How to start a home health agency in District of Columbia
District of Columbia requires a Home Care Agency license from DC Department of Health (DC Health), Health Regulation and Licensing Administration to operate a home health agency. Fee: Annual license fee by patient count: $400 (1–150 patients), $700 (151–750), $1,100 (751–1,250), $1,300 (1,251+); $100 late fee.
- License required
- YesHome Care Agency license
- Application fee
- See details
- Processing time
- —
- Home health nurse visit (RN or LPN)
- $155.16per 15 min · $620.64/hr
- Organizations in the state
- 328NPPES, Sep 13, 2026
On this page
District of Columbia home health agency license
District of Columbia requires a Home Care Agency license from DC Department of Health (DC Health), Health Regulation and Licensing Administration to operate a home health agency. Fee: Annual license fee by patient count: $400 (1–150 patients), $700 (151–750), $1,100 (751–1,250), $1,300 (1,251+); $100 late fee.
- License required
- Yes
- License
- Home Care Agency license
- Fee
- Annual license fee by patient count: $400 (1–150 patients), $700 (151–750), $1,100 (751–1,250), $1,300 (1,251+); $100 late fee.
- Renewal
- Every year · Same annual fee tiers; renewal application and fee are due 90 days before the license expires.
- Insurance and bonds
- An insurance verification form is required with initial and renewal applications; coverage amounts are not stated.
- Survey and inspection
- Initial licensure inspection, then an unannounced visit before the 90-day provisional license ends; renewal inspections are scheduled only if the renewal application and fee arrive 90 days before expiration.
- Certificate of need
- Required
- Regulation
- 22-B DCMR Chapter 39 (Home Care Agencies); D.C. Code § 44-501 et seq.
Steps to get licensed in District of Columbia
In order, as the licensing agency describes the process.
- Obtain a Certificate of Occupancy in the operator's name
- Obtain the home care agency application from HRLA
- Obtain a Certificate of Need from the State Health Planning and Development Agency (SHPDA)
- Submit the licensure package with the license fee
- Pass the initial licensure inspection; submit a plan of correction within 10 days if deficiencies are cited (30 days to correct)
- Receive a 90-day provisional license and begin services
- Pass an unannounced visit before the provisional license expires to receive a one-year license
What you need to submit
8 documents listed by the licensing agency.
Staffing and training requirements
- Staffing
- Director must be a licensed physician, a licensed RN, or have health services administration training with at least one year of supervisory or administrative experience in home health or related programs
Enrolling as a District of Columbia Medicaid provider
- 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.
Does District of Columbia require a certificate of need?
- For this business
- Required (licensing source)
- CON program
- Yes
- Program
- Certificate of Need
- 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.
Electronic visit verification in District of Columbia
- Model
- hybrid
- State vendor
- Sandata
- Services in scope
- personal care
- home health
- Alternate EVV allowed
- Yes
District of Columbia wage floor
- 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.
District of Columbia market size
Counts from federal public files: NPPES (active organization NPIs), CMS Care Compare and CMS Medicaid enrollment.
- Home health agencies — active organization NPIs (NPPES)
- 328 (as of Sep 13, 2026)
- Medicare-certified home health agencies (CMS Care Compare)
- 35 (as of May 27, 2026)
- Total Medicaid and CHIP enrollment (latest reported month)
- 237,170 (as of Jun 1, 2026)
What District of Columbia Medicaid pays
Home health: published District of Columbia fee-for-service rates, each linked to its source.
| Service | Code | District of Columbia rate | Per hour | Rank |
|---|---|---|---|---|
| Home health nurse visit (RN or LPN)Registered nurse | G0299 | $155.16per 15 min | $620.64 | 1 of 14 |
| Home health physical therapyPhysical therapist | G0151 | $31.79per 15 min | $127.16 | 8 of 19 |
| Home health occupational therapyOccupational therapist | G0152 | $31.79per 15 min | $127.16 | 7 of 18 |
| Home health speech therapySpeech-language pathologist | G0153 | $31.79per 15 min | $127.16 | 8 of 16 |
All District of Columbia Home health Medicaid rates, ranked →
Frequently asked questions
Do you need a license to start a home health agency in District of Columbia?
District of Columbia requires a Home Care Agency license from DC Department of Health (DC Health), Health Regulation and Licensing Administration to operate a home health agency. Fee: Annual license fee by patient count: $400 (1–150 patients), $700 (151–750), $1,100 (751–1,250), $1,300 (1,251+); $100 late fee.
How much does a home health agency license cost in District of Columbia?
Annual license fee by patient count: $400 (1–150 patients), $700 (151–750), $1,100 (751–1,250), $1,300 (1,251+); $100 late fee. Renewal: Every year · Same annual fee tiers; renewal application and fee are due 90 days before the license expires..
Does District of Columbia require a certificate of need for a home health agency?
Yes, according to the licensing source. District of Columbia's CON program covers: 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.
How do you become a Medicaid provider in District of Columbia?
Enroll through DC Medicaid Provider Data Management System (PDMS) (https://www.dcpdms.com/), run by Gainwell Technologies (fiscal agent and claims vendor since March 2, 2026, replacing Conduent).
What does District of Columbia Medicaid pay a home health agency?
District of Columbia Medicaid pays $155.16 per 15 min for home health nurse visit (rn or lpn), effective Oct 1, 2026, ranking 1 of 14 states.