How to start a home care agency in West Virginia and reach your first client faster
West Virginia has no state license for nonmedical home care, but Medicaid home care has a gate in front of it. Medicaid Personal Care requires a Certificate of Need from the Health Care Authority, county by county, before the Bureau of Senior Services will certify you. Then come a qualifying office, an RN, WV CARES fingerprint checks, separate Aged and Disabled Waiver certification and electronic visit verification. 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 West Virginia rulesBMS Provider Manual Chapters 517 and 501 and the HCA Certificate of Need standards
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what West Virginia requires.
Nonmedical home care for Medicaid Personal Care and ADW members
- State license
- No license; HCA Certificate of Need (W. Va. Code 16-2D-8) for Medicaid Personal Care, then Bureau of Senior Services certification
- Who you deal with
- West Virginia Health Care Authority, Bureau of Senior Services (operating agency), Bureau for Medical Services and its fiscal agent, Acentra Health (utilization management)
- Must haves
- Certificate of Need for each county, a physical office in West Virginia open 40 hours a week, an employed RN, competency based caregiver training, WV CARES checks, certification onsite review, BMS provider agreement, separate ADW certification, EVV
- Realistic time to first client
- Several months or more
Orientation for West Virginia only. We confirm your exact path on the free call.
Three places new West Virginia agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
The Certificate of Need comes before everything
BMS Chapter 517 says a provider must have a Certificate of Need from the Health Care Authority to provide Medicaid Personal Care, and the HCA counts need county by county. A county is open only if its unmet need is 25 or more, and each new provider approved there in the past 12 months takes another 25 off the count. Owners who lease an office and hire first can end up in a county the methodology says is full.
What it costs: Rent, an RN salary and months of planning spent on a county you cannot serve under Medicaid.
Certification rules that assume you are already open
After the Certificate of Need, the Bureau of Senior Services certifies you only after an onsite review of a real office: in West Virginia, not in a home, with signage, ADA access, 40 public hours a week and 24 hour contact. You also need an employed RN, a competency based training curriculum and a full set of written policies before BMS's fiscal agent sends the provider agreement.
What it costs: Months of fixed costs before your first billable Medicaid hour.
Two programs, two rulebooks
Medicaid Personal Care (Chapter 517) and the Aged and Disabled Waiver (Chapter 501) each need their own certification and NPI. The rules differ: Personal Care allows a fingerprint pending provisional hire for up to 60 days, while ADW does not allow provisional employees at all. Agencies that mix them up staff the wrong cases or bill services they cannot keep.
What it costs: Repayments, pay holds and caregivers who sit idle while fingerprint results come back.
What does a delay cost your agency?
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Home care vs home health vs hospice in West 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, ADW personal attendant services, homemaker tasks and companionship | Skilled nursing, home health aide services and therapy under a plan of care | Palliative and supportive care for people who are terminally ill, and their families |
| State license | None; Medicaid Personal Care needs an HCA Certificate of Need and Bureau of Senior Services certification | No state license; HCA Certificate of Need, then Medicare certification through OHFLAC or an accrediting organization | OHFLAC hospice license (W. Va. Code 16B-8; 71 CSR 14) after an HCA Certificate of Need |
| Certificate of Need | Yes for Medicaid Personal Care (county need methodology); ask the HCA about private pay hands on care and ADW | Yes, county by county; new providers need an unmet need of at least 75 in each county | Yes, county by county; unmet need of 75 or more required |
| Main payers | Private pay, Medicaid Personal Care, Aged and Disabled Waiver (both paid by BMS outside managed care) | Medicare, West Virginia Medicaid and Mountain Health Trust plans, commercial insurance | Medicare hospice benefit, West Virginia Medicaid, private insurance |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment; check the CMS moratorium | Accreditation or state survey, then Medicare enrollment; check the CMS moratorium |
| Key staff | Agency RN with a West Virginia license for nursing plans of care and training; trained direct care workers | Administrator, clinical manager, RNs, therapists and trained home health aides (42 CFR Part 484) | Physician medical director, RN, social worker, counselor and RN supervised aides (71 CSR 14) |
| Startup capital | Low for private pay; higher for Medicaid because of the CON, office and RN | Higher: CON application and clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks (private pay) to several months or more (Medicaid) | Longest: CON, survey, Medicare enrollment | Longest: CON, licensure, survey, Medicare enrollment |
Many West Virginia owners start with private pay care while the Certificate of Need for Medicaid Personal Care is under review, then add the Aged and Disabled Waiver: Chapter 501 lets the operating agency waive the ADW onsite review for agencies already enrolled in Personal Care. Home health and hospice are harder to enter, because both need a Certificate of Need in counties with documented unmet need, and West Virginia Medicaid only enrolls home health agencies that are already Medicare certified. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
West Virginia requirements at a glance
| Nonmedical home care license | None at the state level. Medicaid Personal Care requires a Certificate of Need and Bureau of Senior Services certification. |
|---|---|
| Certificate of Need | West Virginia Health Care Authority under W. Va. Code 16-2D-8, which lists personal care services, home health agencies and hospice services. Need is set county by county. |
| Home health | No state license. Certificate of Need, then Medicare certification; OHFLAC is the state survey agency. |
| Hospice licensing | Office of Health Facility Licensure and Certification (OHFLAC), Office of Inspector General, under W. Va. Code 16B-8 and 71 CSR 14 (effective May 28, 2025) |
| Medicaid agency | Bureau for Medical Services (BMS), Department of Human Services; claims through the BMS fiscal agent |
| Medicaid home care programs | Medicaid Personal Care (Chapter 517) and the Aged and Disabled Waiver (Chapter 501, effective June 1, 2026), operated by the Bureau of Senior Services with Acentra Health as utilization management contractor |
| Caregiver training | Competency based initial training before the first shift (CPR, first aid, personal care skills, abuse and neglect, HIPAA, ethics and more), then yearly refreshers: four hours for Personal Care, two for ADW |
| Background screening | WV CARES: registry prescreen, fingerprint based state and FBI check, Rap Back and monthly registry rechecks |
| Electronic visit verification | Required for Personal Care, ADW personal attendant services and home health; agencies may use the state system or their own |
| Entity filing | West Virginia Secretary of State and State Tax Department business registration, through the One Stop Business Portal |
Summary of West Virginia requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in West Virginia
The order matters. In West Virginia the Certificate of Need decides which counties you can serve under Medicaid, so check the HCA need methodology before you lease an office or hire an RN.
Form the business and register
File your LLC or corporation with the Secretary of State, get an EIN, and register through the One Stop Business Portal for a State Tax Department business registration certificate and with WorkForce West Virginia. Every West Virginia employer must carry workers' compensation.
You do this; we give you the checklistChoose your services, payers and counties
Private pay companion and homemaker care can start quickly. Medicaid Personal Care needs a Certificate of Need, and the HCA's need methodology shows which counties are open. Use the path finder above.
Decided on your free consultationApply for the Certificate of Need
File a Letter of Intent with the Health Care Authority at least 10 days before the application. The application must show county need, a physical office in your service area, staffing that meets Medicaid rules, two years of financial statements and a three year pro forma. The HCA asks BMS for a recommendation, then decides. Unsure whether your plan is reviewable? Ask for a determination of reviewability.
We prepare the applicationSet up a qualifying office
Personal Care and ADW offices must be in West Virginia, not in a private residence, identified by signage, ADA accessible, open to the public at least 40 hours a week, with a listed business phone and 24 hour contact.
You do this; we specify what is requiredWrite policies to BMS Chapters 517 and 501
Certification requires a quality management plan, a competency based training curriculum, complaint and grievance procedures, rules for electronic devices, member transfer and discharge policies, an emergency plan and conflict of interest safeguards.
We write this for youHire your RN and build the caregiver pipeline
Employ an RN with a current West Virginia license. Prescreen every applicant in WV CARES, request fingerprints, and complete initial competency based training before anyone works with a member. Track yearly refreshers.
We set up the system and trackerGet certified and enroll with BMS
Submit the Personal Care certification application to the Bureau of Senior Services. After a satisfactory onsite review, BMS's fiscal agent sends the provider agreement, and you may bill only after its approval letter arrives.
We prepare and manage itAdd Aged and Disabled Waiver certification
ADW personal attendant services need their own certification and NPI. The operating agency may waive the ADW onsite review for agencies already enrolled in Personal Care. Case management is a separate certification, and you may not provide both to the same member without a BMS exception.
We prepare and manage itSet up electronic visit verification
EVV is required for Personal Care and ADW personal attendant visits. West Virginia allows the state system or your own compliant system, and each attendant who does not live with the member needs an individual NPI.
We walk you through setup
Caregiver training and WV CARES background checks
West Virginia has no state license for nonmedical caregivers. For Medicaid work, BMS Chapters 517 (Personal Care) and 501 (Aged and Disabled Waiver) set the training, and WV CARES sets the screening. Workers must be at least 18 and finish initial competency based training before they provide services.
- Personal Care initial training: CPR and first aid with a skills demonstration, universal precautions, ADL and IADL skills taught by the agency RN, abuse, neglect and exploitation, HIPAA, direct care ethics and member health and welfare. Competency means a graded posttest score of at least 80%.
- Personal Care yearly training: Keep CPR and first aid current, renew universal precautions, abuse and neglect, and HIPAA training every 12 months, and add four hours of training on direct care skills.
- ADW personal attendant training: The same core topics plus person centered planning, attendant safety and HCBS Settings Rule training, before the first shift. The June 2026 manual sets competency at 70% and requires two additional hours of training each year.
- CNAs and LPNs on the ADW: Can be hired right away with a current credential once they complete CPR (and first aid for CNAs), fingerprinting and Settings Rule training. They work as personal attendants and cannot provide skilled care.
- WV CARES screening: Prescreen every direct access applicant against the required registries, including the federal exclusion list, the West Virginia Medicaid exclusions list, nurse aide registries and sex offender registries, then a fingerprint based state and FBI check. Registry rechecks run monthly and Rap Back reports new arrests.
- Provisional hiring: Personal Care allows provisional work for up to 60 days while the fitness determination is pending, under direct onsite supervision. The ADW does not allow provisional employees, and its criminal identification checks repeat every five years.
- Agency RN: Personal Care agencies must employ an RN with a current West Virginia license, who develops nursing plans of care and completes yearly abuse and neglect and person centered planning training.
- Home health aides: Home health agencies follow 42 CFR 484.80: at least 75 hours of classroom and supervised practical training, a competency evaluation and 12 hours of in service training every year.
Six mistakes that slow West Virginia agencies down
We look for every one of these in the first week of an engagement.
Leasing an office before the Certificate of Need
- What it costs
- A signed lease in a county the HCA methodology shows as closed to new Medicaid Personal Care providers.
- How we prevent it
- We check the current need calculation for your counties on your first call.
Expanding into a new county without a new CON
- What it costs
- Chapter 517 requires a new Certificate of Need to serve an additional county, so services there cannot be billed.
- How we prevent it
- We map your service area at the start and file contiguous counties together where need allows.
Running the agency from home
- What it costs
- The operating agency will not certify an office in a private residence or one without 40 posted public hours.
- How we prevent it
- We give you the office criteria checklist before you sign anything.
Letting an ADW attendant start before fingerprints clear
- What it costs
- The ADW does not allow provisional employees, so those hours can be disallowed and repaid.
- How we prevent it
- A tracker that shows each caregiver's WV CARES status, training dates and NPI before scheduling.
Providing case management and personal attendant care to the same member
- What it costs
- A conflict of interest finding can cost your ADW certification for a year.
- How we prevent it
- Policies and an organization chart that keep the two services separate.
Planning home health or hospice without checking need and Medicare
- What it costs
- No CON without documented county need, and no Medicare enrollment while the CMS moratorium lasts, which also blocks Medicaid home health enrollment.
- How we prevent it
- We check the HCA need methodology and the CMS moratorium status before you commit capital.
In a free 30 minute call we confirm your West Virginia path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
West 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.
- West Virginia path and a dated launch plan
- Policy and procedure manual written to BMS Provider Manual Chapters 517 and 501 and the HCA Certificate of Need standards
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Medicaid Personal Care and ADW ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Medicaid Personal Care and ADW requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for the Bureau of Senior Services (certification) and the Bureau for Medical Services (enrollment)
- Survey and audit readiness
- West 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 HCA and OHFLAC 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 West 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 BMS Provider Manual Chapters 517 and 501 and the HCA Certificate of Need standards |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for the Bureau of Senior Services (certification) and the Bureau for Medical Services (enrollment) 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 West Virginia home care startup checklist
Every West 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, payers and counties (private pay, Medicaid Personal Care, ADW)
- Form your LLC or corporation with the West Virginia Secretary of State
- Get an EIN and a State Tax Department business registration certificate through the One Stop Business Portal
- Register with WorkForce West Virginia and buy workers' compensation, liability and auto coverage
- Check the HCA In Home Personal Care need methodology for your counties
- and 15 more steps
Christine Ochimas, RN, LMFT, MBA
Christine founded Lunaria Care Consulting to give nurses and caregivers a direct route from "I want my own agency" to a compliant business with clients. She reads state requirements the way a reviewer does and writes policies the way a nurse would actually use them.
- We serve owners in all 50 states and DC, with a plan written for West 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 West Virginia cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Medicaid Personal Care and ADW, 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 West Virginia
| Item | Notes |
|---|---|
| State license | None for nonmedical care. OHFLAC charges hospices a $100 initial license fee, and $50 or $100 a year to renew depending on caseload (71 CSR 14). |
| Certificate of Need | HCA application fee from $1,500 for projects up to $1,500,000, rising with project size. A determination of reviewability is $100 and an exemption application is $1,000. |
| Business registration | Secretary of State filing fee, plus the State Tax Department's $30 business registration fee |
| WV CARES screening | Registry prescreening and fingerprinting fees per applicant; check current amounts with WV CARES |
| Office | Commercial office space in West Virginia; a home office does not qualify for Personal Care or ADW |
| RN and training | Agency RN payroll, CPR and first aid courses, and training materials |
| Insurance | Workers' compensation (required for every West Virginia employer), liability and auto coverage |
| EVV and scheduling software | State EVV system or your own compliant system |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance during CON review, certification and enrollment |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in West Virginia
Weeks, once the business, insurance and hiring process are in place.
Several months or more: Letter of Intent and Certificate of Need review, then office setup, Bureau of Senior Services certification and onsite review, and BMS enrollment.
Longest: Certificate of Need in a county with unmet need, hospice licensure, certification survey and Medicare enrollment, subject to the CMS moratorium.
West Virginia is rural and mountainous, so reliable staffing and short drive times between clients matter as much as marketing. For Medicaid Personal Care, the Health Care Authority's need methodology effective February 3, 2025 showed the largest unmet need in counties such as Kanawha, Berkeley, Wood, Mason, Cabell, Raleigh and Monongalia, while several southern and smaller counties showed none; the numbers are updated at least twice a year. Families often search for care for a parent from out of state, so a strong Google Business Profile and pages for Charleston, Huntington, Morgantown, Parkersburg, Wheeling, Beckley, Martinsburg and your counties help them find you.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in West Virginia?
No. West Virginia does not license nonmedical home care agencies. To provide Medicaid Personal Care, though, an agency needs a Certificate of Need from the Health Care Authority, certification from the Bureau of Senior Services and enrollment with BMS. If you plan hands on personal care for private pay clients, ask the HCA for a determination of reviewability.
Does West Virginia still require a Certificate of Need for personal care?
Yes. W. Va. Code 16-2D-8 lists providing personal care services, establishing a home health agency and providing hospice services. House Bill 5096 (2026) would have exempted personal care; it passed the House in February 2026 but did not pass the Senate.
Who licenses home health and hospice agencies in West Virginia?
West Virginia does not issue a state home health license; home health agencies need a Certificate of Need and Medicare certification, with OHFLAC as the state survey agency. Hospices are licensed by OHFLAC, part of the Office of Inspector General, under W. Va. Code 16B-8 and 71 CSR 14, after obtaining a Certificate of Need.
Is the CMS Medicare moratorium still in effect?
CMS paused new Medicare enrollment of home health agencies and hospices nationwide from May 13, 2026 for six months. It was set to end around November 13, 2026 unless CMS extended it, so check its current status. In West Virginia it matters for Medicaid too, because BMS only enrolls home health agencies that are Medicare certified.
How do West Virginia agencies get Medicaid Personal Care and ADW clients?
After certification and BMS enrollment, your agency appears on the provider selection lists that members choose from. Members qualify through a Pre-Admission Screening by BMS's utilization management contractor. Both programs are paid by BMS outside the Mountain Health Trust health plans.
Do caregivers need certification in West Virginia?
There is no state license for nonmedical caregivers. Medicaid caregivers must be at least 18, complete competency based training before their first shift and clear WV CARES registry and fingerprint checks. Current CNAs and LPNs have a shorter path into ADW work.
Can I run a West Virginia home care agency from my home?
Not for Medicaid. Personal Care and ADW agencies must have a physical office in West Virginia that is not in a private residence, open to the public at least 40 hours a week. A private pay only agency has no state office rule.
Is a franchise a better way to start a home care agency in West Virginia?
A franchise gives you a brand and playbook in exchange for fees and ongoing royalties, but it does not get you a Certificate of Need. Starting independently with Lunaria costs one fixed price, and you own 100% of your agency with no franchise fees or royalties.
How much does West Virginia home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Medicaid Personal Care and ADW, 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 West Virginia?
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 (36)
- West Virginia Health Care Authority, Certificate of Need program
- HCA CON Frequently Asked Questions (Letter of Intent, determination of reviewability, exemptions)
- HCA CON filing fees
- HCA exemptions from Certificate of Need
- HCA CON standards list
- HCA In Home Personal Care Services CON standards (approved April 27, 2023)
- HCA In Home Personal Care need methodology (effective February 3, 2025)
- HCA Home Health Services CON standards (approved April 27, 2023)
- HCA Home Health need methodology (FY 2021 data, as of August 26, 2022)
- HCA Hospice Services CON standards (approved 9/17/20)
- HCA Hospice need methodology (as of April 1, 2025)
- HB 5096 (2026) engrossed text, showing current W. Va. Code 16-2D-8
- BMS Provider Manual Chapter 517, Personal Care Services (effective 1/1/2018)
- BMS Chapter 517 Personal Care Services page
- BMS Provider Manual Chapter 501, Aged and Disabled Waiver (effective June 1, 2026)
- BMS Provider Manual Chapter 508, Home Health (revised 12/21/2018)
- BMS Provider Manual Chapter 509, Hospice (effective May 1, 2020)
- BMS Mountain Health Trust managed care (carved out services)
- Aged and Disabled Waiver program site (Bureau of Senior Services, Acentra Health, Gainwell contacts)
- Acentra Health WV ASO (ADW, Personal Care, TBI and IDD programs)
- West Virginia Medicaid Electronic Visit Verification
- WV CARES, Office of Inspector General
- 69 CSR 10-3, WV CARES prescreening (Cornell LII)
- 71 CSR 14, Hospice Licensure Rule (effective May 28, 2025), Secretary of State
- OHFLAC hospice care program licensure application
- OHFLAC facility types data (home health certified, not licensed; hospice licensed)
- OHFLAC laws and rules list
- West Virginia State Tax Department, business registration FAQ ($30 fee, One Stop Business Portal)
- West Virginia Offices of the Insurance Commissioner, employer workers' compensation coverage
- Federal Register 2026-09717, nationwide moratorium on enrollment of home health agencies (govinfo)
- Federal Register 2026-09718, nationwide moratorium on enrollment of hospices (govinfo)
- CMS Provider Enrollment Moratoria
- 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)
- BillTrack50, HB 5096 status (secondary, pointer only)
This guide is general information and reflects West Virginia requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the West Virginia Health Care Authority, the Bureau for Medical Services, the Bureau of Senior Services, OHFLAC 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.