How to start a home care agency in District of Columbia

District of Columbia requires a Home Care Agency license from DC Health (District of Columbia Department of Health), Health Regulation and Licensing Administration to operate a home care agency. Fee: $600.

License required

Yes

License

Home Care Agency license

Issuing agency

DC Health (District of Columbia Department of Health), Health Regulation and Licensing Administration

Fee

$600

Fee details

$600 initial application fee. Duplicate license $50; certification of license validity $50.

Renewal

Every year · Annual fee by yearly DC admissions: 1–150 patients $400; 151–750 $700; 751–1,250 $1,100; 1,251+ $1,300; late fee $100.

Insurance and bonds

Blanket malpractice insurance of at least $1,000,000 per incident for professional employees; general liability of at least $1,000,000 per occurrence (property damage, bodily injury, libel and slander); product liability where applicable.

Survey and inspection

Inspections, licensing and enforcement follow 22-B DCMR Chapter 31. Records kept outside the DC office must be produced within 24 hours on request.

Medicare certification

Agencies serving Medicare or DC Medicaid patients must also meet those programs' conditions of participation.

Regulation

22-B DCMR Chapter 39 (Home Care Agencies); 17 DCMR Chapter 93 (Home Health Aides)

1. Set up an operating office inside the District, staffed at least 8 hours a day Monday–Friday, holding DC patient records and policies
2. Have the governing body appoint a qualified Director
3. Obtain the required malpractice and general liability insurance
4. Submit the DC Health home care agency application with the $600 fee
5. Pass DC Health licensing inspection (22-B DCMR Chapter 31 procedures)
6. Post the license in the DC office; pay the annual fee based on the yearly census

Staffing

• Director who is a licensed physician, a licensed RN, or has health services administration training with at least 1 year of supervisory/administrative experience in home health or related programs
• Personal care aides must be certified home health aides through the DC Board of Nursing and work under a licensed nurse or other licensed health professional
• On-site supervision of non-skilled aide services at least every 62 calendar days (every 2 weeks for skilled services)

Training

• DC Board of Nursing home health aide certification: approved course plus competency exam
• 12 hours of continuing education or in-service each year (24 hours per 2-year renewal), including 3 hours on HIV/AIDS and 2 hours on cultural competency
• The 2004 agency rule sets aide training at 75 hours (16 supervised practical); Board of Nursing HHA certification rules now govern aide credentials

Program

DC Medicaid (Department of Health Care Finance)

Enrollment portal

DC Medicaid Provider Data Management System (PDMS)

Fiscal agent

Gainwell Technologies (fiscal agent and claims vendor since March 2, 2026, replacing Conduent)

Application fee

DHCF has collected the institutional application fee at enrollment and re-enrollment since May 1, 2015, under the District's Medicaid provider screening, enrollment and termination rule. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full District of Columbia Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

State Health Planning and Development Agency (SHPDA), DC Health

Services covered

• hospitals (general, psychiatric, rehabilitation, specialty)
• skilled nursing facilities
• intermediate care facilities
• ambulatory care centers / clinics
• ambulatory surgical facilities
• kidney disease treatment / freestanding hemodialysis
• diagnostic health care facilities
• home health agencies
• hospice
• new health services by facilities with operating budgets of $500,000+
• capital expenditures of $6M+ (hospitals) or $3.5M+ (other facilities)
• major medical equipment ($3.5M hospitals / $2M other facilities / $350,000 single physician-owned unit)
• bed relocations and redistribution

Moratoria

SHPDA may impose a moratorium of up to 120 days on CONs for a specific service while it develops review standards; the same service cannot be placed under moratorium more than once in 12 months (D.C. Code §44-418). No standing moratorium identified.

District of Columbia certificate of need details →

Model

hybrid

State vendor

Sandata

Services in scope

• personal care
• home health

Alternate EVV allowed

Yes

Program

https://dhcf.dc.gov/page/providers-evv

District of Columbia EVV requirements →

State minimum wage

$18.40 an hour

Effective

2026-07-01

Scheduled increases

Adjusted each July 1 by formula (US DOL); the July 2027 rate was not yet published in the sources reviewed.

Direct-care wage floor

For FY2026, DC must pay direct care service providers a rate that supports direct care professional pay at the highest of: 117.6% of the DC living wage in effect on 2025-07-01, the current DC minimum wage, or the current DC living wage. DHCF's supplemental payment program requires eligible HCBS providers to pay their direct care workforce, on average, at or above the target wage.

Rate pass-through

Supplemental payments must fund wages, salaries and benefits of direct care professionals (DHCF Transmittal 25-03).

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Personal care / in-home supportive care organizations — active organization NPIs (NPPES)

210 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

237,170 (as of Jun 1, 2026)

All District of Columbia Home care Medicaid rates, ranked →

• Adult Day Health Program (ADHP) (1915(i))
• Elderly and Persons with Physical Disabilities Waiver (1915(c))
• People with Intellectual and Developmental Disabilities (IDD) Waiver (1915(c))
• Individual and Family Support (IFS) Waiver (1915(c))

District of Columbia waivers and waiting lists →