enrolls only Medicare certified home health agencies and hospices, and new Medicare enrollments have been paused since May 2026.
- How we prevent it
- We check the CMS and DHS moratoria on your first call and plan around them.
Drifting into skilled care without a Chapter 601 license
- What it costs
- Exposure to enforcement under the Health Care Facilities Act and problems with every payer.
- How we prevent it
- Clear service definitions so nonmedical caregivers never perform skilled tasks.
In a free 30 minute call we confirm your Pennsylvania path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Pennsylvania 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.
- Pennsylvania path and a dated launch plan
- Policy and procedure manual written to 28 Pa. Code Chapter 611 and 55 Pa. Code Chapter 52
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Community HealthChoices ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Community HealthChoices requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for each Community HealthChoices plan in your area
- Survey and audit readiness
- Pennsylvania city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to DOH 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 Pennsylvania 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 28 Pa. Code Chapter 611 and 55 Pa. Code Chapter 52 |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for each Community HealthChoices plan 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 Pennsylvania home care startup checklist
Every Pennsylvania 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 agency or registry, and your payer mix (private pay, Community HealthChoices, or both)
- Form your LLC or corporation through Department of State Business Filing Services
- Get an EIN and register for withholding and unemployment compensation in myPATH
- Set up local earned income tax and local services tax withholding
- Lease or set up a physical office (no virtual offices) and choose your counties
- 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 Pennsylvania
- 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 Pennsylvania cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Community HealthChoices, 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 Pennsylvania
| Item | Notes |
|---|---|
| DOH home care license | $100 per application or renewal under 28 Pa. Code § 611.2, for each physical location, every year. Fees are not refunded or prorated. |
| DOH home health or hospice license | The current DOH home health and hospice applications list a $250 fee per license, paid by check or money order. Check current fees with DOH. |
| Entity formation | Department of State filing fee, plus a fictitious name registration if you use a trade name |
| Criminal history checks | State Police check fee per person; FBI fingerprint check fee of $26.20 per person through the Department of Aging process, plus any vendor fee |
| TB screening and competency | Clinic fees per worker, and exam or approved training program costs |
| Insurance | Workers' compensation, general and professional liability, auto coverage |
| EVV and scheduling software | HHAeXchange through the CHC plans, or your own system connected to it |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while the license, plan contracts or Medicare enrollment are pending; Medicare also requires proof of reserve funds for new home health agencies |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Pennsylvania
Weeks to months: you cannot serve anyone until DOH reviews your application, inspects and issues the license.
Several months: DOH license, then OLTL enrollment, then contracting and credentialing with each CHC plan.
Longest: DOH licensure, a certification survey and Medicare enrollment, which CMS paused for new agencies in May 2026.
Demand in Pennsylvania follows its two big metro areas, Philadelphia with its suburban counties and Pittsburgh with Allegheny County, where agencies compete for Community HealthChoices plan contracts and private pay families. Much of the state's north and center is rural, so travel distance and reliable staffing become your selling point there. Licenses are tied to one office and its service counties, so pick counties you can staff well. Many families search for care for a parent from out of state, which makes a strong Google Business Profile and clear county pages matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Pennsylvania?
Yes. Any organization that supplies, arranges or schedules employees, or refers independent contractors, to provide home care services in a consumer's home must hold a home care agency or home care registry license from the Department of Health under 28 Pa. Code Chapter 611 before serving anyone.
What is the difference between a home care agency and a home care registry?
An agency employs its direct care workers. A registry refers independent contractors. Both are licensed under Chapter 611 and both follow the same clearance, competency and TB rules, but consumers must be told in writing whether the worker is an employee and who is responsible for taxes and insurance.
How much is the Pennsylvania home care license fee?
28 Pa. Code § 611.2 sets the application and renewal fee at $100 for each licensed location. Licenses are renewed every year, and renewal applications are due at least 60 days before the license expires.
Can I run a Pennsylvania home care agency from my house?
Yes, but it must be a real physical location, because the address is printed on the license and DOH does not accept virtual offices. DOH inspections will take place in your home.
What training do Pennsylvania home care workers need?
Chapter 611 sets no hour count. Before assignment, each worker needs a Pennsylvania nurse license, a passed competency exam or an approved training program covering the required subjects, and competency is reviewed at least once a year.
Does Pennsylvania require a Certificate of Need for home health or hospice?
No. The certificate of need provisions of the Health Care Facilities Act sunset in the 1990s. DOH licensure, a certification survey and Medicare enrollment still apply.
How do Pennsylvania home care agencies get Medicaid clients?
After the DOH license, enroll with the DHS Office of Long-Term Living as a Personal Assistance Services provider, then contract with the Community HealthChoices plans in your counties. Service coordinators build each member's service plan, and you may serve a member only once the plan names your agency.
Can a new Pennsylvania 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 on May 13, 2026, for six months with possible extensions. DHS enrolls only Medicare certified home health agencies and hospices, and it has paused Medical Assistance enrollment of new hospices since May 15, 2026.
How much does Pennsylvania home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Community HealthChoices or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges.
Do you only work in Pennsylvania?
No. Lunaria works with owners in all 50 states and DC, so you can expand into a second state with the same team. You own 100% of your agency, with no franchise fees or royalties.
Sources checked for this guide (32)
- 28 Pa. Code Chapter 611, Home Care Agencies and Home Care Registries (Pennsylvania Code)
- 28 Pa. Code Chapter 601, Home Health Care Agencies (Pennsylvania Code)
- 55 Pa. Code Chapter 52, Long-Term Living Home and Community-Based Services (Pennsylvania Code)
- Health Care Facilities Act (DOH copy): § 806(d.1) home care, § 806(g) hospices, § 807 fees, § 809 license term, § 904.1 CON sunset
- DOH Home Care page (online application, no paper after March 31, 2026)
- DOH Home Care Regulations page
- DOH Home Care Agency/Registry License FAQ (physical location, separate licenses, Medicaid networks)
- DOH Home Health licensure and Medicare certification page
- DOH Initial Home Health Agency Application (revised February 4, 2025)
- DOH Hospice licensure and Medicare certification page
- DOH Initial Hospice Application (revised February 20, 2025)
- DHS Community HealthChoices page (eligibility, zones)
- DHS CHC contact information (plan names)
- Community HealthChoices 1915(c) waiver PA.0386.R05.01, effective July 1, 2026 (PAS qualifications, background checks, EVV)
- DHS Provider Enrollment Documents (provider types 59, 05, 06)
- OLTL HCBS Provider Enrollment Information Form (7/1/2026)
- OLTL HCBS Waiver Enrollment Checklist and policy checklist
- DHS Requirements for Provider Type 05, Home Health Agency (Medicare certification first)
- DHS Medical Assistance Bulletin 99-26-03, temporary moratorium on enrollment of new hospices
- DHS Electronic Visit Verification
- DHS EVV for Personal Care Services (HHAeXchange for CHC, claim denials)
- DHS ODP Provider Qualifications
- Department of Aging, Criminal History Background Check (Peake, FBI fee)
- PA Business One-Stop Shop, basic business registration
- Department of Revenue, Register My Business for Taxes
- CMS Provider Enrollment Moratoria (HHAs and hospices, May 13, 2026)
- Federal Register 2026-09717, CMS moratorium on Medicare enrollment of home health agencies
- 42 CFR 489.28, HHA initial reserve operating funds (Cornell LII)
- 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)
- CMS-855A Medicare enrollment application, institutional providers
This guide is general information and reflects Pennsylvania requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Pennsylvania Department of Health, the Department of Human Services, the Department of Aging 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.