How to start a home care agency in Washington and reach your first client faster
Washington licenses nonmedical home care, so you cannot serve a single client until the Department of Health issues an In-Home Services Agency license with the home care category. Before you can even apply, you take a DOH orientation class. Then come the $5,000 initial fee, an initial survey, and a caregiver system built around 75 hours of training, Home Care Aide certification and fingerprint checks. Medicaid clients also need an Area Agency on Aging contract and EVV. 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 Washington rulesWAC 246-335 Part 2 and Area Agency on Aging home care agency contract requirements
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Washington requires.
Nonmedical home care for Community First Choice clients
- State license
- DOH In-Home Services Agency license, home care category (RCW 70.127; WAC 246-335 Part 2)
- Who you deal with
- Department of Health, DSHS Home and Community Living Administration, your local Area Agency on Aging
- Must haves
- DOH license, a home care agency contract with each Area Agency on Aging you serve, DSHS fingerprint background checks, trained and certified caregivers, ProviderOne billing, EVV and caregiver rostering
- Realistic time to first client
- Several months
Orientation for Washington only. We confirm your exact path on the free call.
Three places new Washington agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
A license with a class before the application
Washington requires a DOH license before the first client, and DOH will not process an application without a certificate from its In-Home Services Orientation Class. The class runs once a month. After the application is accepted, you still have to pass an initial survey, and DOH can close an application that is not finished within nine months without refunding the fee.
What it costs: Months of rent and a $5,000 fee at risk if the steps start in the wrong order.
Caregivers on a state training clock
Almost every agency caregiver in Washington is a long term care worker under state law. Each one needs five hours of orientation and safety training before their first shift, 75 hours in total within 120 days of hire, a Home Care Aide application within 14 days, and certification by the deadline. Fingerprint background checks run alongside.
What it costs: A client you cannot staff when a caregiver misses a deadline and has to stop working.
Medicaid clients come through a second contract
The DOH license does not bring Medicaid clients. A home care agency also needs a contract with the local Area Agency on Aging, submitted to each AAA it wants to serve, and DSHS says a contract does not guarantee referrals. Since 2026, ProviderOne denies personal care claims that are missing EVV data such as a rostered caregiver ID.
What it costs: Weeks of unpaid visits and payroll you carry before the first clean claim pays.
What does a delay cost your agency?
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Home care vs home health vs hospice in Washington
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, homemaker help, respite, companionship, and nurse delegated tasks where an RN delegates them | Two or more home health services, such as skilled nursing and therapy, in the patient's residence | Care for people who are terminally ill, directed by an interdisciplinary team |
| State license | DOH In-Home Services Agency license, home care category (WAC 246-335 Part 2) | DOH In-Home Services Agency license, home health category (WAC 246-335 Part 3) | DOH In-Home Services Agency license, hospice category (WAC 246-335 Part 4) |
| Certificate of Need | No | Yes for Medicare or Medicaid certified agencies; not for private pay only | Yes for Medicare or Medicaid certified hospices, with annual review cycles |
| Main payers | Private pay, WA Cares, Medicaid through Area Agency on Aging contracts, long term care insurance | Medicare, Apple Health, commercial insurance | Medicare hospice benefit, Apple Health |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment | Accreditation or state survey, then Medicare enrollment |
| Key staff | Administrator, supervisor of direct care services, caregivers on the Home Care Aide track | Administrator, director of clinical services, licensed clinical staff, aides | Administrator, director of clinical services, interdisciplinary team |
| Startup capital | Lowest of the three, but the license fee and caregiver training come first | Higher: Certificate of Need and clinical payroll before Medicare revenue | Highest: Certificate of Need and a full team before revenue |
| Time to first client | Months (private pay) to several months (Medicaid) | Longest: Certificate of Need, licensure, survey, enrollment | Longest: Certificate of Need cycle, licensure, survey, enrollment |
In Washington all three are one In-Home Services Agency license with different categories, and adding a category later is a new application with its own $5,000 fee and survey. A home care agency that uses RN delegation is still a home care agency, not a home health agency, under RCW 70.127.010. Many owners start with home care, then add home health. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Washington requirements at a glance
| Nonmedical home care license | Required. DOH In-Home Services Agency license with the home care category, under RCW 70.127 and WAC 246-335 |
|---|---|
| Licensing agency | Washington State Department of Health (DOH); initial surveys by its Office of Investigation and Inspection |
| Before you apply | Free DOH In-Home Services Orientation Class, about four hours online; the certificate is valid for one year |
| Initial license fee | $5,000 per service category, plus $500 for each extra urban county or $100 for each extra rural county (WAC 246-335-990) |
| Certificate of Need | Required for Medicare or Medicaid certified home health agencies and hospices; not for home care |
| Caregiver training | 75 hours within 120 days of hire, five of them before the first shift; Home Care Aide certification through DOH; 12 hours of continuing education a year |
| Background checks | Washington State Patrol checks renewed every two years (DOH); fingerprint based state and FBI checks through DSHS for long term care workers |
| Medicaid route | Community First Choice, COPES and Medicaid Personal Care, through a contract with the local Area Agency on Aging |
| Electronic visit verification | Required for Medicaid personal care and respite; agencies choose their own system and bill through ProviderOne |
| Medicare (home health, hospice) | Accreditation by a CMS approved organization or a state survey, then Medicare enrollment |
Summary of Washington requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Washington
The order matters. Book the orientation class first, because DOH will not process an application without it, and set up caregiver training and background checks before you hire, because each caregiver's 120 day clock starts on the hire date.
Form the business and register with the state
File your LLC or corporation with the Secretary of State, then get your business license and UBI number through the Department of Revenue. Open a workers' compensation account with L&I, which Washington employers cannot buy from private insurers, and register with the Employment Security Department for unemployment, Paid Leave and WA Cares premiums.
You do this; we give you the checklistDecide your payer mix
Private pay, WA Cares, Medicaid through an Area Agency on Aging, or a mix. Decide now whether you will add home health within two years, because each added category is another application and fee. Use the path finder above.
Decided on your free consultationTake the DOH orientation class
The In-Home Services Orientation Class is free, online and about four hours, held monthly with limited seats. Your certificate arrives by email and is valid for one year. Applications without it are not processed.
You do this; we give you the checklistWrite policies to WAC 246-335
Policies must cover every requirement in WAC 246-335 Part 2 for home care: plan of operation, delivery of services, personnel, bill of rights, plan of care, supervision, client records and quality improvement. Home care policies may not reference Medicare rules.
We write this for youSubmit the DOH application
Send the application with the $5,000 fee, proof of commercial general liability insurance ($1 million per occurrence or $2 million combined single limit), Washington State Patrol checks and disclosure statements for your administrator and direct care supervisor dated within three months, your business licenses, an FTE worksheet, an organizational chart and a description of services.
We prepare the applicationPass the initial survey
Once DOH accepts the application, its Office of Investigation and Inspection schedules an announced initial survey. The license is issued only after you pass. All steps must be complete within nine months of submitting the application.
We get you ready for the surveyBuild the caregiver pipeline
Set up fingerprint background checks through DSHS, Washington State Patrol checks every two years, TB risk assessments, and an approved training program for the 75 hours. Make sure each caregiver applies for Home Care Aide certification within 14 days of hire and finishes training within 120 days.
We set up the system and trackerContract with your Area Agency on Aging
Washington has 13 Area Agencies on Aging. Send the home care agency contract application to each AAA whose area you want to serve. The same AAAs process WA Cares registration for in home personal care and respite.
We prepare and manage itSet up ProviderOne billing and EVV
Choose an EVV system that meets the DSHS requirements guide, roster every caregiver in ProviderOne before their first Medicaid shift, and submit claims with the required EVV data. Claims missing the caregiver's ProviderOne ID have been denied since January 1, 2026.
We walk you through setup
Home Care Aide training, certification and background checks
Under RCW 74.39A.009, caregivers paid by a licensed home care agency are long term care workers, whether the client pays privately or through Medicaid. RCW 74.39A.074 sets their training, RCW 18.88B and WAC 246-980 set Home Care Aide certification, and WAC 246-335-425 sets the agency's personnel rules.
- Before the first shift: Two hours of orientation and three hours of safety training. These five hours count toward the 75.
- Basic training: 75 hours in 120 days: Seventy hours of core and population specific basic training plus the five hours above, through a DSHS approved program, finished within 120 calendar days of hire or the caregiver must stop working.
- Home Care Aide certification: The caregiver applies to DOH within 14 days of hire, passes the Home Care Aide exam (written and skills) after training, and must be certified within 365 days of hire, or 425 days with a provisional certificate for limited English speakers. Those timelines apply to applicants who apply by December 31, 2027.
- Exemptions: RNs, LPNs, ARNPs and certified nursing assistants do not need certification or the 75 hours. Caregivers who care only for certain relatives, or provide 20 hours or less a month to one person, are also exempt from certification.
- Continuing education: Twelve hours of approved continuing education every year to keep working and keep certification.
- Background checks: Washington State Patrol checks and disclosure statements for anyone with direct client contact, renewed every two years (WAC 246-335-425). Long term care workers also need a fingerprint based state and FBI check at hire through the DSHS Background Check Central Unit (RCW 74.39A.056).
- TB screening and skills check: A TB risk assessment at hire with testing based on the result, in person orientation to agency policies, and verified skills before anyone provides care alone. Annual evaluations include observing care.
- Nurse delegation: An RN may delegate some nursing tasks, including some medication administration, to a certified Home Care Aide or nursing assistant who has completed core nurse delegation training. Injections other than insulin, sterile procedures and central line care cannot be delegated.
Six mistakes that slow Washington agencies down
We look for every one of these in the first week of an engagement.
Applying before the orientation class
- What it costs
- DOH will not process the application, and the next class may be a month away.
- How we prevent it
- Your first call ends with your class date, your exact Washington path and the order to do it in.
Serving clients before the license is issued
- What it costs
- Washington requires the license first, and unlicensed care puts the whole application and your reputation at risk.
- How we prevent it
- We plan your opening around the survey date so marketing and hiring line up with the license.
Letting the 120 day training window run out
- What it costs
- A caregiver who has not finished 75 hours by day 120 must stop working until they do.
- How we prevent it
- A tracker that flags training, the 14 day certification application, exam and continuing education dates for every caregiver.
Adding home health without a Certificate of Need plan
- What it costs
- Medicare or Medicaid home health and hospice need a Certificate of Need first, and hospice applications follow fixed yearly cycles.
- How we prevent it
- We map the Certificate of Need question on your first call, before you pay for a second category.
Waiting on the Area Agency on Aging until after licensure
- What it costs
- Months with a license and staff but no Medicaid clients, since each AAA contracts separately and a contract does not guarantee referrals.
- How we prevent it
- We prepare the AAA packet while the DOH application is in review and file with every AAA in your area.
Billing Medicaid before EVV rostering
- What it costs
- ProviderOne denies personal care claims without the caregiver's rostered ID and visit times.
- How we prevent it
- We set up your EVV system and roster each caregiver during onboarding, before the first Medicaid shift.
In a free 30 minute call we confirm your Washington path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Washington 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.
- Washington path and a dated launch plan
- Policy and procedure manual written to WAC 246-335 Part 2 and Area Agency on Aging home care agency contract requirements
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Community First Choice ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Community First Choice requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for your local Area Agency on Aging
- Survey and audit readiness
- Washington 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 Washington 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 WAC 246-335 Part 2 and Area Agency on Aging home care agency contract requirements |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for your local Area Agency on Aging 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 Washington home care startup checklist
Every Washington 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 care type and payer mix (private pay, WA Cares, Medicaid, or a mix)
- Register for the next DOH In-Home Services Orientation Class
- Form your LLC or corporation with the Secretary of State
- Get your business license and UBI number through the Department of Revenue, plus any city endorsement
- Open L&I workers' compensation and ESD unemployment, Paid Leave and WA Cares accounts
- 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 Washington
- 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 Washington cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Community First Choice, 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 Washington
| Item | Notes |
|---|---|
| DOH initial license fee | $5,000 for each service category (home care, home health, hospice), covering the first 12 months (WAC 246-335-990) |
| County surcharge | One county is included; each additional county adds $500 if urban or $100 if rural |
| DOH renewal | Every 24 months, priced by category and FTE count. For a home care agency with five FTEs or fewer it is $2,400, or $1,700 if it qualifies for the reduced fee through a monitored DSHS or AAA contract |
| Certificate of Need (home health, hospice) | Application review fee and preparation costs; check current fees with the DOH Certificate of Need Program |
| Business registration | Secretary of State filing, Department of Revenue business license and any city endorsement fees |
| Caregiver training and certification | Approved training program tuition for 75 hours, plus DOH certification and exam fees per caregiver |
| Insurance and payroll premiums | General liability, auto, L&I workers' compensation premiums by hours worked, and Paid Leave and WA Cares payroll reporting |
| EVV and scheduling software | Paid by the agency; required for Medicaid personal care and respite claims |
| Operating reserve | Covers payroll for caregivers in training, rent and insurance while the survey and AAA contracts are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Washington
Months: orientation class, application, then the DOH initial survey before the license is issued. DOH allows nine months to finish.
Several months: DOH licensure first, then Area Agency on Aging contracting, ProviderOne enrollment and EVV rostering.
Longest: Certificate of Need review if you will bill Medicare or Medicaid, then DOH licensure, certification survey and Medicare enrollment.
Washington's largest markets are around Puget Sound, from Snohomish County through Seattle and King County to Tacoma, with Spokane, the Tri-Cities and Vancouver as the main hubs east and south. Each extra county on your license adds a surcharge, so plan your service area before you apply, and remember that each Area Agency on Aging contracts separately. WA Cares benefits became available statewide on July 1, 2026, giving many working families a new way to pay for in home care, and they find registered providers through the WA Cares directory and local search. 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 Washington?
Yes. Washington requires an In-Home Services Agency license from the Department of Health under RCW 70.127 and WAC 246-335, approved for the home care category, before you provide personal care, homemaker or respite services to clients.
How much is the Washington home care license fee?
The initial fee is $5,000 for each service category, plus $500 for each additional urban county or $100 for each additional rural county. Renewals are every 24 months and depend on your size: $2,400 for a home care agency with five FTEs or fewer under the standard table (WAC 246-335-990, effective June 1, 2026).
What is the DOH orientation class?
A free online class of about four hours that every new applicant must complete before applying for an In-Home Services license. DOH holds it monthly, emails a certificate within two business days, and the certificate is valid for one year.
Is a home care license different from a home health license in Washington?
Both are the same In-Home Services Agency license. The approved category decides what you may do: home care for nonmedical services, home health for skilled services, hospice for end of life care. Each category has its own rules and initial fee.
Does Washington require a Certificate of Need for home health or hospice?
Yes, for agencies that are or plan to become Medicare or Medicaid certified. The DOH Certificate of Need Program reviews new home health agencies and hospices, and serving a new county counts as a new agency. Hospice applications follow yearly review cycles. Home care agencies do not need one.
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 the Health Care Authority before you plan around Apple Health.
How many training hours do Washington home care aides need?
Seventy five hours: two hours of orientation and three of safety training before the first shift, and 70 hours of basic training, all within 120 days of hire. Caregivers then pass the Home Care Aide exam and must be certified within 365 days of hire for applications filed by December 31, 2027.
Can a Washington home care agency help with medications?
Through nurse delegation, an RN can delegate certain tasks, including some medication administration, to a certified Home Care Aide or nursing assistant who has completed core nurse delegation training. Injections other than insulin cannot be delegated.
How do Washington home care agencies get Medicaid clients?
By contracting with the local Area Agency on Aging to provide in home personal care under Community First Choice, COPES and Medicaid Personal Care. Clients choose between agencies and individual providers, so a contract makes you eligible but does not guarantee referrals.
How does WA Cares affect home care agencies?
WA Cares benefits became available on July 1, 2026, with up to $36,500 in covered services that grows with inflation. Home care agencies register through the online application, and the local Area Agency on Aging processes it and sends a contract. Services are approved and billed through ProviderOne.
Sources checked for this guide (55)
- RCW 70.127.010, in-home services agency definitions
- WAC 246-335, in-home services agencies (chapter list)
- WAC 246-335-320, initial application (orientation class, insurance, nine months)
- WAC 246-335-350, substantial equivalency to the state survey
- WAC 246-335-410, home care definitions
- WAC 246-335-415, home care plan of operation
- WAC 246-335-425, home care personnel policies (background checks, TB, skills)
- WAC 246-335-445, supervision of home care services
- WAC 246-335-515, home health plan of operation
- WAC 246-335-525, home health personnel policies
- WAC 246-335-545, supervision of home health services
- WAC 246-335-990, fees (WSR 26-04-110, effective 6/1/26)
- DOH Home Care Agencies
- DOH Home Care Agencies: License Requirements
- DOH Home Care Agencies: Orientation Class
- DOH Home Care Agencies: Rules in Progress
- DOH Certificate of Need Program
- RCW 70.38.025, health care facility definition (includes home health agencies and hospices)
- RCW 70.38.105, activities subject to Certificate of Need review
- WAC 246-310-010, Certificate of Need definitions (Medicare or Medicaid certified home health and hospice)
- WAC 246-310-020, applicability (new county counts as a new agency)
- WAC 246-310-290, hospice need method and review cycles
- DOH Home Health Agency Certificate of Need laws and rules (DOH 260-062, May 2025)
- RCW 74.39A.009, long term care worker definition
- RCW 74.39A.074, 75 hour training and 120 day deadline
- RCW 74.39A.341, 12 hours of continuing education
- RCW 74.39A.056, fingerprint background checks for long term care workers
- RCW 18.88B.041, Home Care Aide certification exemptions
- RCW 18.88B.031, Home Care Aide certification exam
- WSR 26-12-065, DOH permanent rule extending certification to 365 days (effective 7/3/26)
- DOH Home Care Aide Frequently Asked Questions
- RCW 18.79.260, nurse delegation
- WAC 388-71-0510, qualifications of long term care workers
- WAC 388-71-0513, background checks for home care agency workers
- WAC 388-71-0516, home care agency responsibilities for DSHS clients
- WAC 388-71-0991, continuing education deadlines
- DSHS Information for Potential Medicaid Contractors
- DSHS Home and Community Living Administration
- DSHS Long-Term Care Manual, Chapter 7b: Community First Choice (revised 07/2026)
- DSHS Electronic Visit Verification
- DSHS EVV Desk Aid (July 2026)
- DSHS Background Check Central Unit
- WA Cares Fund: for providers
- WA Cares Fund: benefits now available (July 1, 2026)
- WA Cares Fund: for employers
- Secretary of State, Corporations and Charities Division
- Department of Revenue, apply for a business license
- L&I, do I need a workers' comp account
- L&I, paid sick leave
- 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)
- 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 Washington requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Washington State Department of Health, DSHS, the Health Care Authority 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.