How to start a private duty nursing agency in Idaho

Private duty nursing — Idaho Medicaid (Idaho-licensed RNs/LPNs; children under 21).

Issuing agency

Idaho Department of Health and Welfare (Medicaid)

Regulation

IDAPA 16.03.10 §§200–209 (Private Duty Nursing)

1. Enroll with Idaho Medicaid as a PDN provider
2. Provide care through Idaho-licensed RNs or LPNs
3. Have the primary RN submit the medical plan of care at least annually for redetermination
4. Where LPNs deliver care, an RN supervisor visits at least every 30 days

Staffing

• Idaho-licensed RN or LPN
• RN supervisor overseeing LPN-delegated care per Board of Nursing rules

Program

Idaho Medicaid (Department of Health and Welfare)

Enrollment portal

Idaho Medicaid Health PAS OnLine (www.idmedicaid.com) — Trading Partner Account and Provider Enrollment Application

Fiscal agent

Gainwell Technologies

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

Idaho is moving its high-risk provider types to revalidation every three years, more often than the federal five-year minimum, and posts its 2026 revalidation correspondence with CMS on its enrollment page. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Idaho Medicaid enrollment guide →

CON program

No

Idaho certificate of need details →

Model

open/provider choice

State vendor

Sandata (aggregator)

Services in scope

• personal care
• home health

Alternate EVV allowed

Yes

Program

https://healthandwelfare.idaho.gov/providers/home-and-community-based-long-term-care/long-term-care-provider-resources

Idaho EVV requirements →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

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.

Nursing care agencies (private duty nursing) — active organization NPIs (NPPES)

81 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

307,060 (as of Jun 1, 2026)

All Idaho Private duty nursing Medicaid rates, ranked →

• Adult Developmental Disabilities Waiver (1915(c))
• Aged and Disabled Waiver (1915(c))
• 1915(i) State Plan HCBS Benefit for Children with Developmental Disabilities (1915(i))

Idaho waivers and waiting lists →