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Minnesota - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Minnesota funds Adult Companion Services through the Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI), and Elderly Waiver (EW) programs to provide non-medical supervision and socialization. The service is governed by the Community-Based Services Manual (CBSM) and requires providers to hold a specific state license before they can bill the Minnesota Health Care Programs (MHCP).

The Minnesota Department of Human Services (DHS) requires providers to hold a 245D Basic Support Services license and enroll via the Minnesota Provider Screening and Enrollment (MPSE) portal. A temporary 245D licensing moratorium blocks all new applications through December 31, 2027, unless the applicant secures a specific exception request from a county or tribal lead agency.

1. Service Definition and Scope

Adult companion services in Minnesota provide non-medical care, supervision, and socialization to individuals aged 18 and older. The service is designed to help the person work toward a therapeutic or community integration goal outlined in their support plan.

The service does not include hands-on nursing care or assistance with activities of daily living (ADLs) like bathing or dressing, which fall under different service categories. It focuses strictly on supervision and socialization that allow the adult to remain safely in the community.

2. Regulatory and Oversight Agencies

The Minnesota Department of Human Services (DHS) is the primary state agency responsible for licensing HCBS providers and managing Medicaid enrollment. Within DHS, specific divisions handle the distinct phases of provider approval and oversight.

County and tribal human services offices act as lead agencies, conducting assessments, determining eligibility, and issuing the service authorizations required for providers to get paid.

3. Gatekeeping Prerequisites: Who Can Even Apply

Minnesota has implemented a strict statutory moratorium on new 245D licenses. Effective January 1, 2026, through December 31, 2027, DHS has stopped accepting new applications for 245D licenses and stopped adding new service lines to currently licensed providers.

To bypass this moratorium, a prospective provider must obtain a formal exception. This exception cannot be requested by the provider directly; it must be requested by a county or tribal lead agency based on a demonstrated local need for the service.

4. Licensure and Certification Requirements

Adult companion services require a 245D Basic Support Services license from DHS. This licensure ensures the provider meets state standards for health, safety, and dignity of individuals receiving home and community-based services.

The application process requires submission of specific policies, procedures, and proof of insurance. If an application is submitted without a lead agency exception during the moratorium, it will be canceled.

5. Medicaid Provider Enrollment

Once the 245D license is obtained, providers must enroll with Minnesota Health Care Programs (MHCP) to bill for services. Enrollment is conducted entirely online through the Minnesota Provider Screening and Enrollment (MPSE) portal.

Providers must submit specific DHS forms detailing the services they intend to provide, their ownership structure, and proof of required training.

6. Staffing, Training and Background Checks

Minnesota requires strict background studies and foundational training for all owners, managing employees, and direct care staff. Background studies are processed through the state's NETStudy 2.0 system.

Before enrolling with MHCP, the owner or managing employee must complete specific waiver training and submit proof of completion with their enrollment application.

7. Documentation, Policies and Records

Providers must maintain comprehensive records to comply with 245D licensing standards and MHCP billing rules. This includes maintaining active service authorizations and documenting all service delivery.

State law requires providers to implement and adhere to specific written policies regarding participant rights, health, and safety.

8. Billing, Rates and Claims

Billing for Adult Companion Services is processed through the MN-ITS system. Providers must register for a MN-ITS account upon approval as an MHCP-enrolled provider.

Rates are determined by the lead agency using the Disability Waiver Rate System (DWRS) frameworks and are specified on the Service Authorization Letter (SAL).

9. Approval Sequence and Timeline

The approval process is sequential and heavily dependent on securing a moratorium exception. Without the exception, the process cannot begin.

Processing times vary, but providers should expect several months from the initial lead agency request to final MHCP enrollment approval.

10. Common Denials and Survey Findings

Applications are frequently rejected at the very beginning if providers attempt to apply for a 245D license without an approved lead agency exception during the moratorium.

During the MHCP enrollment phase, discrepancies in business names or missing insurance documentation are the most common causes for application return or denial.

11. Key Contacts and Resources

DHS provides several dedicated help desks and online manuals to assist providers through the licensing and enrollment processes.

Providers must also work closely with local county and tribal human service offices, which act as the lead agencies for waiver services.

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