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California - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

California funds Homemaker services primarily through the Multipurpose Senior Services Program (MSSP) 1915(c) waiver as Supplemental Homemaker (Service 3.1) and through CalAIM Community Supports as Personal Care and Homemaker Services (PCHS). Approval to deliver these services requires securing a direct subcontract with a designated local MSSP Waiver Agency or a Medi-Cal Managed Care Plan (MCP), rather than enrolling as an independent fee-for-service provider.

Agencies must hold a local business license or a Home Care Organization (HCO) license from the California Department of Social Services (CDSS) and ensure all staff meet the Division 30, Chapter 30-757 standards. Providers bill the contracting agency or MCP directly using negotiated rates or standard codes like T1019 U6 for CalAIM.

1. Service Definition and Scope

In California, Homemaker services provide general household support to individuals who cannot perform these tasks independently. Under the MSSP waiver, this is designated as Supplemental Homemaker (Service 3.1) and includes tasks authorized under the California DSS Manual, Division 30, Chapter 30-757.

Under CalAIM Community Supports, Personal Care and Homemaker Services (PCHS) support Instrumental Activities of Daily Living (IADLs) such as meal preparation, grocery shopping, and money management. These services are often used as supplemental support when In-Home Supportive Services (IHSS) hours are insufficient or during the IHSS application waiting period.

2. Regulatory and Oversight Agencies

Multiple state departments oversee the delivery of Homemaker services depending on the funding stream. The California Department of Aging (CDA) administers the MSSP waiver, while the Department of Health Care Services (DHCS) oversees CalAIM and the broader Medi-Cal program.

The California Department of Social Services (CDSS) regulates Home Care Organizations (HCOs) and manages the IHSS program. Local MSSP sites and Medi-Cal Managed Care Plans (MCPs) act as the direct oversight entities for contracted provider agencies.

3. Gatekeeping Prerequisites: Who Can Even Apply

California does not enroll standalone Homemaker agencies directly into Medi-Cal fee-for-service. To provide MSSP Supplemental Homemaker services, an agency must secure a subcontract with a designated local MSSP Waiver Agency. The MSSP site holds the master contract with the state and procures local vendors.

For CalAIM PCHS, providers must contract directly with regional Medi-Cal Managed Care Plans (MCPs). Access is restricted to agencies that successfully negotiate a network agreement with the MCP or MSSP site, meaning open enrollment is not available at the state level.

4. Licensure and Certification Requirements

California does not issue a specific "Homemaker Agency" license. Instead, agencies providing these services must hold a local business license and, if employing non-medical caregivers, must be licensed as a Home Care Organization (HCO) by the CDSS Care Provider Management Bureau.

Alternatively, licensed Home Health Agencies (HHAs) may provide these services. The MSSP Appendix 40 specifies that Supplemental Homemaker providers can be HHAs, private nonprofit, or proprietary agencies with a local business license.

5. Medicaid Provider Enrollment

Because Homemaker services under MSSP and CalAIM are managed by local sites and MCPs, providers do not typically enroll directly through the DHCS PAVE portal for these specific codes. Instead, they complete the vendor credentialing process required by the specific MSSP site or MCP.

Agencies must still obtain a National Provider Identifier (NPI) and may need to enroll in PAVE as a general Medi-Cal provider depending on the MCP's specific network requirements.

6. Staffing, Training and Background Checks

Staff providing Supplemental Homemaker services must meet the standards outlined in the California DSS Manual, Division 30, Chapter 30-757. This includes basic competency, communication skills, and physical capability to perform the work.

If operating as an HCO, all employed caregivers must be registered as Home Care Aides, which requires a Department of Justice (DOJ) criminal background check and specific training hours.

7. Documentation, Policies and Records

Providers must maintain detailed records of service delivery to support billing and quality assurance. For CalAIM PCHS, this includes documenting the member's needs and the specific tasks performed during each visit.

MSSP vendors must adhere to the documentation standards set by the local MSSP site, including maintaining simple records of tasks completed and communicating any changes in the participant's status to the case manager.

8. Billing, Rates and Claims

Billing for Homemaker services is submitted to the contracting entity (the MSSP site or the MCP), not directly to the state CA-MMIS system. Rates are negotiated with the local agency or plan, up to maximum allowable limits.

For CalAIM PCHS, providers typically bill using HCPCS code T1019 with modifier U6, billed in 15-minute increments. Providers must adhere to the "Rule of Eights" for time-based billing.

9. Approval Sequence and Timeline

The timeline to become an approved provider depends entirely on the procurement cycles of local MSSP sites and the network adequacy needs of regional MCPs. Obtaining an HCO license from CDSS is the first step and can take 3 to 6 months.

Once licensed, the agency must apply to the local entity. If the MSSP site or MCP is accepting new vendors, the credentialing and contracting phase typically takes an additional 60 to 90 days.

10. Common Denials and Survey Findings

Applications to become a vendor are most frequently denied because the local MSSP site or MCP already has an adequate network of Homemaker providers and is not accepting new subcontracts.

During audits, common findings include failing to document the specific tasks performed, billing for time that overlaps with IHSS hours, and using staff who have not completed their Home Care Aide registration or background checks.

11. Key Contacts and Resources

Providers should contact their local MSSP Waiver Agencies and regional Medi-Cal Managed Care Plans to inquire about contracting opportunities for Homemaker services.

The California Department of Social Services provides guidance on HCO licensure and Home Care Aide registration, which are foundational requirements for operating an agency.

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