How to start a home care agency in Virginia and reach your first client faster
Virginia licenses personal care and home health under one home care organization license from the Virginia Department of Health, while companion only agencies need none. The license now costs $1,500 for three years and must be filed at least 60 days before you open. Barrier crime checks, RN supervision every 90 days, $1 million in liability coverage, DMAS enrollment and a contract with each Cardinal Care health plan decide when your first client starts. We put all of it in the right order for you.
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- One fixed price, agreed in writing
- You own 100%. No franchise fees or royalties
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Virginia rules12VAC5-381 and DMAS CCC Plus Waiver rules
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Virginia requires.
Personal care for CCC Plus Waiver members
- State license
- VDH home care organization license (Va. Code 32.1-162.9; 12VAC5-381)
- Who you deal with
- VDH, DMAS and each Cardinal Care health plan
- Must haves
- VDH license, DMAS enrollment through PRSS, a contract with each Cardinal Care health plan, qualified aides with 12 hours of yearly training, RN supervisory visits at least every 90 days, criminal record and exclusion checks, EVV
- Realistic time to first client
- Several months
Orientation for Virginia only. We confirm your exact path on the free call.
Three places new Virginia agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Not knowing which side of the license line you are on
Virginia exempts agencies that offer only companion, homemaker or chore services, but helping a client bathe, dress or move is personal care, and personal care needs a VDH home care organization license. Owners who start as companion only and then accept a client who needs hands on help are operating without a license.
What it costs: Clients you have to turn away, or an unlicensed operation that has to stop while you apply.
The 60 day license window and the paperwork behind it
12VAC5-381 requires a complete application at least 60 days before opening, and an incomplete one goes inactive after six months. Before you file you need an administrator with the required experience, an RN to supervise personal care, $1 million in general liability coverage and a $50,000 crime policy or fidelity bond.
What it costs: Months of rent and insurance paid while a returned or inactive application starts over.
Medicaid clients come through plans, not the state
A VDH license and DMAS enrollment do not bring referrals on their own. CCC Plus Waiver members are served through Cardinal Care health plans, and DMAS says providers must contract with each plan individually. Five plans have served Virginia Medicaid members since July 1, 2025.
What it costs: Months of payroll with trained aides and no Medicaid clients while plan contracts are pending.
What does a delay cost your agency?
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Home care vs home health vs hospice in Virginia
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 bathing, dressing, eating, mobility and other daily activities; respite. Companion only services are exempt from licensure. | Nursing, physical, occupational, speech and respiratory therapy, and medical social services under a physician signed plan of care | Palliative and supportive care for people who are terminally ill, and their families |
| State license | VDH home care organization license (12VAC5-381 Part V, personal care); none for companion, homemaker or chore only | VDH home care organization license (12VAC5-381 Part III, skilled services) | VDH hospice license (12VAC5-391) |
| Certificate of Need | No | No: home health is not on Virginia's COPN list | No for hospice programs; a hospice facility over 16 beds needs COPN |
| Main payers | Private pay, CCC Plus Waiver through Cardinal Care health plans, DD Waivers | Medicare, Cardinal Care health plans, commercial insurance | Medicare hospice benefit, Virginia Medicaid |
| Medicare | Not covered | VDH license and clients first, then accreditation or state survey and Medicare enrollment | Accreditation or state survey, then Medicare enrollment |
| Key staff | Administrator, RN supervisor, RN or LPN available whenever personal care is provided, qualified home attendants | Administrator, director of skilled services (physician or RN), RNs, LPNs and therapists | Administrator, physician medical director, RN led nursing services, interdisciplinary team |
| Startup capital | Lowest, but the $1,500 license fee and required insurance come before the first client | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Months (private pay) to several months (CCC Plus Waiver) | Longest: licensure, clients, survey, enrollment | Longest: licensure, inspection, survey, enrollment |
Home health and personal care share one license in Virginia, so many owners start with personal care and later add skilled services through a change to their license. Once a licensed agency is Medicare certified or accredited by a CMS recognized organization, Va. Code 32.1-162.8 lets it request an exemption from state licensure, for a $75 processing fee. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Virginia requirements at a glance
| Home care license | Home care organization license from the Virginia Department of Health (VDH), Office of Licensure and Certification, under Va. Code Title 32.1, Chapter 5, Article 7.1 and 12VAC5-381. Covers personal care, skilled (home health) and pharmaceutical services. |
|---|---|
| Companion only agencies | Exempt. 12VAC5-381-30 excludes providers of only homemaker, chore or companion services. |
| License term and fee | Three years. $1,500 for each initial and renewal application since May 22, 2025. File at least 60 days before opening, through the VDH OLC Portal. |
| Hospice licensing | Separate VDH hospice license under Va. Code 32.1-162.3 and 12VAC5-391, renewed every year, $500 fee |
| Certificate of Public Need | Not required for home care, home health or hospice programs. Hospice facilities over 16 beds are licensed as hospitals or nursing facilities and need COPN. |
| Medicaid agency | Department of Medical Assistance Services (DMAS). Personal care and respite are paid through the Commonwealth Coordinated Care Plus (CCC Plus) Waiver and the Cardinal Care health plans. |
| Caregiver qualifications | Home attendants qualify under 12VAC5-381-290 (CNA, nurse aide program, nursing student, competency evaluation or the DMAS Personal Care Aide Training Curriculum) and need 12 hours of inservice training a year |
| Background checks | Sworn disclosure and a Virginia State Police criminal record report within 30 days of hire; no one convicted of a barrier crime may be hired (Va. Code 32.1-162.9:1) |
| Electronic visit verification | Required for Medicaid personal care, respite and companion services and for home health; live in caregivers must use EVV from October 1, 2026 |
| Entity and tax filing | State Corporation Commission for LLCs and corporations; Virginia Tax and the Virginia Employment Commission for payroll accounts |
Summary of Virginia requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Virginia
The order matters. Hire your administrator and RN and buy the required insurance before step 5, because the application must be complete 60 days before you open, and Medicaid plan contracts only follow the license and DMAS enrollment.
Form the business with the State Corporation Commission
File your LLC or corporation, get an EIN, register online with Virginia Tax for payroll withholding and with the Virginia Employment Commission for unemployment insurance, and check your city or county business license rules.
You do this; we give you the checklistDecide your services and payer mix
Companion only care needs no VDH license; personal care does. Choose private pay, the CCC Plus Waiver, the DD Waivers or a mix, and decide whether skilled services are part of your plan. Use the path finder above.
Decided on your free consultationHire your administrator and RN supervisor
The administrator must be an employee with at least one year of training and experience in direct health care service delivery and one year of supervisory or management experience in home health care or a related program within the last five years. An RN supervises personal care, and an RN or LPN must be available whenever services are provided.
You do this; we specify what is requiredBuy the required insurance
12VAC5-381-210 requires at least $1 million in comprehensive general liability per occurrence, malpractice coverage consistent with Va. Code 8.01-581.15, and a $50,000 minimum crime policy or blanket fidelity bond. Add workers' compensation and auto coverage for caregivers who drive.
You do this; we specify what is requiredWrite policies to 12VAC5-381
Cover governance, client rights, complaints, quality improvement, infection control, client records, personnel practices, orientation including mandated reporting of abuse and neglect, and RN written plans of service for personal care.
We write this for youApply for the VDH home care organization license
Submit a complete application and the $1,500 fee through the VDH OLC Portal at least 60 days before your planned opening. OLC offers prelicensure consultation once a complete application is on file, and every applicant is subject to inspection.
We prepare the applicationBuild the caregiver pipeline
Collect the sworn disclosure, order a Virginia State Police criminal record report within 30 days of hire, screen for barrier crimes, confirm each home attendant qualifies under 12VAC5-381-290, and track 12 hours of yearly inservice training.
We set up the system and trackerEnroll with DMAS and contract with Cardinal Care plans
Enroll as a Virginia Medicaid provider through PRSS, then contract with each Cardinal Care health plan: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia, Sentara Health Plans and UnitedHealthcare. Plan contracts are what bring CCC Plus Waiver referrals.
We prepare every plan's packetSet up electronic visit verification
Under 12VAC30-60-65, agency providers choose an EVV system that meets DMAS requirements and submit EVV data with each claim. From October 1, 2026, live in aides must also use EVV for every shift. Check each plan's EVV instructions before your first visit.
We walk you through setup
Home attendant qualifications and barrier crime checks
Virginia calls nonlicensed caregivers home attendants, a term that covers CNAs, home health aides and personal care aides. 12VAC5-381-290 sets who qualifies, Va. Code 32.1-162.9:1 sets the criminal record rules, and DMAS adds its own requirements for Medicaid work.
- Who qualifies: A home attendant must speak, read and write English and have completed an RN or LPN program, a Board of Nursing approved nurse aide program or CNA certification, be enrolled in nursing school with a clinical course completed, or have passed a competency evaluation meeting 42 CFR 484.36(b).
- Personal care only option: For personal care services, completing the DMAS Personal Care Aide Training Curriculum also qualifies a home attendant.
- Yearly training: At least 12 hours of inservice training every year for home attendants providing personal care (12VAC5-381-360). DMAS requires 12 documented hours a year for CCC Plus Waiver aides too.
- DD Waivers: Assistants serving people in the DD Waivers through a VDH licensed agency need at least 40 hours of study on disabilities, which CNA registration or an RN taught curriculum can meet.
- Criminal record report: A sworn disclosure from every applicant and an original Virginia State Police report within 30 days of hire, no more than 90 days old. Until it arrives, the employee may provide direct care only while directly supervised by a cleared employee.
- Barrier crimes: No one convicted of an offense in clause (i) of the barrier crime definition (Va. Code 19.2-392.02) may be hired. The one exception is a single misdemeanor not involving abuse or neglect, after five years.
- Changing agencies: A report stays valid while the employee stays with you. A worker who moves to another home care organization needs a new report and statement, with limited exceptions for transfers within the same owner and short leaves.
- Medicaid extras: For CCC Plus Waiver work, staff must not appear on the federal exclusion list (LEIE), need TB screening, and must be checked against the VDSS Child Protective Services Central Registry when serving minors.
Six mistakes that slow Virginia agencies down
We look for every one of these in the first week of an engagement.
Drifting from companion care into personal care
- What it costs
- Hands on help with bathing or dressing without a VDH license, and clients you must drop when someone notices.
- How we prevent it
- Clear service definitions, or a home care organization license from the start if personal care is in your plan.
Letting a new aide work alone before the record report arrives
- What it costs
- A violation of Va. Code 32.1-162.9:1 and, for Medicaid clients, services DMAS will not pay for.
- How we prevent it
- A tracker that blocks unsupervised scheduling until the State Police report is on file.
Missing RN supervisory visits
- What it costs
- Citations at inspection and plan audits, since personal care supervision may not exceed 90 days.
- How we prevent it
- A supervision calendar for every client, written into your policies and your scheduling system.
Filing before the insurance and leadership are in place
- What it costs
- An incomplete application, and the 60 day clock does not start until it is complete.
- How we prevent it
- We confirm your administrator, RN and the $1 million and $50,000 coverage before anything is filed.
Contracting with only one Cardinal Care plan
- What it costs
- Referrals from only a slice of the CCC Plus Waiver members in your area.
- How we prevent it
- We prepare packets for every Cardinal Care plan at once.
Seeking Medicare accreditation before serving licensed clients
- What it costs
- A wasted survey fee and months of delay, because 12VAC5-381 requires licensure and clients first.
- How we prevent it
- A home health plan that sequences licensure, first clients, survey and enrollment.
In a free 30 minute call we confirm your Virginia path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Virginia 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.
- Virginia path and a dated launch plan
- Policy and procedure manual written to 12VAC5-381 and DMAS CCC Plus Waiver rules
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
CCC Plus Waiver ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to CCC Plus Waiver requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for each Cardinal Care health plan
- Survey and audit readiness
- Virginia city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to VDH 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 Virginia 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 12VAC5-381 and DMAS CCC Plus Waiver rules |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for each Cardinal Care health plan 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 Virginia home care startup checklist
Every Virginia 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 (companion only or personal care) and payer mix
- Form your LLC or corporation with the State Corporation Commission
- Get an EIN and register online with Virginia Tax and the Virginia Employment Commission
- Check your city or county business license rules
- Buy $1 million general liability, malpractice, a $50,000 crime policy or fidelity bond, workers' compensation 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 Virginia
- 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 Virginia cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, CCC Plus 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 Virginia
| Item | Notes |
|---|---|
| VDH home care organization license | $1,500 for each initial and renewal application, covering three years (12VAC5-381-70). Late renewal $50, license reissue $250, exemption request $75. Check current fees with VDH. |
| VDH hospice license | $500 for each initial and yearly renewal application (12VAC5-391-70) |
| Entity formation and local license | State Corporation Commission filing fee plus any city or county business license |
| Criminal record reports | Virginia State Police fees for each new hire |
| Insurance | At least $1 million general liability per occurrence, malpractice, a $50,000 crime policy or fidelity bond, workers' compensation and auto coverage |
| RN supervision | Salaried or contracted RN time for plans of service and supervisory visits |
| Caregiver training | Training program or competency evaluation costs per aide, plus yearly inservice hours. DMAS does not pay for required staff training. |
| EVV and scheduling software | Chosen and paid for by the agency; required for Medicaid personal care |
| 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 |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Virginia
Months: the application must be complete at least 60 days before opening, and the license comes before your first personal care client.
Several months: VDH license, DMAS enrollment, then contracting with each Cardinal Care health plan.
Longest: licensure, serving clients (home health), a certification survey and Medicare enrollment.
Virginia families often search by the name of their independent city or county, such as Virginia Beach, Richmond, Henrico, Fairfax or Roanoke, so pages built around those names and a complete Google Business Profile match how people look for care. Northern Virginia, Hampton Roads and the Richmond area are dense and competitive, while rural Southside and Southwest Virginia involve long drives between clients, which makes reliable staffing your selling point there. Many adult children search for care for a parent from out of state, which makes clear service and pricing pages matter.
Frequently asked questions
Do you need a license to start a home care agency in Virginia?
Yes, if you provide personal care. Agencies that help clients with bathing, dressing, eating or other daily activities need a home care organization license from the Virginia Department of Health under 12VAC5-381. The license costs $1,500 and lasts three years.
Can I start a companion only agency in Virginia without a license?
Yes. 12VAC5-381-30 exempts providers that offer only homemaker, chore or companion services. If your caregivers give any hands on personal care, you need the home care organization license first.
Who licenses home health and hospice agencies in Virginia?
The VDH Office of Licensure and Certification. Home health agencies are licensed as home care organizations providing skilled services under 12VAC5-381, and hospices hold a separate hospice license under 12VAC5-391. Applications are filed through the VDH OLC Portal.
What is the difference between a state license and Medicare certification?
The VDH license lets an agency operate in Virginia. Medicare certification, through accreditation or a state survey and Medicare enrollment, lets it bill Medicare. Virginia requires the license and serving clients before certification.
Does Virginia require a Certificate of Public Need for home health or hospice?
No. Home care, home health and hospice programs are not on Virginia's COPN list. Only a hospice facility with more than 16 beds must be licensed as a hospital or nursing facility and go through COPN.
Can a new home health agency or hospice enroll in Medicare right now?
Not while the federal pause lasts. On May 13, 2026, CMS began a six month nationwide moratorium on new Medicare enrollment of home health agencies and hospices, including new branches and practice locations. It is set to end around November 13, 2026, but CMS can extend it in six month increments, so it may have ended or been extended by the time you read this. Agencies already enrolled are not affected. It covers Medicare only. Each state decides whether to pause its own Medicaid enrollment, so check with DMAS before you plan around it.
What are barrier crimes in Virginia home care?
Offenses listed in clause (i) of the barrier crime definition in Va. Code 19.2-392.02. A licensed home care organization may not hire anyone convicted of one, except a single misdemeanor not involving abuse or neglect after five years. A State Police record report is required within 30 days of hire.
What training do Virginia personal care aides need?
A home attendant must be a CNA, have completed a nurse aide or nursing program, pass a competency evaluation, or for personal care complete the DMAS Personal Care Aide Training Curriculum. They also need at least 12 hours of inservice training a year.
How do Virginia agencies get Medicaid clients?
By holding the VDH license, enrolling with DMAS through PRSS and contracting with each Cardinal Care health plan to provide agency directed personal care and respite under the CCC Plus Waiver. Plan care coordinators connect members with agencies.
How much does Virginia home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, CCC Plus Waiver or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges. We work in all 50 states and DC.
Sources checked for this guide (52)
- Va. Code 32.1-162.7, home care organization definitions
- Va. Code 32.1-162.8, exemptions from home care organization licensing
- Va. Code 32.1-162.9, license required; three year term
- Va. Code 32.1-162.9:1, criminal history checks for home care organizations
- Va. Code 32.1-162.10, inspections of home care organizations
- Va. Code 32.1-162.1, hospice definitions (hospice facility COPN rule)
- Va. Code 32.1-162.3, hospice license required
- Va. Code 32.1-102.1:3, medical care facilities subject to COPN
- Va. Code 19.2-392.02, barrier crime definition
- Va. Code 40.1-33.3, paid sick leave for home health workers
- 12VAC5-381, Regulations for the Licensure of Home Care Organizations (chapter index)
- 12VAC5-381-10, definitions
- 12VAC5-381-20, license
- 12VAC5-381-30, exemption from licensure
- 12VAC5-381-40, license application, initial and renewal
- 12VAC5-381-70, fees (amended effective May 22, 2025)
- 12VAC5-381-80, on site inspections
- 12VAC5-381-110, criminal records checks
- 12VAC5-381-170, administrator
- 12VAC5-381-200, personnel practices
- 12VAC5-381-210, indemnity coverage
- 12VAC5-381-290, home attendants
- 12VAC5-381-300, skilled services
- 12VAC5-381-310, nursing services
- 12VAC5-381-360, personal care services
- Virginia Register Vol. 41 Iss. 17, 12VAC5-381 fast track action (three year license, $1,500 fee, Chapter 172 of the 2022 Acts)
- 12VAC5-391, Regulations for the Licensure of Hospice (chapter index)
- 12VAC5-391-10, hospice definitions
- 12VAC5-391-40, hospice exemption from licensure
- 12VAC5-391-50, hospice license application
- 12VAC5-391-70, hospice fees
- VDH OLC Home Care and Hospice
- VDH OLC Applications and Forms (OLC Portal)
- VDH OLC, The Accreditation Option for Deemed Medicare Status (2008)
- VDH Certificate of Public Need Program
- 12VAC30-120-930, CCC Plus Waiver general provider requirements
- 12VAC30-120-935, CCC Plus Waiver participation standards for specific services
- 12VAC30-122-460, DD Waivers personal assistance service
- 12VAC30-122-490, DD Waivers respite service
- 12VAC30-60-65, electronic visit verification
- DMAS Electronic Visit Verification (live in requirement from October 1, 2026)
- DMAS CCC Plus Waiver
- DMAS Cardinal Care providers (PRSS enrollment, contracting with each plan)
- DMAS press release, July 1, 2025: Cardinal Care Managed Care launch
- Virginia Tax, Register a Business in Virginia
- Virginia Employment Commission, registering as an employer
- Governor of Virginia news release, May 2026: paid sick leave (HB 5 and SB 199)
- CMS accreditation and approved accrediting organizations
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- Federal Register 2026-09717, CMS nationwide temporary moratoria on Medicare enrollment of home health agencies (published May 15, 2026)
- Federal Register 2026-09718, CMS nationwide temporary moratorium on Medicare enrollment of hospices (published May 15, 2026)
This guide is general information and reflects Virginia requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Virginia Department of Health, DMAS 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.