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

Last reviewed: 2026-08-16

In Maryland, "Homemaker" is not licensed or covered as a standalone Medicaid waiver service. Instead, general household support tasks—such as meal preparation, laundry, shopping, and light housekeeping—are classified as Instrumental Activities of Daily Living (IADLs) and are bundled into Personal Assistance Services (PAS). These services are delivered through programs like Community First Choice (CFC), Community Personal Assistance Services (CPAS), and the Community Options (CO) Waiver.

To provide these services, an agency cannot simply enroll as a homemaker entity; it must be formally licensed as a Residential Service Agency (RSA) by the Maryland Department of Health. The single biggest structural barrier to entry is obtaining this RSA license from the Office of Health Care Quality (OHCQ), which requires a rigorous application, a $2,000 fee, a designated administrative structure (often including a Delegating Nurse), and passing an initial on-site state survey before Medicaid enrollment can even be initiated.

1. Service Definition and Scope

Because Maryland does not utilize a distinct "Homemaker" provider category, household support services are integrated into the broader scope of Personal Assistance Services (PAS). These services are designed to assist Medicaid participants with IADLs when they or their informal caregivers are unable to perform them.

The scope of work is strictly limited to general household maintenance and does not include heavy chore services, home modifications, or skilled nursing tasks unless the agency holds a higher-level RSA license and the participant's plan of care authorizes it.

• Service Classification: Bundled under Personal Assistance Services (PAS) as Instrumental Activities of Daily Living (IADLs).
• Covered Tasks: Light housekeeping, laundry, meal preparation, and grocery shopping.
• Primary Programs: Community First Choice (CFC), Community Personal Assistance Services (CPAS), and the Community Options (CO) Waiver.
• Exclusions: Heavy cleaning, yard work, home repairs, and chore services requiring specialized equipment.
• Delivery Setting: The participant's private residence or community setting, excluding assisted living facilities or nursing homes.

2. Regulatory and Oversight Agencies

Providers must navigate a multi-agency oversight structure in Maryland. Licensure is handled by the state's health quality division, while Medicaid enrollment and waiver administration are managed by separate divisions within the Department of Health.

Compliance requires adhering to both state licensing regulations (COMAR) and federal Medicaid waiver guidelines, with routine audits conducted by both licensing surveyors and Medicaid program monitors.

• Licensing Authority: Maryland Department of Health (MDH), Office of Health Care Quality (OHCQ).
• Medicaid Administration: MDH Office of Long Term Services and Supports (OLTSS).
• Provider Enrollment: MDH Medicaid Provider Enrollment Division via the ePREP portal.
• Background Check Agency: Maryland Department of Public Safety and Correctional Services (DPSCS) / Criminal Justice Information System (CJIS).
• Business Registration: Maryland State Department of Assessments and Taxation (SDAT).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland does not require a Certificate of Need (CON) for Residential Service Agencies providing un-skilled personal care and homemaker services. However, there is a strict sequential gatekeeping process: an applicant cannot submit a Medicaid enrollment application until they have fully secured their state license.

Attempting to bypass the OHCQ licensure process or operating without a registered commercial office space will result in immediate rejection of any Medicaid application.

• Licensure Prerequisite: Must hold an active, finalized Residential Service Agency (RSA) license from OHCQ before ePREP Medicaid enrollment is permitted.
• Certificate of Need (CON): Not required for RSAs providing standard PAS/homemaker services in Maryland.
• Business Registration: Must be registered, active, and in "Good Standing" with the Maryland SDAT.
• Physical Location: Must maintain a commercial office space in Maryland (or an approved contiguous state) to store records and host OHCQ surveys; residential home offices are generally prohibited.
• NPI Requirement: Must obtain a Type 2 National Provider Identifier (NPI) prior to initiating the ePREP application.

4. Licensure and Certification Requirements

To legally provide homemaker and personal care services, an agency must apply for a Residential Service Agency (RSA) license under COMAR 10.07.05. Agencies typically apply for a Level 1 license if providing only un-skilled care, or a Level 2/3 license if utilizing a Registered Nurse to delegate tasks.

The licensure process involves a comprehensive review of the agency's operational policies, personnel qualifications, and emergency preparedness plans, culminating in an on-site survey.

• License Type: Residential Service Agency (RSA).
• Regulation Citation: COMAR 10.07.05 (Residential Service Agencies).
• Application Fee: $2,000 initial licensing fee submitted to OHCQ.
• Key Personnel: Must designate a qualified Agency Director and, if providing hands-on personal care alongside homemaker tasks, a Registered Nurse (RN) to serve as the Delegating Nurse.
• Initial Survey: Must pass an on-site OHCQ licensing survey demonstrating compliance with COMAR before the license is issued.
• Renewal: RSA licenses must be renewed every three years with a $2,000 renewal fee.

5. Medicaid Provider Enrollment

Once the RSA license is obtained, the agency must enroll in Maryland Medicaid using the electronic Provider Registry and Enrollment Portal (ePREP). The agency enrolls as a Personal Assistance Services provider to bill for the bundled homemaker/IADL tasks.

The ePREP system requires exact matching of data across the IRS, SDAT, and OHCQ documents. Any discrepancy in the legal business name or address will trigger an application return.

• Enrollment Portal: Maryland Provider Registry and Enrollment Portal (ePREP).
• Provider Type: Enroll as a Personal Assistance Services (PAS) provider to service CFC and CO Waiver participants.
• Required Attachments: Copy of the OHCQ RSA license, IRS W-9, and SDAT certificate of good standing.
• Application Fee: Federal Medicaid application fee (approximately $709) unless waived by prior Medicare enrollment or another state's Medicaid enrollment.
• Revalidation: Required every five years through the ePREP system to maintain active billing status.

6. Staffing, Training and Background Checks

Direct care workers performing homemaker and personal care tasks must meet strict state standards before they can enter a participant's home. Maryland mandates fingerprint-based background checks and specific training hours.

Agencies are responsible for maintaining continuous proof of staff competency, CPR certification, and supervisory oversight by an RN.

• Background Checks: Mandatory fingerprint-based state and federal background checks via Maryland CJIS for all direct care staff prior to client contact.
• Basic Qualifications: Staff must be at least 18 years old, possess a valid ID, and hold current CPR and First Aid certifications.
• Training Requirements: Minimum of 20 hours of initial training covering infection control, emergency procedures, and basic IADL/ADL support.
• Supervision: An RN must conduct an initial assessment and provide ongoing supervision of the aides every 45 to 90 days, depending on the specific waiver requirements.
• Registry Checks: Must clear the Maryland Certified Nursing Assistant (CNA) registry (if applicable) and the federal OIG List of Excluded Individuals/Entities (LEIE).

7. Documentation, Policies and Records

Maryland OHCQ and Medicaid require exhaustive documentation to prove that services were delivered exactly as authorized. Agencies must maintain comprehensive policy manuals that align with COMAR 10.07.05.

Participant records must clearly link the authorized Plan of Service (POS) to the daily tasks performed by the aide, with all records subject to unannounced state audits.

• Plan of Care: Must maintain an individualized care plan signed by the RN and the participant, detailing specific homemaker/IADL tasks to be performed.
• Service Logs: Must utilize Electronic Visit Verification (EVV) to document exact start/stop times and the specific tasks completed during the shift.
• Personnel Files: Must contain I-9s, CJIS background check clearances, CPR cards, training certificates, and annual performance evaluations.
• Emergency Preparedness: Must maintain a written Continuity of Operations Plan (COOP) as required by OHCQ for emergency scenarios.
• Record Retention: Medical and billing records must be retained for a minimum of six years per Maryland Medicaid regulations.

8. Billing, Rates and Claims

Billing for homemaker tasks is processed through Maryland's Long Term Services and Supports (LTSSMaryland) system. Because these tasks are bundled into PAS, providers bill in 15-minute increments based on the state's published fee schedule.

Maryland strictly enforces the federal Electronic Visit Verification (EVV) mandate. Claims will not be paid unless the EVV data matches the authorized Plan of Service.

• Billing System: Claims are processed through the LTSSMaryland system and the state's MMIS.
• EVV Mandate: Maryland requires Electronic Visit Verification (EVV) for all personal care and related IADL services via the In-Home Supports Assurance System (ISAS) or a compliant third-party EVV.
• Reimbursement Rate: Paid at the established 15-minute unit rate for Personal Assistance Services (subject to the current MDH Professional Services Fee Schedule).
• Prior Authorization: All services must be prior-authorized in the participant's Plan of Service (POS) approved by OLTSS.
• Billing Codes: Typically billed under HCPCS codes such as T1019 (Personal care services, per 15 minutes) which encompasses the authorized homemaker tasks.

9. Approval Sequence and Timeline

Becoming a fully approved provider is a lengthy process due to the sequential nature of state licensing followed by Medicaid enrollment. Applicants should prepare for a multi-month runway before generating any revenue.

Delays in securing a commercial office, passing the OHCQ survey, or correcting ePREP application errors can significantly extend this timeline.

• Step 1: Business Formation & SDAT Registration (1-2 weeks).
• Step 2: OHCQ RSA License Application Submission (includes $2,000 fee and submission of COMAR-compliant policies).
• Step 3: OHCQ Initial On-Site Survey (typically scheduled 3-6 months after application acceptance).
• Step 4: License Issuance (1-4 weeks post-survey, assuming all deficiencies are corrected).
• Step 5: ePREP Medicaid Enrollment (30-90 days for MDH review and approval).
• Total Estimated Timeline: 6 to 9 months from initial business formation to active Medicaid billing status.

10. Common Denials and Survey Findings

Many applicants fail the initial OHCQ survey or face ePREP denials due to administrative oversights. State surveyors are particularly strict regarding personnel files and RN delegation protocols.

Understanding these common pitfalls can help new agencies avoid costly delays and mandatory corrective action plans (CAPs).

• Incomplete Policies: OHCQ frequently denies applications that utilize generic, purchased policy manuals that do not specifically cite COMAR 10.07.05.
• RN Delegation Failures: Lack of a qualified RN Delegating Nurse or failure to properly document RN supervision of aides in the field.
• Background Check Gaps: Allowing staff to provide services or attend orientation before the CJIS fingerprint background check officially clears.
• ePREP Mismatches: Denials in ePREP due to the legal business name or address not perfectly matching across the SDAT registration, IRS W-9, and OHCQ license.
• EVV Non-Compliance: Post-enrollment audit failures and clawbacks for missing EVV entries or excessive manual timesheet entries without proper justification.

11. Key Contacts and Resources

Prospective providers must interact with several state portals and help desks. Maintaining accurate contact information for these agencies is critical for resolving application holds and compliance questions.

Providers should regularly check the MDH and OHCQ websites for updates to fee schedules, COMAR regulations, and ePREP system alerts.

• Licensing Agency: MDH Office of Health Care Quality (OHCQ) - (410) 402-8217.
• Medicaid Enrollment: Maryland Provider Registry and Enrollment Portal (ePREP) Help Desk - (844) 463-7768.
• Program Administration: MDH Office of Long Term Services and Supports (OLTSS).
• Business Registration: Maryland State Department of Assessments and Taxation (SDAT) Business Express.
• Background Checks: Maryland Department of Public Safety and Correctional Services (DPSCS) CJIS Division.

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