How to start a home care agency in Maryland

Maryland requires a Residential Service Agency (RSA) license from Maryland Department of Health, Office of Health Care Quality (OHCQ) to operate a home care agency. Fee: The current OHCQ RSA application (rev. 04/22/2026) says there is no fee to apply. The 2016 regulation change set licensure fees at $1,000 per 3-year license (down from $2,100). Processing time: No processing time is published. OHCQ holds an incomplete application for 180 days, then closes it administratively.

License required

Yes

License

Residential Service Agency (RSA) license

Issuing agency

Maryland Department of Health, Office of Health Care Quality (OHCQ)

Fee

The current OHCQ RSA application (rev. 04/22/2026) says there is no fee to apply. The 2016 regulation change set licensure fees at $1,000 per 3-year license (down from $2,100).

Renewal

Every 3 years · A license is valid for 3 years; non-refundable $1,000 renewal fee for each 3-year term (COMAR 10.07.05.04, as amended in 2015–2016).

Processing time

No processing time is published. OHCQ holds an incomplete application for 180 days, then closes it administratively.

Insurance and bonds

Workers' compensation coverage (or proof of exemption) must be attached to the application. No liability insurance or bond amount is stated on the application.

Accreditation

Optional; the application asks whether the agency is accredited and by whom.

Regulation

Md. Code, Health-General Title 19, Subtitle 4A (incl. 19-4A-11); COMAR 10.07.05 (Residential Service Agencies)

1. Have someone with authority over pay/employment practices read OHCQ's worker-classification guidance and complete the online RSA Certification (required even if no personal care aides will be hired)
2. Prepare a business plan (1-year operating budget, marketing plan naming populations served, detailed service description) and an organizational chart
3. Write policies and procedures per COMAR 10.07.05.08B (administration, personnel, patient care, informed consent, environment and safety)
4. Get a Letter of Good Standing from SDAT and workers' compensation coverage (or a certificate of compliance or exemption letter)
5. Fill in the typed RSA license application and submit it with attachments through OHCQ's 'Submit a License Application' link
6. OHCQ approves (with or without conditions) or denies; renew every 3 years

Staffing

• Agencies may train their own in-home staff or use an outside trainer; an outside trainer must get OHCQ approval of training materials first (COMAR 10.07.05.11C)

Training

• Staff training under COMAR 10.07.05.11; outside trainers need OHCQ approval

Program

Maryland Medicaid (Maryland Medical Assistance Program, Maryland Department of Health) — HealthChoice

Enrollment portal

Maryland Provider Registration and Information Management Enterprise (MPRIME), replacing ePREP in October 2026

Application fee

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

To prepare for MPRIME, Maryland moved revalidations due May-October 2026 earlier (notices February-April 2026, 90 days to finish) and put new or updated applications on hold from July 1 (moderate/high risk) and August 1 (limited risk) until the October 2026 go-live. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Maryland Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Maryland Health Care Commission (MHCC)

Services covered

• hospitals and limited service hospitals
• related institutions (including comprehensive care facilities / nursing homes)
• ambulatory surgical facilities
• inpatient rehabilitation facilities
• home health agencies
• hospices
• freestanding medical facilities
• new facilities, relocations, bed capacity changes, changes in type or scope of service, and capital expenditures above the statutory threshold

Maryland certificate of need details →

Model

state-sponsored

State vendor

LTSSMaryland (state system; vendor not named)

Services in scope

• personal care
• Community First Choice
• home health
• private duty nursing
• DDA waiver services

Program

https://health.maryland.gov/mmcp/provider/Pages/ltssmaryland_training.aspx

Maryland EVV requirements →

State minimum wage

$15.00 an hour

Effective

2024-01-01

Scheduled increases

No scheduled change found in the official sources reviewed.

Rate pass-through

Maryland law lets part of the mandated DDA community provider rate increase be allocated to cover the effect of state minimum wage increases on direct support worker wages and benefits; it is permissive, not a required share.

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)

1,251 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,385,888 (as of Jun 1, 2026)

All Maryland Home care Medicaid rates, ranked →

• 1915(i) Home and Community-Based Behavioral Health Services for Children, Youth and Families (1915(i))
• Waiver for Children with Autism Spectrum Disorder (1915(c))
• Brain Injury Waiver (1915(c))
• Community Pathways Waiver (1915(c))
• Medical Day Care Services Waiver (1915(c))
• Model Waiver for Fragile Children (1915(c))
• Home and Community Based Options Waiver (1915(c))

Maryland waivers and waiting lists →