How to start a home care agency in Rhode Island and reach your first client faster
Rhode Island treats home care as a licensed health care facility. Even an agency that only provides personal care and homemaking needs a RIDOH home care provider license, and before that a certificate of need reviewed by the Health Services Council on a fixed calendar. Then come RN supervised nursing assistants, BCI fingerprint checks, accreditation within two years and separate Medicaid rules. Miss a filing deadline and you wait months for the next one. 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 Rhode Island rules216-RICR-40-10-17 and EOHHS rule 210-RICR-20-05-1
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Rhode Island requires.
Home care for Rhode Island Medicaid LTSS members
- State license
- RIDOH home care provider license (216-RICR-40-10-17), after a certificate of need
- Who you deal with
- RIDOH, the Health Services Council, EOHHS (Rhode Island Medicaid) and any Medicaid health plans you join
- Must haves
- Certificate of need and license, RI Medicaid provider number through the Healthcare Portal, licensed nursing assistants for personal care, prior authorization for every client, EVV, and a check with EOHHS on its participation rules in 210-RICR-20-05-1
- Realistic time to first client
- Longest nonmedical path
Orientation for Rhode Island only. We confirm your exact path on the free call.
Three places new Rhode Island agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
The certificate of need calendar
Every new home care, home nursing care and hospice provider needs a certificate of need before RIDOH will license it. Regular applications are due by January 10 or June 10, a Letter of Intent must reach RIDOH at least 45 days earlier, and the review can run up to 120 days after it starts. Owners who learn this late miss a window and wait for the next one.
What it costs: Up to six months of rent, insurance and salaries before you can even apply for the license.
A public review your competitors can join
Once your application is accepted, RIDOH notifies affected persons, which includes existing agencies, and they can send written comments or ask for a public meeting. The Health Services Council then makes its recommendation to the Director. A thin application on ownership, finances, staffing or quality gets questioned in public.
What it costs: Months lost to follow up questions, conditions or a denial you have to start over from.
The Medicaid rules nobody reads first
Rhode Island Medicaid pays for personal care only when a licensed nursing assistant delivers it, needs a prior authorization for every client, and requires EVV. Its 2025 home care rule also lists Medicare certification among the participation requirements, which a home care provider license alone does not give you. Agencies that plan on Medicaid without asking EOHHS how that applies to them can open with no billable clients.
What it costs: A licensed agency, a payroll and no Medicaid revenue while you rework your plan.
What does a delay cost your agency?
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Home care vs home health vs hospice in Rhode Island
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 by licensed nursing assistants under RN supervision, and homemaker services | Skilled nursing by RNs and LPNs, and therapy, and it may include home care services | Palliative and supportive care for people who are terminally ill, and their families |
| State license | RIDOH home care provider license (216-RICR-40-10-17) | RIDOH home nursing care provider license (216-RICR-40-10-17) | RIDOH hospice license (216-RICR-40-10-11) |
| Certificate of Need | Yes: certificate of need before initial licensure | Yes: certificate of need before initial licensure | Yes: certificate of need, unless care is provided without charge |
| Main payers | Private pay, Rhode Island Medicaid LTSS and preventive services, Office of Healthy Aging programs | Medicare, Rhode Island Medicaid and its health plans, commercial insurance | Medicare hospice benefit, Rhode Island Medicaid |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment | Accreditation or state survey, then Medicare enrollment |
| Key staff | Full time administrator, RN directing nursing if the administrator is not a nurse, RN supervisors, licensed nursing assistants, trained homemakers | Full time administrator, RN directed nursing service, RNs and LPNs, therapists, Professional Advisory Committee | Administrator, physician medical director, RN coordinating each plan of care, social worker, spiritual counselor |
| Startup capital | Moderate: certificate of need, office and RN supervision before revenue | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Several months: certificate of need, then licensure | Longest: certificate of need, licensure, survey, enrollment | Longest: certificate of need, licensure, survey, enrollment |
Rhode Island has no unlicensed path for personal care or homemaker services: both license types sit under the same rule, 216-RICR-40-10-17, and both need a certificate of need. A home nursing care provider license can include home care services, so owners who expect to add skilled nursing later should weigh which license to request in the first certificate of need, since each new license is its own review. We plan both from day one so your application, policies and hiring grow with you instead of being rewritten.
Rhode Island requirements at a glance
| Nonmedical home care license | Yes. Personal care and homemaker services need a RIDOH home care provider license under R.I. Gen. Laws chapter 23-17 and 216-RICR-40-10-17, renewed every year and expiring December 31. |
|---|---|
| Certificate of need | Required before initial licensure of home care, home nursing care and hospice providers (R.I. Gen. Laws 23-15-2; 216-RICR-40-10-22). Regular applications are due January 10 or June 10, with a Letter of Intent at least 45 days earlier. |
| Home health and hospice licensing | RIDOH home nursing care provider license (216-RICR-40-10-17) and hospice license (216-RICR-40-10-11) |
| Accreditation | Every home care and home nursing care licensee must be accredited by a nationally recognized accrediting body within two years of initial licensure and stay accredited |
| Medicaid agency | Executive Office of Health and Human Services (EOHHS). Home care is paid through Medicaid long term services and supports (LTSS), preventive services, Office of Healthy Aging programs and Medicaid health plans, always with prior authorization. |
| Caregiver training | Nursing assistants: at least 120 hours of training (80 classroom, 40 practical), written and practical exams and a RIDOH license. Homemakers: 20 classroom hours, at least 5 practical hours and a final exam. |
| Background screening | National fingerprint criminal records check through the Attorney General's Bureau of Criminal Identification, started before or within one week of employment (R.I. Gen. Laws 23-17-34), plus pre employment health screening |
| Electronic visit verification | Required for Medicaid personal care, homemaker and home health visits. EOHHS uses Sandata, or you can use a third party system that meets the RI Alternate EVV Specification. |
| State fees | Certificate of need: $500 plus 0.25% of capital cost (regular review). Annual license: $650 for home care or home nursing care providers, $3,000 for hospice (216-RICR-10-05-2). |
| Entity and tax filing | Rhode Island Department of State, Business Services; one Division of Taxation registration covers withholding, unemployment insurance and TDI |
Summary of Rhode Island requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Rhode Island
The order matters. The certificate of need has fixed filing deadlines, so step 3 sets your whole timeline. Start caregiver screening and policies while the review runs, so you are ready to staff clients the day the license arrives.
Form the business with the Department of State
File your LLC or corporation with Rhode Island Department of State Business Services, get an EIN, and file one Division of Taxation business registration for income tax withholding, unemployment insurance and temporary disability insurance (TDI).
You do this; we give you the checklistChoose your license and payer mix
A home care provider license covers personal care and homemaker services. A home nursing care provider license adds skilled nursing and therapy. Decide on private pay, Medicaid LTSS or both, and ask EOHHS how its participation rules apply before you count on Medicaid. Use the path finder above.
Decided on your free consultationFile the Letter of Intent and certificate of need
Send RIDOH a Letter of Intent at least 45 days before the application, then file by January 10 or June 10 for a regular review. RIDOH gives public notice, existing agencies can comment, the Health Services Council reviews the application, and the decision is due within 120 days after the review starts. Show ownership, finances, staffing, quality and access.
We prepare the applicationSet up the office and leadership
The rule requires an office in Rhode Island, phone access to responsible staff 24 hours a day, seven days a week, a governing body, and a full time administrator. If the administrator is not a nurse, a Rhode Island licensed RN must direct nursing services.
You do this; we specify what is requiredWrite policies to 216-RICR-40-10-17
Cover patient rights, admission and discharge, plans of care, nursing assistant and homemaker supervision, personnel and criminal records checks, health screening, in service training, quality improvement and an emergency plan reviewed every year.
We write this for youApply for the home care provider license
After certificate of need approval, file the RIDOH license application with the $650 fee and a notarized list of every direct and indirect owner. RIDOH may inspect before it decides. Licenses expire December 31 and renew every year.
We prepare the applicationBuild the caregiver pipeline
Hire RIDOH licensed nursing assistants for personal care, train homemakers (20 classroom hours, 5 practical hours, final exam), start each fingerprint check through the Attorney General's BCI before or within a week of hire, complete health screening, and schedule RN supervision at least every three months.
We set up the system and trackerEnroll in Rhode Island Medicaid and set up EVV
Apply for a RI Medicaid provider number through the Healthcare Portal, then choose the state's Sandata EVV system or a compliant third party system. Medicaid clients come through prior authorizations and the EOHHS Home Care Provider Referral Portal.
We prepare and manage itPlan accreditation within two years
Every licensee must be accredited by a nationally recognized accrediting body within two years of initial licensure. Choose the body early and build your records to its standards from the first client.
We get you ready for the survey
Nursing assistant training, homemakers and background checks
Rhode Island splits home care staff into two groups. Personal care is delivered by nursing assistants licensed by RIDOH under R.I. Gen. Laws chapter 23-17.9 and 216-RICR-40-05-22, supervised by an RN. Homemakers handle housekeeping and are trained by the agency. Rhode Island Medicaid pays for personal care only when a nursing assistant delivers it.
- Nursing assistant training: An approved program of at least 120 clock hours: 80 hours of classroom instruction, which may be online, and 40 hours of supervised practical training. Trainees need at least 16 classroom hours before any patient contact.
- Nursing assistant exams and license: Written and practical exams within one year of starting training, with three attempts. Graduates may get a 120 day temporary permit to work under direct supervision of a licensed nurse until they pass. The license fee is $35.
- Nursing assistant renewal: Licenses expire June 30 every other year. Renewal needs at least 8 hours of work as a nursing assistant in the past 24 months and 12 hours of in service training a year.
- Homemakers: At least 20 hours of classroom instruction, at least 5 hours of practical experience and a passed final exam before working, supervised by a licensed nurse or a person with a bachelor's degree in social work, home economics, gerontology or a related field.
- Supervision: An RN or other Rhode Island licensed professional assesses the client in the home before nursing assistant services start and supervises at least every three months. Homemaker services are reassessed at least every three months.
- Criminal records checks: A national fingerprint check through the Attorney General's Bureau of Criminal Identification for staff with routine patient contact, started before or within one week of employment. The employee pays for it, and the agency keeps the results on file for RIDOH.
- Health screening: Pre employment health screening before any staff member with patient contact provides services.
- Medicaid assignment rules: Medicaid does not pay when a caregiver lives with the client, is a parent, child, grandparent, grandchild, sibling or spouse, or holds guardianship or power of attorney for them.
- Rate enhancements: Rhode Island Medicaid pays more for evening, night, weekend and holiday shifts and for agencies with at least 30% of direct care staff certified in behavioral healthcare. Agencies must pass 100% of those increases to staff.
Six mistakes that slow Rhode Island agencies down
We look for every one of these in the first week of an engagement.
Assuming nonmedical care needs no license
- What it costs
- Rhode Island licenses personal care and homemaker agencies. Unlicensed agencies cannot operate, and using the title home care provider without a license can bring a fine of up to $5,000, up to a year in prison, or both.
- How we prevent it
- Your first call ends with your exact Rhode Island license type and the order to do it in.
Missing the certificate of need window
- What it costs
- Regular applications are due only January 10 and June 10, with the Letter of Intent 45 days earlier. Missing one pushes you to the next cycle.
- How we prevent it
- We set your filing date on day one and work backward from it.
Sending homemakers to do personal care
- What it costs
- Rhode Island Medicaid only pays for personal care delivered by a licensed nursing assistant, and RIDOH holds homemakers to housekeeping tasks.
- How we prevent it
- Clear job roles and a scheduling tracker that matches each task to a qualified worker.
Skipping the three month supervision visits
- What it costs
- Missed RN supervision is a licensing deficiency on inspection and an audit finding for payers.
- How we prevent it
- A tracker that flags every client's next supervisory visit and plan of care review.
Forgetting the two year accreditation deadline
- What it costs
- A licensee that is not accredited within two years of initial licensure is not in good standing.
- How we prevent it
- We pick the accrediting body with you early and build your records to its standards.
Counting on Medicaid without checking EOHHS rules
- What it costs
- The 2025 EOHHS home care rule lists Medicare certification among participation requirements, and RI Medicaid can pause new enrollment for whole provider types.
- How we prevent it
- We confirm your Medicaid route with EOHHS before you build your budget around it.
In a free 30 minute call we confirm your Rhode Island path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Rhode Island 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.
- Rhode Island path and a dated launch plan
- Policy and procedure manual written to 216-RICR-40-10-17 and EOHHS rule 210-RICR-20-05-1
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Medicaid LTSS ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Medicaid LTSS requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for Rhode Island Medicaid (EOHHS) and each Medicaid health plan you join
- Survey and audit readiness
- Rhode Island city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to RIDOH 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 Rhode Island 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 216-RICR-40-10-17 and EOHHS rule 210-RICR-20-05-1 |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for Rhode Island Medicaid (EOHHS) and each Medicaid health plan you join 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 Rhode Island home care startup checklist
Every Rhode Island 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 type (home care provider or home nursing care provider) and payer mix
- Form your LLC or corporation with Rhode Island Department of State Business Services
- Get an EIN and file the Division of Taxation registration for withholding, unemployment insurance and TDI
- Buy workers' compensation, general and professional liability, and auto coverage
- Set up payroll with paid sick and safe leave (one hour per 35 hours worked, up to 40 hours a year, for employers with 18 or more employees)
- 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 Rhode Island
- 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 Rhode Island cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Medicaid LTSS, 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 Rhode Island
| Item | Notes |
|---|---|
| Certificate of need fee | $500 plus 0.25% of capital cost for regular or accelerated review; $750 plus 0.25% for expedited review (216-RICR-10-05-2). Check current fees with RIDOH. |
| State license | $650 a year for a home care provider or home nursing care provider license; $3,000 a year for a hospice license |
| Change of owner, operator or lessee | $1,500 to $50,000 application fee, plus Health Services Council review |
| Entity formation and tax registration | Department of State filing fee and any Division of Taxation registration fees |
| Nursing assistant licenses and fingerprint checks | Nursing assistant license fee is $35. The employee pays for the BCI fingerprint check under R.I. Gen. Laws 23-17-34. |
| Homemaker training | Instructor time and materials for 20 classroom hours and 5 practical hours per homemaker |
| Medicaid enrollment | RI Medicaid may charge an application fee; check the EOHHS fee schedule for your provider type |
| Accreditation | Accrediting body application and survey fees, due within two years of licensure |
| Office, insurance and EVV | Rhode Island office lease, workers' compensation, liability and auto coverage, and scheduling software that works with EVV |
| Operating reserve | Covers rent, administrator and RN salaries during the certificate of need review and until clients start |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Rhode Island
Several months: a Letter of Intent, a certificate of need filed on January 10 or June 10 and reviewed for up to 120 days, then licensure.
Longer: the license comes first, then RI Medicaid enrollment, EVV setup and prior authorized referrals.
Longest: certificate of need, licensure, certification survey and Medicare enrollment, which the CMS moratorium may still affect.
Rhode Island is small enough that an agency can serve families across the state from one office, but every new agency has to make its case in a public certificate of need review that existing agencies can join. Applications that show how you will reach people who are harder to serve, such as clients in Washington and Newport counties, clients who speak Spanish or Portuguese, or clients who need evening and weekend care, give the Health Services Council a reason to say yes. Many families search for care for a parent by town, which makes a strong Google Business Profile and clear pages for Providence, Warwick, Cranston, Pawtucket, Newport and your other communities matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Rhode Island?
Yes. Agencies that provide personal care or homemaker services need a RIDOH home care provider license under R.I. Gen. Laws chapter 23-17 and 216-RICR-40-10-17. Agencies that also provide skilled nursing or therapy need a home nursing care provider license.
Does Rhode Island require a certificate of need for home care?
Yes. R.I. Gen. Laws 23-15-2 lists home care providers, home nursing care providers and hospice providers as health care facilities, and RIDOH rules make a certificate of need a precondition to initial licensure. The Health Services Council reviews it and the Director of Health decides.
When can I file a certificate of need application?
Regular review applications are due by 4:30 p.m. on January 10 or June 10. A Letter of Intent must reach RIDOH at least 45 days before the application. Review starts with public notice on February 20 or July 20, and a decision is due within 120 days.
Who licenses home health and hospice agencies in Rhode Island?
RIDOH. Home health agencies are licensed as home nursing care providers under 216-RICR-40-10-17, and hospices under 216-RICR-40-10-11. Both need a certificate of need first, and Medicare certification is a separate step through a survey and CMS enrollment.
Do Rhode Island caregivers need certification?
Caregivers who give personal care must be nursing assistants licensed by RIDOH after at least 120 hours of training and written and practical exams. Homemakers need 20 classroom hours, at least 5 practical hours and a final exam. RN supervision is required at least every three months.
What background checks do Rhode Island home care workers need?
A national fingerprint criminal records check through the Attorney General's Bureau of Criminal Identification, started before or within one week of employment, for staff with routine patient contact. The employee pays for it. Pre employment health screening is also required.
How do Rhode Island home care agencies get Medicaid clients?
By enrolling with Rhode Island Medicaid through the Healthcare Portal and serving members who have a prior authorization, often found through the EOHHS Home Care Provider Referral Portal or Medicaid health plans. EOHHS rule 210-RICR-20-05-1 also lists Medicare certification among its participation requirements, so confirm with EOHHS how it applies to your agency.
Is Rhode Island freezing new home care licenses?
Not as of our research. A 2026 bill, H 8214, would have stopped new home care, home nursing care and hospice licenses until July 1, 2031, but it did not become law. Separately, CMS paused new Medicare home health and hospice enrollment nationwide from May 13, 2026 for six months; check whether that pause has ended or been extended.
How much does Rhode Island home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Medicaid LTSS 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 Rhode Island?
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 (29)
- 216-RICR-40-10-17, Licensing Home Nursing Care Providers and Home Care Providers (amended effective 05/06/2024)
- 216-RICR-40-10-22, Determination of Need (certificate of need) rules
- 216-RICR-40-10-11, Licensing Hospice Care (amended effective 11/03/2025)
- 216-RICR-10-05-2, RIDOH fee structure (effective 03/25/2026)
- 216-RICR-40-05-22, Nursing assistants and training programs (effective 02/01/2023)
- 210-RICR-20-05-1, EOHHS Home Care and Home Health Providers (adopted effective 06/03/2025)
- R.I. Gen. Laws 23-15-2, certificate of need definitions (Internet Archive copy, September 2026)
- R.I. Gen. Laws chapter 23-15 section index (Internet Archive copy, September 2026)
- R.I. Gen. Laws 23-17-2, licensing definitions (Internet Archive copy, May 2025)
- R.I. Gen. Laws 23-17-34, criminal records review (Internet Archive copy, March 2025)
- R.I. Gen. Laws 28-57-5, paid sick and safe leave accrual (Internet Archive copy, August 2026)
- 2026 H 8214, proposed moratorium on new home care, home nursing care and hospice licenses (Internet Archive copy)
- RIDOH Home Care Providers licensing page (Internet Archive copy, May 2026)
- EOHHS Electronic Visit Verification page (Internet Archive copy, July 2026)
- EOHHS Home Health and Personal Care Assistant provider page (Internet Archive copy, May 2026)
- EOHHS Provider Enrollment page (Internet Archive copy, June 2026)
- EOHHS provider enrollment FAQ (January 2026)
- EOHHS Home Care Provider Referral Portal (Internet Archive copy, May 2026)
- RI Division of Taxation business registration (Internet Archive copy, May 2026)
- Rhode Island Department of State, Business Services
- Federal Register 2026-09717: nationwide moratorium on Medicare enrollment of home health agencies
- Federal Register 2026-09718: nationwide moratorium on Medicare enrollment of hospices
- CMS accreditation and approved accrediting organizations
- 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)
- Neighborhood Health Plan of Rhode Island, Home Health Care Services payment policy, August 2026 (health plan document)
- Healthcare Law Insights on H 8214 and the CMS moratorium (secondary, pointer only)
- MedSole RCM on RI Medicaid enrollment moratoria (secondary, pointer only)
This guide is general information and reflects Rhode Island requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Rhode Island Department of Health, EOHHS 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.