North Carolina - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The North Carolina Division of Health Service Regulation (DHSR) requires agencies providing meal preparation, laundry, and light housekeeping to obtain a Home Care Agency license under 10A NCAC 13J before billing Medicaid. North Carolina does not license a standalone "Homemaker" service; instead, these instrumental activities of daily living are authorized and regulated under the umbrella of In-Home Aide (IHA) or Personal Care Services (PCS) within the state's Medicaid waiver programs.

Applicants must complete a mandatory Home Care Provider Training prior to submitting the initial licensure application, unless they can prove previous ownership of a licensed agency. Once the DHSR issues the Home Care Agency license, providers must complete mandatory billing and fraud prevention training before their enrollment application is accepted in the NCTracks Medicaid portal.

1. Service Definition and Scope

North Carolina Medicaid does not use a distinct "Homemaker" service definition for general household support. Instead, tasks such as meal preparation, laundry, shopping, and light housekeeping are bundled into In-Home Aide (IHA) or Personal Care Services (PCS) when the beneficiary cannot perform them independently.

These services are primarily delivered through the Community Alternatives Program for Disabled Adults (CAP/DA) and the NC Innovations Waiver. The scope is strictly limited to non-medical household and personal support, explicitly excluding skilled nursing or specialized therapies.

• Service Classification: Regulated and billed as In-Home Aide (IHA) or Personal Care Services (PCS).
• Primary Waivers: Community Alternatives Program for Disabled Adults (CAP/DA) and NC Innovations Waiver.
• Covered Tasks: Light housekeeping, meal preparation, laundry, and grocery shopping.
• Exclusions: Cannot include medically necessary skilled nursing services or specialized therapies.

2. Regulatory and Oversight Agencies

The physical licensure of the agency is managed by the Division of Health Service Regulation (DHSR), specifically the Acute and Home Care Licensure and Certification Section. They conduct the initial policy reviews and issue the Home Care Agency license.

Medicaid enrollment and waiver funding are overseen by the NC Medicaid Division of Health Benefits (DHB). All claims and provider credentialing are processed through the state's MMIS system, NCTracks.

• Licensing Body: NC DHSR Acute and Home Care Licensure and Certification Section (https://info.ncdhhs.gov/dhsr/ahc).
• Medicaid Authority: NC Medicaid Division of Health Benefits (https://medicaid.ncdhhs.gov).
• Enrollment Portal: NCTracks (https://www.nctracks.nc.gov).
• Rulemaking Body: North Carolina Medical Care Commission (https://info.ncdhhs.gov/dhsr/ruleactions.html).

3. Gatekeeping Prerequisites: Who Can Even Apply

North Carolina imposes a strict educational prerequisite before a Home Care Agency license application is even accepted. Applicants must submit proof of completing the state-mandated Home Care Provider Training with their application packet.

The only exception to this training requirement is providing documented proof of previously owning and operating a licensed home care agency. Additionally, G.S. 108C-9 requires applicants to complete specific NCTracks online trainings regarding billing and fraud before Medicaid enrollment is granted.

• Mandatory Training: Home Care Provider Training completion certificate required with the DHSR application.
• Training Exemption: Proof of previously owning and operating a home care agency.
• Corporate Status: Must be registered and in good standing with the NC Secretary of State.
• Medicaid Training: G.S. 108C-9 requires completion of the Basic Medicaid Billing Guide and fraud reporting training prior to enrollment.

4. Licensure and Certification Requirements

Agencies must apply for a Home Care Agency license through DHSR using the official licensure application form (PDF, 206 KB). The application must be accompanied by a non-refundable fee and the required training documentation.

Rather than an immediate on-site inspection, DHSR conducts an initial survey by reviewing the applicant's submitted policies, procedures, and personnel documents for compliance with 10A NCAC 13J rules.

• Statutory Authority: North Carolina General Statutes 131E-135 through 142.
• Regulatory Code: Title 10A of the North Carolina Administrative Code (10A NCAC 13J).
• Application Fee: $510.00 submitted via check or money order payable to the N.C. Division of Health Service Regulation.
• Initial Survey: A desk review of policies, procedures, and personnel documents for compliance with licensure requirements.

5. Medicaid Provider Enrollment

After obtaining the Home Care Agency license, providers must enroll in NC Medicaid via the NCTracks online provider portal. The application requires a valid email address for all correspondence and receipt acknowledgments.

Providers must attest that they meet all minimum business requirements and do not owe outstanding taxes or fines to the NC Department of Revenue or the Division of Employment Security.

• System: NCTracks Provider Portal.
• Attestation: Required statement confirming compliance with federal/state requirements and no outstanding state tax liabilities.
• Recredentialing: Required every five years using the online process in NCTracks.
• Recredentialing Fee: NC law requires a $100 fee for Medicaid recredentialing.
• Out-of-State Providers: Must complete the enrollment process every 365 days if utilizing a lite-enrollment application.

6. Staffing, Training and Background Checks

Direct care workers providing In-Home Aide services must meet specific competency and background check requirements before client contact. Agencies must maintain comprehensive personnel records demonstrating compliance with 10A NCAC 13J rules.

While homemaker tasks do not require nursing skills, agencies providing personal care alongside household support must ensure aides are supervised by a Registered Nurse (RN).

• Competency: Aides must pass a competency evaluation or be listed on the NC Nurse Aide I Registry.
• Supervision: Registered Nurse (RN) supervision is required for aides performing personal care tasks.
• Background Checks: Criminal background checks are required for all direct care staff prior to client contact.
• Personnel Records: Must include the application, background check results, competency verification, and performance reviews.

7. Documentation, Policies and Records

Agencies must maintain comprehensive policies and client records as dictated by DHSR and NC Medicaid. The primary reason applicants fail the initial licensure survey is non-compliance with the Initial Home Care Survey Checklist regarding policy manuals.

Records must be kept at the provider's office responsible for delivering services and made available to NC Medicaid or DHSR upon request.

• Policy Manual: Must cover admission, discharge, client rights, and emergency procedures per the Initial Home Care Survey Checklist.
• Service Notes: Must include the employee's signature, title, date, and time the entry is made.
• Plan of Care: A copy of the completed CMS-485 or similar POC form signed and dated by the physician.
• Record Retention: Maintained at the home health provider's office responsible for providing services to the beneficiary.

8. Billing, Rates and Claims

Claims for In-Home Aide and Personal Care Services are submitted through the NCTracks MMIS system. Providers must use the specific HCPCS codes designated in their approved waiver authorization.

Rates are established by the NC Medicaid Division of Health Benefits and are published on the official NC Medicaid Fee Schedule page. Providers must complete the Basic Medicaid Billing Guide training to understand common billing errors.

• Billing System: NCTracks MMIS.
• Procedure Codes: Billed using HCPCS codes specified in the CAP/DA or Innovations Waiver service authorization.
• Rate Publication: Published on the NC Medicaid Fee Schedule page.
• Claim Format: Professional claims submitted via 837P electronic format or CMS-1500.

9. Approval Sequence and Timeline

The approval sequence in North Carolina is strictly linear, beginning with the mandatory Home Care Provider Training. Only after this training is complete can the agency submit the DHSR license application and fee.

Once DHSR receives the requested policies, the initial survey is conducted. If no additional information is needed, the license is issued within 5-10 business days, allowing the provider to proceed to NCTracks Medicaid enrollment.

• Step 1: Complete the mandatory Home Care Provider Training.
• Step 2: Submit the DHSR license application with the $510 fee.
• Step 3: Submit policies, procedures, and personnel documents for the DHSR initial desk survey.
• Step 4: Receive approval letter and license within 5-10 business days of a successful survey.
• Step 5: Complete G.S. 108C-9 Medicaid trainings and submit the NCTracks enrollment application.

10. Common Denials and Survey Findings

DHSR explicitly notes that the primary reason home care licensure applicants are not approved is because they do not understand or comply with the Initial Home Care Survey Checklist and NC licensure rules.

On the Medicaid enrollment side, NC Medicaid cannot provide special consideration or expedite processing for applications delayed due to provider error, incomplete information, or missing credentialing data.

• Checklist Non-compliance: Failure to follow the Initial Home Care Survey Checklist during policy drafting.
• Training Gaps: Missing proof of Home Care Provider Training in the initial application packet.
• Enrollment Errors: Submitting NCTracks applications without a valid email address.
• Recredentialing Suspension: Providers are suspended if the re-credentialing application is not submitted by the due date, leading to termination after 50 days.

11. Key Contacts and Resources

Providers should utilize the official state websites for the most current forms, checklists, and fee schedules. The DHSR Acute and Home Care Licensure and Certification Section is the primary contact for all licensing questions.

For Medicaid enrollment and billing inquiries, providers must use the NCTracks portal and the NC Medicaid Division of Health Benefits resources.

• DHSR Acute and Home Care Licensure: 919-855-4620, https://info.ncdhhs.gov/dhsr/ahc
• NC Medicaid Provider Enrollment: https://medicaid.ncdhhs.gov/provider-enrollment
• NCTracks Portal: https://www.nctracks.nc.gov
• NC Administrative Code (10A NCAC 13J): http://reports.oah.state.nc.us/ncac.asp

See all North Carolina services · North Carolina Medicaid consulting · book a consultation.