How to start a home care agency in Wyoming and reach your first client faster
Wyoming has no license for nonmedical home care, so new owners think they can open next week. For private pay families, they nearly can. Medicaid is different. The Community Choices Waiver needs WDH provider certification and Medicaid enrollment, every caregiver needs a four part background screening, and hands on personal care for waiver clients can only be billed by a licensed home health agency. Home health and hospice add a state license and Medicare. 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 Wyoming rulesWyoming Medicaid Chapters 3 and 34, the CCW Agreement and the CCW Provider Manual
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Wyoming requires.
Nonmedical home care for Community Choices Waiver participants
- State license
- None for Homemaker, Respite or Companion Services; Personal Support Services require a home health agency license (W.S. 35-2-901)
- Who you deal with
- WDH Division of Healthcare Financing, HCBS Section, and Wyoming Medicaid provider enrollment
- Must haves
- CCW certification in the Wyoming Healthcare Providers portal, Medicaid enrollment with the CCW taxonomy and an NPI, OIG, sex offender, national criminal and DFS Central Registry checks, policies, EVV through Carebridge
- Realistic time to first client
- Several months
Orientation for Wyoming only. We confirm your exact path on the free call.
Three places new Wyoming agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Planning on waiver personal care without a license
No license for nonmedical care leads many owners to assume they can bill the Community Choices Waiver for bathing, dressing and other hands on help. Under the waiver renewed July 1, 2026, agency Personal Support Services can only be delivered by a licensed home health agency. A nonmedical agency can be certified for Homemaker, Respite and Companion Services instead.
What it costs: Months spent building a business plan around a service you cannot bill.
Two separate approvals before the first waiver client
Waiver providers need CCW certification from the WDH HCBS Section in the Wyoming Healthcare Providers portal and Wyoming Medicaid enrollment under the CCW taxonomy. You are only certified once both are complete, and services delivered before you have a Wyoming provider number cannot be paid. Case managers then send referrals through the same portal.
What it costs: Payroll and rent carried by your reserve while paperwork sits in two systems.
Distance and caregiver screening
Wyoming is large and thinly populated, so one caregiver may cover long drives between clients. Every waiver caregiver also needs an OIG exclusion search, a national sex offender search, a national criminal background screening and a DFS Central Registry check, repeated every five years. A screening that is missing or expired stops billing for that caregiver.
What it costs: Visits you cannot staff or bill, and drive time that eats your margin.
What does a delay cost your agency?
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Home care vs home health vs hospice in Wyoming
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 | Homemaker, companion, respite and private pay personal care | Nursing and other health care services in the home, including home health aides | Medical, palliative, psychological, spiritual and supportive care for people who are terminally ill, and their families |
| State license | None | WDH home health agency license (W.S. 35-2-901 to 35-2-914; Aging Division rules, Chapters 9 and 10) | WDH hospice license (Aging Division rules, Chapter 10, Hospice Programs) |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step |
| Main payers | Private pay; Community Choices Waiver Homemaker, Respite and Companion Services | Medicare, Wyoming Medicaid, CCW Personal Support Services, commercial insurance | Medicare hospice benefit, Wyoming Medicaid |
| Medicare | Not covered | Certification survey, then Medicare enrollment (paused by CMS since May 13, 2026) | Certification survey, then Medicare enrollment (paused by CMS since May 13, 2026) |
| Key staff | Owner or manager who oversees staff; screened caregivers trained on each participant's plan | Administrator, supervisory RN with one year of home health experience, CNA home health aides | Governing body, administrator, medical director, interdisciplinary team |
| Startup capital | Lowest | Higher: clinical payroll before revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks (private pay) to months (waiver) | Longest: licensure, survey, enrollment | Longest: licensure, survey, enrollment |
In Wyoming the home health license matters more than in most states, because it is what lets an agency bill Community Choices Waiver Personal Support Services, Home Health Aide and Skilled Nursing. Many owners start with private pay and waiver Homemaker, Respite and Companion Services, then add a home health license once they have a caregiver team and a supervising RN. We plan both from day one so your policies grow with you instead of being rewritten.
Wyoming requirements at a glance
| Nonmedical home care license | None at the state level. CCW certification and Wyoming Medicaid enrollment are required to serve waiver participants. |
|---|---|
| Home health and hospice licensing | Wyoming Department of Health, Aging Division, Healthcare Licensing and Surveys, under W.S. 35-2-901 through 35-2-914 and Aging Division rules (Chapter 9 and 10 for home health, Chapter 10 for hospice programs) |
| Medicaid agency | WDH Division of Healthcare Financing (Wyoming Medicaid); providers enroll through the HHS Technology Group portal |
| Main Medicaid home care program | Community Choices Waiver (CCW), renewed July 1, 2026; fee for service with open enrollment for qualified providers, no managed care plans |
| Caregiver training | No state hour minimum for nonmedical agencies; participant specific training for each CCW caregiver; CNA certification for home health aides; eight hours for homemakers in licensed home health agencies |
| Background screening | For CCW services: OIG exclusion search, national sex offender search, national name and Social Security number criminal screening, and DFS Central Registry check, repeated every five years. Licensed home health agencies and hospices must have a Central Registry check on file for every employee. |
| Electronic visit verification | Required for CCW Companion Services, agency Personal Support Services, Home Health Aide, Skilled Nursing and Respite; claims go through Carebridge |
| Medicare (home health, hospice) | Certification survey, then Medicare enrollment. New enrollment has been paused nationwide by CMS since May 13, 2026. |
| Entity and employer filings | Wyoming Secretary of State; joint DWS registration for unemployment insurance and workers' compensation |
Summary of Wyoming requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Wyoming
The order matters. Background screening, policies and the WHP portal application should start while the business paperwork is still in progress, because you are only certified once both the HCBS Section and Medicaid enrollment approve you.
Form the business with the Wyoming Secretary of State
File your LLC or corporation, get an EIN and a Type 2 NPI, and check your city or county license rules. Wyoming Medicaid now requires every enrolled provider to have an NPI.
You do this; we give you the checklistRegister with the Department of Workforce Services
Complete the joint DWS business registration on WYUI for unemployment insurance and workers' compensation. DWS says employers covered by the Workers' Compensation Act need a statement of coverage before work starts, and the law covers health care and social assistance employers.
You do this; we specify what is requiredDecide your services and payer mix
Private pay, the Community Choices Waiver or both. A nonmedical agency can be certified for Homemaker, Respite and Companion Services. Agency Personal Support Services need a home health agency license. Use the path finder above.
Decided on your free consultationWrite policies to the CCW standard
Cover participant rights, choice, incident reporting, abuse and neglect reporting, background screening, documentation, emergencies and staff training, written to Wyoming Medicaid Chapters 3 and 34, the CCW Agreement and the CCW Provider Manual.
We write this for youBuild the caregiver screening system
Run the OIG exclusion search, the national sex offender search, a national name and Social Security number criminal screening and a DFS Central Registry check for every caregiver, keep the results in the personnel file, and repeat them every five years.
We set up the system and trackerApply for CCW certification and Medicaid enrollment
Request access to the Wyoming Healthcare Providers portal and complete the initial certification application with your policies and training. Enroll with Wyoming Medicaid through the HHS Technology Group portal under the CCW taxonomy, 251B00000X.
We prepare the applicationSet up electronic visit verification
Respite and Companion Services are billed through Carebridge, the state EVV vendor. You can use another EVV system only if it meets federal rules and integrates with Carebridge.
We walk you through setupIntroduce your agency to case managers
Case managers write each participant's service plan and send referrals through the WHP portal. Participants choose their providers, so case managers need to know what you offer and where you travel.
We prepare and manage it
Caregiver training and background screening
Wyoming sets no hour minimum for nonmedical caregivers in private pay agencies. The Community Choices Waiver and the home health rules set the standards that matter, and they differ by service. Background screening is the same four checks for every CCW service.
- Participant specific training: Each CCW caregiver must be trained on the participant's person centered service plan. The case manager provides it to the agency, and the agency must be able to show who trained each staff member and when.
- Certification training: The CCW Provider Manual says training is part of initial certification and depends on the service you provide. The HCBS Section confirms what applies to your services.
- Home health aides: Must be certified nursing assistants and trained for competency in the home setting. An RN or LPN supervises them at least every 30 days when skilled services are in the home.
- Homemakers in home health agencies: At least eight hours of training before the first assignment, with RN or LPN supervisory visits at least every 90 days. Homemakers do not provide personal care.
- Background screening for CCW: OIG exclusion search, National Sex Offender Public Website search, national name and Social Security number criminal screening, and a DFS Central Registry check. A new hire may start provisionally after signing an attestation, and screening repeats every five years.
- Barrier crimes: A caregiver cannot bill CCW services if excluded from federal health programs, substantiated for abuse or neglect, or convicted of crimes in Wyoming Title 6, Chapters 2 or 4.
- Licensed agencies: Home health agencies and hospices must have a DFS Central Registry check on file for every employee and keep it confidential.
Six mistakes that slow Wyoming agencies down
We look for every one of these in the first week of an engagement.
Planning to bill waiver personal care without a license
- What it costs
- Agency Personal Support Services under the CCW can only be delivered by a licensed home health agency.
- How we prevent it
- We map your services to what Wyoming lets a nonmedical agency bill on your first call.
Serving waiver clients before you have a provider number
- What it costs
- Services delivered before Medicaid enrollment is complete cannot be reimbursed.
- How we prevent it
- We run the WHP certification and Medicaid enrollment together and track both to approval.
Missing one of the four screening checks
- What it costs
- A caregiver without a complete screening on file cannot bill CCW services, and claims can be recovered.
- How we prevent it
- A tracker that flags each check at hire and every five years for every caregiver.
Skipping the DWS registration
- What it costs
- DWS says covered employers need a statement of coverage before work starts in Wyoming.
- How we prevent it
- We put the joint WYUI registration in week one of your checklist.
Underpricing rural visits
- What it costs
- Long drives between clients use caregiver hours that no client is paying for.
- How we prevent it
- We plan your service area with travel time built in before you accept referrals.
Drifting into nursing without a home health license
- What it costs
- Enforcement under W.S. 35-2-909 and problems with every payer.
- How we prevent it
- Clear service definitions so nonmedical caregivers never perform skilled tasks.
In a free 30 minute call we confirm your Wyoming path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Wyoming 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.
- Wyoming path and a dated launch plan
- Policy and procedure manual written to Wyoming Medicaid Chapters 3 and 34, the CCW Agreement and the CCW Provider Manual
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Community Choices Waiver ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Community Choices Waiver requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for the WDH HCBS Section (CCW certification) and Wyoming Medicaid enrollment
- Survey and audit readiness
- Wyoming city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to WDH Healthcare Licensing and Surveys 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 Wyoming 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 Wyoming Medicaid Chapters 3 and 34, the CCW Agreement and the CCW Provider Manual |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for the WDH HCBS Section (CCW certification) and Wyoming Medicaid 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 Wyoming home care startup checklist
Every Wyoming 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, Community Choices Waiver, or both)
- Form your LLC or corporation with the Wyoming Secretary of State
- Get an EIN and a Type 2 NPI
- Complete the joint DWS registration on WYUI for unemployment insurance and workers' compensation
- Check your city or county business license rules
- and 12 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 Wyoming
- 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 Wyoming cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Community Choices 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 Wyoming
| Item | Notes |
|---|---|
| State license | None for nonmedical care. W.S. 35-2-904 sets a $150 yearly fee for a home health agency and $250 for a hospice. Licenses run July 1 to June 30, and the full fee is due for a partial year. A revised license after a name or location change costs $250. |
| Fidelity bond | Home health agencies need a bond of at least $2,500 and hospices at least $5,000, increased with the number of employees |
| Entity formation and city license | Wyoming Secretary of State filing fee plus any local license |
| Background screening | National criminal screening vendor fees and the DFS Central Registry fee for each caregiver, repeated every five years |
| Workers' compensation and unemployment insurance | Premiums set by DWS based on payroll and classification |
| Insurance | General and professional liability, auto coverage for caregivers who drive |
| EVV and scheduling software | Carebridge, or a third party system that integrates with it |
| Operating reserve | Covers payroll, rent and insurance while certification, enrollment or Medicare are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Wyoming
Weeks, once the business, DWS registration, insurance and screening are in place.
Several months: CCW certification in the WHP portal and Medicaid enrollment, then referrals from case managers.
Longest: state licensure and survey, then a certification survey and Medicare enrollment, which CMS has paused for new agencies since May 13, 2026.
Wyoming is a large, rural state where many families live far from the nearest agency office, so reliable coverage across long distances is what sets an agency apart. Demand is spread between the larger towns such as Cheyenne, Casper, Laramie, Gillette, Rock Springs and Sheridan and the small communities around them. Many adult children search for care for a parent from out of state, so a strong Google Business Profile and clear pages for each town you serve matter as much as referrals from case managers.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Wyoming?
No. Wyoming's licensing law covers home health agencies, which it defines as agencies primarily engaged in arranging and directly providing nursing or other health care services at home, but it has no license for nonmedical care. You still need business and DWS registration, insurance and screened caregivers, and CCW certification to serve Medicaid waiver participants.
Who licenses home health and hospice agencies in Wyoming?
The Wyoming Department of Health, Aging Division, Healthcare Licensing and Surveys, under W.S. 35-2-901 through 35-2-914. Home health agencies follow Aging Division rules Chapters 9 and 10, and hospices follow the Chapter 10 rules for hospice programs. HLS publishes a licensure checklist for each type.
How much does a Wyoming home health agency license cost?
W.S. 35-2-904 sets the fee at $150 a year for a home health agency and $250 for a hospice. Licenses run July 1 to June 30, the full fee is due even for part of a year, and a revised license after a name or location change costs $250.
Does Wyoming require a Certificate of Need for home health or hospice?
No. The health care facility licensing act has no need review for home health agencies or hospices. A 2025 law effective July 1, 2026 also removed the remaining bed expansion limits for nursing care facilities and hospitals.
Can a nonmedical agency bill the Community Choices Waiver?
Yes, for Homemaker, Respite and Companion Services, after CCW certification by the WDH HCBS Section and Wyoming Medicaid enrollment. Agency Personal Support Services, Home Health Aide and Skilled Nursing require a home health agency license.
Does Wyoming Medicaid use managed care plans for home care?
No. The Community Choices Waiver pays providers directly on a fee for service basis using a standard fee schedule, and enrollment is open to all willing and qualified providers. You work with the state and with each participant's case manager, not with health plans.
What background checks do Wyoming caregivers need?
For CCW services: an OIG exclusion search, a National Sex Offender Public Website search, a national name and Social Security number criminal screening and a DFS Central Registry check, repeated every five years. Licensed home health agencies and hospices must have a Central Registry check on file for every employee.
Can I open a Medicare home health agency or hospice in Wyoming 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 Wyoming license, then apply to Medicare once new applications are accepted.
How much does Wyoming home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, the Community Choices Waiver 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 Wyoming?
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 (26)
- W.S. Title 35 (35-2-901 to 35-2-914 health care facility licensing; 35-20-115 and 35-20-116 central registry), Wyoming Legislature
- W.S. Title 27 (27-14-108 workers' compensation coverage by industry), Wyoming Legislature
- HB0289 (2025), Certificate of need repeal-3, bill summary (effective 7/1/2026)
- Community Choices Waiver renewal application WY.0236.R07.00, effective July 1, 2026
- CCW Provider Manual, effective July 2026
- CCW renewal summary of proposed changes (July 2026)
- Wyoming Medicaid notice: High Risk Provider Revalidation and Mandatory NPI Requirement (August 17, 2026)
- WDH Aging Division, Healthcare Licensing and Surveys
- HLS Home Health Agency Checklist for State Licensure (03/16/2026)
- HLS Hospice Checklist for State Licensure (08/14/2025)
- Licensure of Home Health Agencies, Chapter 10 (WDH copy)
- Aging Division rules Chapter 9, Program Administration of Home Health Agencies (Cornell LII)
- Chapter 9, Section 5, organization and administration (Cornell LII)
- Chapter 9, Section 6, home health aide (Cornell LII)
- Chapter 9, Section 7, homemaker (Cornell LII)
- Aging Division rules Chapter 10, Program Administration of Hospice Programs (Cornell LII)
- Hospice Chapter 10, Section 5, organization and management (Cornell LII)
- DD Waiver Provider Standards, Chapter 45, Section 5 (Cornell LII)
- Wyoming Department of Workforce Services, Workers' Compensation
- CMS Provider Enrollment Moratoria (last modified 08/27/2026)
- CMS QSO-26-11-HHA & Hospice, six month national moratoria (May 20, 2026)
- Federal Register 2026-09717: nationwide moratorium on Medicare enrollment of home health agencies
- Federal Register 2026-09718: nationwide moratorium on Medicare enrollment of hospices
- CMS-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)
This guide is general information and reflects Wyoming requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Wyoming Department of Health, Wyoming Medicaid, the Department of Workforce Services 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.