How to start a home care agency in Hawaii

Hawaii requires a Home Care Agency license from Hawaii Department of Health, Office of Health Care Assurance (OHCA), State Licensing Section to operate a home care agency. Fee: $1,200.

License required

Yes

License

Home Care Agency license

Issuing agency

Hawaii Department of Health, Office of Health Care Assurance (OHCA), State Licensing Section

Fee

$1,200

Fee details

$1,200 initial licensure fee, paid after the application is processed and before the license is issued, under HAR Chapter 11-103.1.

Renewal

A renewal fee applies under HAR Chapter 11-103.1; the amount was not found on the OHCA pages reviewed.

Survey and inspection

OHCA makes unannounced inspections of licensed home care agencies.

Regulation

HRS 321-14.8 (as amended by Act 51, SLH 2025); HAR Chapter 11-700 (Home Care Agencies); HAR Chapter 11-103.1 (fees)

1. Obtain a General Excise Tax clearance (Dept. of Taxation) and a Certificate of Good Standing (DCCA)
2. Prepare the policies and procedures manual required by HAR 11-700-8 and the administration standards in HAR 11-700-9
3. Designate an administrator and a qualified supervisor
4. Complete the OHCA home care agency application and mail it with supporting documents in hard copy to OHCA State Licensing Section, 601 Kamokila Blvd, Room 361, Kapolei
5. Pay the $1,200 licensure fee when OHCA asks for it
6. Receive the license before operating; expect unannounced inspections

Staffing

• Administrator responsible for managing the agency
• Supervisor with at least 2 years of experience or training in home care or a closely related field, or a professional license (RN, LPN, social worker, PT, OT); may be the administrator but not a client's case manager
• Personal care aides must have completed a state-approved basic nurse aide course or equivalent, or hold qualifying health care professional coursework
• Homemakers need experience or training in homemaker services
• Pre-hire TB clearance and background check for employees and volunteers

Training

• Personal care aide: state-approved basic nurse aide course or equivalent
• Employee orientation and training policies required by HAR 11-700-8

Program

Hawaii Medicaid — Med-QUEST Division (QUEST Integration)

Enrollment portal

HOKU provider enrollment system

Fiscal agent

Med-QUEST's 2010 general-information manual names Affiliated Computer Services (ACS), a Xerox company, as fiscal agent; we found no newer Med-QUEST statement

Application fee

Med-QUEST's HOKU FAQ describes an application fee ($500 at the time it was written) charged at initial enrollment and at revalidation, temporarily waived during the COVID-19 emergency. The provider-type list shows which types need a site visit and/or fee (e.g., home health agencies need both). 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

Med-QUEST runs fingerprint-based criminal history record checks (state repository and FBI), combined with Adult Protective Services and Child Abuse and Neglect registry checks, for certain provider requirements. 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

Med-QUEST's provider-type requirements list says which provider types get a site visit (for example, home health agencies). 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

Med-QUEST began revalidating all providers in 2017 and requires revalidation every five years. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Hawaii Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Hawaii State Health Planning and Development Agency (SHPDA)

Services covered

• hospitals
• extended care and rehabilitation centers
• nursing homes / skilled nursing facilities
• intermediate care facilities
• hospices requiring state licensure or certification
• kidney disease treatment centers / freestanding hemodialysis
• outpatient clinics and organized ambulatory health care facilities
• emergency care facilities
• home health agencies
• health maintenance organizations

Hawaii certificate of need details →

Model

hybrid

State vendor

Sandata

Services in scope

• personal care
• home and community nursing
• home health

Alternate EVV allowed

Yes

Program

https://medquest.hawaii.gov/content/medquest/en/plans-providers/electronic-visit-verification.html

Hawaii EVV requirements →

State minimum wage

$16.00 an hour

Effective

2026-01-01

Scheduled increases

Rises to $18.00 on 2028-01-01.

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)

196 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

391,710 (as of Jun 1, 2026)

All Hawaii Home care Medicaid rates, ranked →

• HCB Services for People with Intellectual and Developmental Disabilities (I/DD) Waiver (1915(c))
• QUEST Integration — long-term services and supports under Hawaii's Section 1115 demonstration (1115)

Hawaii waivers and waiting lists →