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

Last reviewed: 2026-09-10

The Maryland Department of Health (MDH) does not enroll providers under a standalone "Homemaker Service" category; instead, general household support tasks such as meal preparation, laundry, and light housekeeping are covered as Instrumental Activities of Daily Living (IADLs) under Personal Assistance Services within the Community Options (CO) Waiver and the Community Pathways Waiver. To bill Medicaid for these services, an agency must first obtain a Residential Service Agency (RSA) license from the Office of Health Care Quality (OHCQ) and then enroll through the state's ePREP portal.

Approval requires navigating a sequential process where state licensure acts as the primary gatekeeper before Medicaid enrollment can begin. Providers must demonstrate compliance with Code of Maryland Regulations (COMAR) Title 10, implement Electronic Visit Verification (EVV) through the LTSSMaryland system, and maintain strict background check and training standards for all direct care workers.

1. Service Definition and Scope

In Maryland, homemaker tasks are not billed as a distinct service code but are integrated into Personal Assistance Services. These services assist waiver participants with activities they cannot perform independently due to age or disability, ensuring they can remain safely in their homes.

The scope of work includes both Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). When a participant's plan of care authorizes it, the direct care worker performs household support tasks alongside or in support of personal care.

• Service Classification: Covered as Personal Assistance Services under the Community Options Waiver and Community Pathways Waiver.
• Included IADLs: Light housekeeping, laundry, meal planning and preparation, and grocery shopping.
• Excluded Tasks: Heavy chore services, home modifications, and skilled nursing tasks are not covered under this definition.
• Care Plan Requirement: All household support tasks must be explicitly documented and authorized in the participant's individualized plan of care.
• Delivery Setting: Services must be delivered in the participant's private residence, not in a licensed assisted living or institutional facility.

2. Regulatory and Oversight Agencies

Multiple divisions within the Maryland Department of Health (MDH) oversee the licensure, enrollment, and monitoring of agencies providing personal assistance and household support. The Office of Health Care Quality (OHCQ) handles the facility and agency licensing, while the Medical Care Programs Administration manages Medicaid enrollment.

Waiver operations are divided by target population, with the Developmental Disabilities Administration (DDA) managing the Community Pathways Waiver and the Office of Long Term Services and Supports (OLTSS) managing the Community Options Waiver.

• Maryland Department of Health (MDH): The overarching state Medicaid agency. https://health.maryland.gov/
• Office of Health Care Quality (OHCQ): Licenses Residential Service Agencies (RSAs) required to provide in-home care. https://health.maryland.gov/ohcq/Pages/home.aspx
• Medical Care Programs Administration (MCPA): Manages the ePREP provider enrollment portal and MMIS. https://health.maryland.gov/mmcp/Pages/home.aspx
• Developmental Disabilities Administration (DDA): Operates the Community Pathways Waiver. https://health.maryland.gov/dda/Pages/home.aspx
• Office of Long Term Services and Supports (OLTSS): Administers the Community Options Waiver. https://health.maryland.gov/mmcp/ltc/Pages/Home.aspx

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland requires a specific structural precondition before an agency can apply to bill Medicaid for in-home personal assistance and homemaker tasks. An applicant must hold an active Residential Service Agency (RSA) license issued by the Office of Health Care Quality (OHCQ).

There is no Certificate of Need (CON) required for an RSA, nor is there a closed network or moratorium currently in place for the Community Options Waiver. However, the OHCQ RSA license is a hard prerequisite; the ePREP Medicaid enrollment application will be immediately rejected without it.

• Licensure Prerequisite: Must possess an active Residential Service Agency (RSA) license from OHCQ prior to Medicaid enrollment.
• Certificate of Need (CON): Not required for Residential Service Agencies in Maryland.
• Network Status: Open enrollment; there is no current moratorium on new RSA Medicaid providers.
• Business Registration: Must be registered and in good standing with the Maryland State Department of Assessments and Taxation (SDAT).
• NPI Requirement: Must obtain a Type 2 (Organizational) National Provider Identifier (NPI) before applying.

4. Licensure and Certification Requirements

To provide these services, agencies must be licensed as a Residential Service Agency (RSA) under COMAR 10.07.05. The RSA license ensures the agency has the administrative structure, policies, and clinical oversight necessary to deliver in-home care safely.

The licensure process involves submitting a detailed application to OHCQ, paying the required licensing fee, and passing an initial desk review of the agency's operational policies, including infection control, client rights, and emergency preparedness.

• Regulatory Citation: Governed by Code of Maryland Regulations (COMAR) 10.07.05 (Residential Service Agencies).
• License Type: Residential Service Agency (RSA) - Level 1 (if providing only un-skilled personal care/homemaker services).
• Application Fee: A non-refundable fee (typically $2,000, subject to current OHCQ fee schedules) must accompany the RSA application.
• Policy Manual: Must submit comprehensive policies covering client rights, grievance procedures, and abuse reporting.
• Administrator Qualifications: The agency must designate a qualified administrator with experience in health care or human services management.

5. Medicaid Provider Enrollment

Once licensed by OHCQ, the agency must enroll in Maryland Medicaid using the electronic Provider Revalidation and Enrollment Portal (ePREP). Note that Maryland is transitioning from ePREP to the Maryland Provider Registration and Information Management Enterprise (MPRIME) portal in October 2026.

Providers must complete the specific application addenda for their provider type, upload their OHCQ license, and sign the Maryland Medical Assistance Provider Agreement.

• Enrollment Portal: ePREP (transitioning to MPRIME in October 2026). https://eprep.health.maryland.gov/sso/login.do
• Provider Type: Typically enrolls under Provider Type 82 (Personal Care) or the specific waiver provider type designated for RSAs.
• Required Addendum: Must submit the applicable ePREP Provider Application Addendum for HCBS/Waiver services.
• Application Fee: Subject to the federal Medicaid/Medicare institutional application fee unless waived by prior Medicare enrollment.
• Revalidation: Providers must revalidate their Medicaid enrollment every five years through the ePREP system.

6. Staffing, Training and Background Checks

Maryland strictly regulates the personnel who enter waiver participants' homes. All direct care workers providing personal assistance and homemaker tasks must pass comprehensive background checks and complete state-mandated training before providing care.

Agencies are responsible for maintaining personnel files that prove ongoing compliance with CPR/First Aid certifications and annual in-service training requirements.

• Background Checks: Mandatory state and federal criminal history records check via the Maryland Criminal Justice Information System (CJIS).
• Registry Checks: Must screen staff against the Maryland Certified Nursing Assistant (CNA) registry (if applicable) and the federal OIG List of Excluded Individuals/Entities (LEIE).
• Initial Training: Workers must complete basic training covering infection control, client rights, and emergency procedures prior to independent client contact.
• CPR/First Aid: All direct care staff must hold current, valid CPR and First Aid certification.
• Supervision: A registered nurse (RN) or qualified supervisor must conduct initial assessments and periodic in-home supervisory visits.

7. Documentation, Policies and Records

Providers must maintain exhaustive records to justify Medicaid billing and demonstrate compliance with OHCQ regulations. Maryland utilizes the LTSSMaryland system for care planning and service tracking.

Electronic Visit Verification (EVV) is mandatory for all personal assistance services. Agencies must use the state-sponsored EVV system or a compliant third-party system to record the exact start and end times of every home visit.

• EVV Mandate: Must use Electronic Visit Verification via LTSSMaryland or an integrated vendor to capture visit data.
• Care Plans: Services must strictly align with the participant's Plan of Service generated in LTSSMaryland.
• Service Notes: Workers must document the specific tasks completed during the shift (e.g., meal prep, laundry) and obtain client verification.
• Record Retention: Medicaid records must be retained for a minimum of six years from the date of service or final payment.
• Incident Reporting: Must have documented procedures for reporting critical incidents to OHCQ and the waiver operating agency within 24 hours.

8. Billing, Rates and Claims

Billing for personal assistance (including homemaker tasks) is processed through the LTSSMaryland system, which interfaces with the state's MMIS for payment. Claims are generated automatically based on validated EVV data.

Rates are established by the Maryland Department of Health and are typically billed in 15-minute increments. Providers cannot bill for time spent traveling to the participant's home.

• Billing System: Claims are submitted and processed via LTSSMaryland and the Medicaid MMIS.
• Unit of Service: Typically billed in 15-minute increments using standard HCPCS codes (e.g., T1019 for personal care).
• Rate Setting: Rates are published annually in the MDH fee schedule; providers must accept the Medicaid rate as payment in full.
• EVV Linkage: Claims will deny if they are not supported by matching, verified EVV records.
• Third-Party Liability: Medicaid is the payer of last resort; providers must bill any applicable third-party insurance before billing Medicaid.

9. Approval Sequence and Timeline

Becoming a fully approved provider is a multi-step process that typically takes 4 to 8 months from start to finish. The timeline is heavily dependent on the speed of the OHCQ licensure review.

Agencies must secure their physical location, develop policies, and hire an administrator before applying to OHCQ. Only after the RSA license is in hand can the ePREP application be submitted.

• Step 1: Business Formation: Register with SDAT and obtain an NPI and EIN (1-2 weeks).
• Step 2: OHCQ Licensure: Submit RSA application and policies to OHCQ (3-6 months for review and approval).
• Step 3: ePREP Enrollment: Submit Medicaid enrollment application via ePREP with the RSA license attached (30-60 days).
• Step 4: LTSSMaryland Access: Complete required training to gain access to the LTSSMaryland and EVV systems (1-2 weeks).
• Step 5: Contracting: Receive participant referrals from Supports Planners and begin service delivery.

10. Common Denials and Survey Findings

Applications and ongoing licenses are frequently delayed or revoked due to administrative oversights. OHCQ surveyors strictly enforce personnel record requirements during routine inspections.

In the ePREP portal, applications are often returned for correction if the ownership disclosures do not perfectly match the SDAT business registration records.

• Licensure Denial: Failure to submit a complete, customized policy manual to OHCQ (submitting generic templates without agency-specific details).
• ePREP Rejection: Missing or incomplete ownership and control interest disclosure forms.
• Survey Citation: Missing CJIS background check results in employee personnel files prior to their first shift.
• Survey Citation: Lapsed CPR/First Aid certifications for active direct care workers.
• Billing Denial: Submitting claims without corresponding, verified EVV clock-in and clock-out data.

11. Key Contacts and Resources

Providers should rely on official state portals and help desks for the most current regulations, fee schedules, and application statuses. The ePREP help desk is the primary contact for enrollment issues.

For licensure questions, the OHCQ RSA unit provides guidance on COMAR compliance and application requirements.

• ePREP Provider Portal: https://eprep.health.maryland.gov/sso/login.do
• ePREP Hotline: 1-844-463-7768 (Monday-Friday, 9:00 a.m. to 5:00 p.m.).
• MDH Provider Enrollment Page: https://health.maryland.gov/mmcp/provider/Pages/enrollment.aspx
• OHCQ RSA Licensing Unit: https://health.maryland.gov/ohcq/rsa/Pages/home.aspx
• LTSSMaryland Training Center: Accessed via the MDH provider portal for EVV and billing training.

See all Maryland services · Maryland Medicaid consulting · book a consultation.