How to start a home care agency in Utah and reach your first client faster
Utah's personal care agency rule is short, so new owners expect a quick license. The details are where they stall. Owners must clear DACS background screening before a provisional license is issued, every caregiver needs a DACS entry before they start, aides need a licensed nurse or experienced CNA supervisor, and Medicaid waiver work means separate enrollment in PRISM for each program. Home health and hospice add their own licenses and Medicare on top. We put all of it in the right order for you.
- Guides reviewed by Christine Ochimas, RN, LMFT, MBA
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Utah rulesUtah Admin. Code R432-725, R432-35 and Utah Medicaid provider manuals
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Utah requires.
Nonmedical home care for Medicaid waiver members
- State license
- DLBC Personal Care Agency license (Utah Admin. Code R432-725)
- Who you deal with
- DHHS Office of Licensing, Utah Medicaid (PRISM), the Division of Aging and Adult Services, the New Choices Waiver program and DSPD
- Must haves
- Personal Care Agency license, Utah Medicaid enrollment in PRISM, an Attachment B for each New Choices Waiver service, a DSPD contract for DSPD waivers, DACS screening, EVV records with every claim
- Realistic time to first client
- Several months
Orientation for Utah only. We confirm your exact path on the free call.
Three places new Utah agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Screening that has to happen before the license
Under R432-35, an owner seeking licensure must obtain DACS certification for direct patient access before the Office of Licensing issues a provisional license, and every covered staff member must be entered in DACS before the provisional license is issued and before they start. Owners who treat background checks as a hiring task find the license waiting on them.
What it costs: Weeks added to the license date, with rent and insurance already running.
Medicaid is several doors, not one
Utah Medicaid pays for in home help through several 1915(c) waivers run by different offices: the Aging Waiver by the Division of Aging and Adult Services, the New Choices Waiver by the Office of Long Term Services and Supports, and five waivers by DSPD. Each has its own enrollment steps in PRISM, and DSPD work starts with a DSPD contract award.
What it costs: Months of payroll with no Medicaid clients if you enroll in the wrong program or only one.
Supervision and paperwork found at inspection
R432-725 requires aides to be supervised by a licensed nurse or a CNA with two years of personal or home care experience, with an on site evaluation in each client's home every six months. Licensors inspect line by line from a published checklist and ask for six months of client and employee rosters and in service records.
What it costs: Noncompliance findings and correction deadlines that pull you away from new clients.
What does a delay cost your agency?
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Home care vs home health vs hospice in Utah
The three sound alike and are regulated differently. The one you choose decides your regulator, staffing, startup capital and timeline.
| Topic | Nonmedical home care | Home health (skilled) | Hospice |
|---|---|---|---|
| What your staff do | Help with activities of daily living and other tasks that do not need a licensed health care professional | Skilled nursing and therapy at home, directed by a licensed practitioner, plus aide services | Palliative and supportive care for people with a terminal illness, and their families |
| State license | Personal Care Agency license (R432-725) | Home health agency license (R432-700) | Hospice license (R432-750) |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step |
| Main payers | Private pay, Medicaid waivers (Aging, New Choices, DSPD waivers), Medicaid personal care | Medicare, Utah Medicaid and its health plans, commercial insurance | Medicare hospice benefit, Utah Medicaid |
| Medicare | Not covered | State survey or accreditation, then Medicare enrollment; new enrollment paused by CMS since May 13, 2026 | State survey or accreditation, then Medicare enrollment; new enrollment paused by CMS since May 13, 2026 |
| Key staff | Administrator and designee, both at least 21; licensed nurse or experienced CNA supervisor; aides at least 18 with first aid | Governing body, administrator, director of nursing services, licensed nurses, CNAs and aides | Governing body, hospice administrator, medical director, RN director of nursing services, interdisciplinary team |
| Startup capital | Lowest | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks to months (private pay) to several months (Medicaid waivers) | Longest: licensure, survey, enrollment | Longest: licensure, survey, enrollment |
Many Utah owners start with a personal care agency, build a caregiver team and private pay cash flow, then add Medicaid waivers and later home health. The rules overlap: R432-700 personal care aides have the same 18 year minimum, first aid and six hours of yearly in service as R432-725 aides. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Utah requirements at a glance
| Nonmedical home care license | Personal Care Agency license, required for two or more individuals providing personal care services on a visiting basis (Utah Admin. Code R432-725) |
|---|---|
| Licensing agency | Utah Department of Health and Human Services (DHHS), Division of Licensing and Background Checks (DLBC), Office of Licensing |
| Home health and hospice | Home health agency license under R432-700; hospice license under R432-750; both from the DHHS Office of Licensing |
| Certificate of Need | No Certificate of Need step for personal care, home health or hospice licensing |
| Background screening | DACS certification for direct patient access under R432-35: owners before a provisional license, staff entered before they start, fingerprints within 15 working days |
| Aide requirements | At least 18, trained in first aid, competency in all personal care training areas, six hours of in service a year including abuse reporting, TB test within two weeks of hire |
| Medicaid | Utah Medicaid enrollment in PRISM; Aging Waiver (DAAS), New Choices Waiver (Office of Long Term Services and Supports), DSPD waivers by contract |
| Electronic visit verification | Required for Medicaid personal care and home health services; agencies choose their own EVV vendor and submit EVV records with each claim (R414-522) |
| Medicare (home health, hospice) | State survey or accreditation, then Medicare enrollment; new enrollment paused nationwide by CMS from May 13, 2026 |
| Entity filing | Utah Division of Corporations and Commercial Code, plus a city business license, which the license application asks for |
Summary of Utah requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Utah
The order matters. DACS screening for owners and staff has to be in motion before the license can issue, and Medicaid enrollment only starts once you hold the license.
Form the business and get a city business license
Register your LLC or corporation with the Utah Division of Corporations and Commercial Code, get an EIN, open state withholding and unemployment insurance accounts, and get your city business license. The Office of Licensing asks for a current city business license with the application.
You do this; we give you the checklistDecide your services and payer mix
Private pay, Medicaid waivers or both, and which waivers. Keep your service list inside personal care: R432-725 lets you accept and keep a client only while their needs stay within personal care as determined and documented by a licensed health care professional. Use the path finder above.
Decided on your free consultationName your administrator and supervisor
Appoint in writing an administrator who is at least 21 with one year of managerial or supervisory experience, and a designee who is at least 21. One of them must be available during business hours. Hire a supervisor who is a licensed nurse or a CNA with at least two years of personal or home care experience.
You do this; we specify what is requiredWrite policies to R432-725
Cover health screening and TB testing, orientation, admission and retention, service agreements with 30 days' notice of charge changes, termination of services, clients' rights, records kept three years, abuse reporting, identification badges and life sustaining treatment orders under R432-31. Licensors inspect against this checklist.
We write this for youApply to the Office of Licensing
Email the health facilities licensing team first, then submit the Health Facility Application with owner and administrator details and your city business license. No sooner than four working days later, pay the fees, create a UtahID login and open the DLBC provider portal.
We prepare the applicationClear DACS screening for owners and staff
You get DACS access after you apply. Owners must obtain certification for direct patient access before a provisional license is issued. Enter each caregiver in DACS before they start, collect a signed background check authorization, have fingerprints taken within 15 working days, and update DACS within five working days of any hire or termination.
We set up the system and trackerTrain, supervise and track caregivers
Orient every employee, confirm first aid and competency, test for TB within two weeks of hire, schedule six hours of in service per calendar year including abuse reporting, and book the supervisor's on site evaluation in each client's home every six months.
We set up the system and trackerEnroll with Utah Medicaid
Enroll in PRISM for each program you will serve. The Aging Waiver is run by the Division of Aging and Adult Services; the New Choices Waiver needs an Attachment B for each service and a Settings Rule self attestation; DSPD waivers start with a DSPD contract award.
We prepare and manage itSet up electronic visit verification
Utah Medicaid requires EVV for personal care services. Choose an EVV vendor that meets the state's technical specifications and submit an EVV record with each claim within three months of submitting it.
We walk you through setup
Personal care aide training and DACS background checks
Utah does not certify personal care aides or set a fixed number of training hours. R432-725 instead requires each aide to be at least 18, know agency policies, be trained in first aid and demonstrate competency in every area of personal care training, under a qualified supervisor.
- Orientation: Documented for every employee: job duties, ethics, confidentiality, clients' rights and how to report suspected abuse, neglect or exploitation.
- In service: At least six hours per employee each calendar year, prorated in the first year, including documented yearly training on abuse, neglect and exploitation reporting.
- Supervision: A licensed nurse, or a CNA with at least two years of personal or home care experience, evaluates each aide on site in the client's home every six months and documents the quality of care.
- Health screening: A written health screening policy, and TB testing within two weeks of hire, suspected exposure or symptoms. Personnel files hold the health inventory, TB results and first aid records.
- DACS screening: Enter each covered individual in DACS before they start, keep a signed background check authorization on file, and have fingerprints taken within 15 working days. Workers may start provisionally while certification is pending, as Utah Code 26B-2-239 allows.
- What DACS reviews: Criminal history, plus findings that may include the Division of Aging and Adult Services vulnerable adult abuse database, child abuse findings, nurse aide registries, professional licensing records and the federal OIG exclusion list (R432-35-8).
- Keeping DACS current: Update a worker's status within five working days of hire or termination. At renewal, run a DACS verification report and correct names, addresses, emails and employment status.
- Home health aides: In a home health agency, CNAs need a certificate of completion within six months of hire and CPR, and Medicare certified agencies follow the federal 75 hour aide training and 12 hour yearly in service rules.
Six mistakes that slow Utah agencies down
We look for every one of these in the first week of an engagement.
Leaving owner screening until after the application
- What it costs
- No provisional license until every owner seeking licensure has DACS certification for direct patient access.
- How we prevent it
- Your first call ends with your exact Utah order, starting with screening.
Letting a new hire work without a DACS entry
- What it costs
- A noncompliance finding under R432-35, and a caregiver you may have to pull from a client.
- How we prevent it
- A tracker that blocks scheduling until the DACS entry, authorization and fingerprints are on file.
Hiring the wrong supervisor
- What it costs
- Aide supervision that does not count: it must be a licensed nurse or a CNA with two years of personal or home care experience.
- How we prevent it
- We confirm the supervisor's credential and experience before you build the schedule.
Missing six month home evaluations and in service hours
- What it costs
- Findings at inspection, since licensors request in service records and rosters before they arrive.
- How we prevent it
- A tracker that flags supervisory visits, TB tests, first aid and in service hours for every aide.
Assuming one Medicaid enrollment covers every waiver
- What it costs
- Referrals you cannot accept because the Aging Waiver, New Choices Waiver and DSPD waivers each have their own steps.
- How we prevent it
- We map the programs you will serve and prepare each enrollment.
Keeping clients whose needs exceed personal care
- What it costs
- A breach of R432-725, which requires a referral when needs go beyond personal care, plus exposure for unlicensed skilled care.
- How we prevent it
- Clear service definitions and a documented professional determination for every client.
In a free 30 minute call we confirm your Utah path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Utah 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.
- Utah path and a dated launch plan
- Policy and procedure manual written to Utah Admin. Code R432-725, R432-35 and Utah Medicaid provider manuals
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Medicaid waiver ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Medicaid waiver requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for Utah Medicaid through PRISM, and DSPD for its waivers
- Survey and audit readiness
- Utah city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to DHHS Office of Licensing 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 Utah 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 Utah Admin. Code R432-725, R432-35 and Utah Medicaid provider manuals |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for Utah Medicaid through PRISM, and DSPD for its waivers 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 Utah home care startup checklist
Every Utah 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 services and payer mix (private pay, Medicaid waivers, or both)
- Form your LLC or corporation with the Utah Division of Corporations and Commercial Code
- Get an EIN and open state withholding and unemployment insurance accounts
- Get a city business license (the license application asks for it)
- 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 Utah
- 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 Utah cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Medicaid waiver, Medicare
- Your target opening month and rough budget
No client or patient records. We never need them for a first call.
What it costs to start a home care agency in Utah
| Item | Notes |
|---|---|
| State license | Personal care, home health and hospice fees are set in the DLBC health facility fee schedule, which has included a one time new provider fee and yearly license fees. Check current amounts with the Office of Licensing before you budget. |
| Entity formation and city license | Division of Corporations filing fee plus your city business license |
| DACS screening and fingerprints | Screening and fingerprinting fees for each owner and covered staff member |
| Supervisor time | Licensed nurse or experienced CNA for six month in home evaluations of each aide |
| Training | First aid certification, orientation and six hours of yearly in service per employee |
| Insurance | Workers' compensation, general and professional liability, auto coverage |
| EVV and scheduling software | Paid by the agency; required for Medicaid personal care and home health claims |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while screening, licensing, Medicaid enrollment or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Utah
Weeks to a few months: application, owner and staff DACS screening, then the provisional license.
Several months: the license first, then PRISM enrollment for each waiver, and a DSPD contract award for DSPD waivers.
Longest: licensure, then a certification survey and Medicare enrollment once the CMS moratorium allows new applications.
Most Utah families looking for care search by city: Salt Lake City, West Valley City, Provo, Orem, Ogden, Sandy and St. George. Demand and competition concentrate along the Wasatch Front, while Cache Valley in the north, Iron and Washington counties in the south and the rural central and eastern counties have long drives between clients, so reliable staffing becomes your selling point there. Medicaid waiver clients come through case management agencies and Area Agencies on Aging, so introducing your agency to them matters as much as search. A complete Google Business Profile and clear city pages match how families look.
Frequently asked questions
Do you need a license to start a home care agency in Utah?
Yes. Two or more individuals providing personal care services on a visiting basis need a Personal Care Agency license from the DHHS Division of Licensing and Background Checks under Utah Admin. Code R432-725. Personal care covers help with daily living and other tasks that do not need a licensed health care professional. Skilled care needs a home health agency license under R432-700.
Who licenses home health and hospice agencies in Utah?
The DHHS Office of Licensing, part of the Division of Licensing and Background Checks. Home health agencies follow R432-700 and hospices follow R432-750, along with the general licensing and background screening rules. Applications go through the Health Facility Application and the DLBC provider portal.
What is DACS?
The Direct Access Clearance System, Utah's online background screening system for licensed health facilities. Under R432-35, owners must be certified before a provisional license is issued, each covered staff member is entered before they start, and fingerprints are due within 15 working days. Workers may start provisionally while certification is pending.
Do caregivers need certification in Utah?
Personal care aides do not need a state certificate. R432-725 requires them to be at least 18, trained in first aid, able to demonstrate competency, oriented, screened through DACS, TB tested and given six hours of in service a year. A licensed nurse or a CNA with two years of experience supervises them.
Does Utah require a Certificate of Need for home health or hospice?
No. Utah's licensing application for health facilities asks for owner and administrator details, a city business license and local inspections, with no need review. Licensure, survey and Medicare enrollment still apply.
How do Utah home care agencies get Medicaid clients?
By enrolling with Utah Medicaid in PRISM for the programs they will serve. The Aging Waiver is run by the Division of Aging and Adult Services, the New Choices Waiver by the Office of Long Term Services and Supports, and five waivers, including the Community Supports and Acquired Brain Injury waivers, by DSPD, which contracts with providers first.
Can I open a Medicare home health agency or hospice in Utah right now?
CMS put a nationwide moratorium on new Medicare enrollment of home health agencies and hospices from May 13, 2026, for six months, so it was due to run out around November 13, 2026. It may have ended or been extended by the time you read this. You can still pursue the Utah license, then apply to Medicare once new applications are accepted.
Is a franchise a better way to start a home care agency in Utah?
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.
How much does Utah home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Medicaid waivers 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 Utah?
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 (31)
- DLBC Personal Care Agency Inspection Checklist, R432-725, R432-35 and 2026 legislative updates (revised 5/20/2026)
- DLBC Home Health Agency Inspection Checklist, R432-700 (5/20/2026)
- DLBC Hospice Inspection Checklist, R432-750 (5/20/2026)
- DLBC health facility rules and descriptions
- DLBC health facility applications and renewals
- DLBC notice: CMS moratorium on new Medicare enrollments for home health and hospice
- DLBC Office of Background Processing, program staff screening
- Utah Admin. Code R432-725-4, definitions (Cornell LII)
- Utah Admin. Code R432-725, Personal Care Agency Rule (Cornell LII)
- Utah Admin. Code R432-700, Home Health Agency Rule (Cornell LII)
- Utah Admin. Code R432-35-8, background screening sources (Cornell LII)
- Utah Admin. Code R414-522-3, electronic visit verification requirements (Cornell LII)
- Utah Medicaid Electronic Visit Verification
- Utah Medicaid long term care and waiver programs
- Utah Medicaid Aging Waiver
- Utah Medicaid New Choices Waiver
- Utah Medicaid Aging Waiver fact sheet (Internet Archive copy, February 2025)
- Utah Medicaid managed care (ACO health plans)
- Utah Medicaid, become a Medicaid provider (PRISM)
- DSPD Policy 1.61, Medicaid Enrollment and Billing (revised 12/11/2025)
- DSPD Physical Disabilities Waiver fact sheet (June 2026)
- DHHS Division of Aging and Adult Services, services
- CMS Provider Enrollment Moratoria
- CMS QSO-26-11-HHA & Hospice, six month national moratoria (May 20, 2026)
- CMS home health and hospice moratorium FAQs (revised 7/09/26)
- Federal Register 2026-09717: nationwide moratorium on Medicare enrollment of home health agencies
- Federal Register 2026-09718: nationwide moratorium on Medicare enrollment of hospices
- 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 Utah requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Utah Department of Health and Human Services (DLBC and Utah Medicaid) 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.