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

Last reviewed: 2026-09-10

The Washington State Department of Social and Health Services (DSHS) does not cover a standalone "Adult Companion Services" category under its Medicaid waivers; instead, non-medical supervision and socialization are authorized as Personal Care or Respite Care under the Community First Choice (CFC) program and the COPES waiver. Agencies seeking to provide these supervision and socialization services must first obtain an In-Home Services Agency license (Home Care category) from the Department of Health (DOH) before applying for a Medicaid contract through their local Area Agency on Aging (AAA).

Individual practitioners cannot enroll directly as independent agency providers to deliver these services. Solo caregivers must instead be hired by a licensed agency or enroll as Individual Providers through Washington's designated Consumer Directed Employer, Consumer Direct Care Network Washington (CDWA).

1. Service Definition and Scope

Because Washington does not use the "Adult Companion" taxonomy, providers deliver non-medical supervision, cueing, and socialization under the umbrella of Personal Care or Respite Care. These services ensure the health and safety of adults who cannot be left alone due to physical or cognitive impairments.

Services are delivered in the participant's own home or in the community, focusing on maintaining independence and preventing institutionalization.

• Service Equivalents: Personal Care and Respite Care.
• Funding Authorities: Community First Choice (CFC) 1915(k) state plan option and the COPES 1915(c) waiver.
• Scope of Tasks: Non-medical assistance, supervision, cueing, meal preparation, and socialization.
• Delivery Setting: The participant's private residence or integrated community settings.

2. Regulatory and Oversight Agencies

Licensure is managed by the Department of Health, while Medicaid waiver operations are overseen by DSHS. Regional contracting and monitoring are delegated to local Area Agencies on Aging.

The Health Care Authority manages the state's Medicaid payment system and final provider enrollment.

• Licensing Agency: Washington State Department of Health (DOH) (https://doh.wa.gov).
• Operating Agency: DSHS Aging and Long-Term Support Administration (ALTSA) (https://www.dshs.wa.gov/altsa).
• Contracting Entities: Regional Area Agencies on Aging (AAAs) (https://www.dshs.wa.gov/altsa/resources).
• Medicaid Agency: Washington State Health Care Authority (HCA) (https://www.hca.wa.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Washington imposes specific structural prerequisites before a provider can bill Medicaid for in-home supervision and personal care. The state delegates Medicaid contracting for these services entirely to regional entities.

There is no Certificate of Need requirement for the Home Care license category, unlike Home Health or Hospice.

• Licensure Prerequisite: Applicants must hold an active In-Home Services Agency (Home Care category) license from DOH before a Medicaid contract application will be accepted.
• Network Access: Medicaid contracts are issued exclusively by regional Area Agencies on Aging (AAAs); providers must apply directly to the AAA covering their target counties.
• Individual Provider Restriction: Solo practitioners cannot obtain a Medicaid contract directly; they must be employed by the state's Consumer Directed Employer (CDWA) or a licensed agency.
• Certificate of Need: Not required for non-medical Home Care agencies in Washington.

4. Licensure and Certification Requirements

Agencies must be licensed by the Department of Health under the In-Home Services rules. The Home Care category specifically covers non-medical personal care and supervision.

The application requires submission of operational policies, a business plan, and designated administrative personnel.

• License Type: In-Home Services Agency (Home Care category).
• Governing Regulation: Washington Administrative Code (WAC) Chapter 246-335.
• Application Form: DOH In-Home Services Agency License Application.
• Initial Fee: Determined by the DOH fee schedule, scaled based on the agency's projected Full-Time Equivalents (FTEs).

5. Medicaid Provider Enrollment

Medicaid enrollment is a secondary step that occurs only after the regional AAA approves the provider's contract application. The Health Care Authority issues the actual enrollment packet.

Providers must register in the ProviderOne system to receive authorizations and submit claims.

• System Name: ProviderOne.
• Contracting Step: Application materials for a Home and Community Services Medicaid contract are submitted directly to the Area Agency on Aging.
• Enrollment Packet: Mailed to the provider by the Health Care Authority only after the AAA approves the contract.
• Taxonomy Code: Typically 253Z00000X (In Home Supportive Care) for non-medical home care agencies.

6. Staffing, Training and Background Checks

Washington has stringent training and certification requirements for caregivers providing personal care and supervision. Most direct care workers must become certified Home Care Aides.

Background checks are centralized through DSHS and must be completed before unsupervised client contact.

• Background Check: Washington State name/DOB check and National Fingerprint check processed via the DSHS Background Check Central Unit (BCCU).
• Staff Credential: Direct care workers must obtain a Home Care Aide (HCA) certification from DOH within 200 days of hire.
• Basic Training: 75 hours of DSHS-approved basic training is required for uncertified staff before taking the HCA exam.
• Continuing Education: 12 hours of approved continuing education required annually for certified Home Care Aides.

7. Documentation, Policies and Records

Licensed agencies must maintain comprehensive records demonstrating compliance with DOH rules and AAA contract terms. Documentation must clearly link the services provided to the AAA-authorized care plan.

Personnel files are heavily scrutinized during state surveys to ensure training and background check timelines are met.

• Plan of Care: Agencies must develop and maintain a written plan of care based on the DSHS/AAA assessment and authorization.
• Personnel Records: Must contain BCCU background check results, HCA certification status, and primary training certificates.
• Service Logs: Time and attendance records must verify dates, start/stop times, and the specific supervision or care tasks performed.
• Incident Reporting: Agencies must maintain written policies for reporting abuse, neglect, and exploitation to DSHS Adult Protective Services.

8. Billing, Rates and Claims

Reimbursement rates for in-home services are established by DSHS and are uniform statewide. Providers bill through the HCA ProviderOne portal.

Services are authorized in 15-minute increments or daily rates depending on whether the authorization is for standard personal care or respite.

• Billing Portal: ProviderOne.
• Rate Setting: DSHS ALTSA Office of Rates Management establishes and publishes the Medicaid fee schedules.
• Procedure Codes: Typically T1019 for Personal Care or S5150 for Unskilled Respite, as specified on the AAA authorization.
• Claim Format: Professional claim (837P) or direct data entry into the ProviderOne portal.

9. Approval Sequence and Timeline

The approval process is sequential and cannot be expedited. Providers must secure their state license before approaching the AAA for a Medicaid contract.

The entire process from initial DOH application to billing the first Medicaid claim typically takes 6 to 9 months.

• Step 1: Submit the In-Home Services Agency application and policies to DOH (approx. 3-6 months for licensure).
• Step 2: Submit the Medicaid contract application to the regional Area Agency on Aging.
• Step 3: Receive and complete the ProviderOne Enrollment Packet from the Health Care Authority.
• Step 4: Pass the AAA readiness review, execute the contract, and begin receiving client authorizations.

10. Common Denials and Survey Findings

Agencies are surveyed by DOH for licensure compliance and monitored by AAAs for contract compliance. Deficiencies often stem from administrative oversights in human resources.

Failure to adhere to strict background check and training timelines will result in citations and potential contract suspension.

• Background Check Violations: Allowing staff to work before receiving preliminary BCCU clearance.
• Training Lapses: Failure to ensure staff complete the 75-hour training or obtain HCA certification within the 200-day window.
• Care Plan Deviations: Providing and billing for supervision or tasks not explicitly authorized in the AAA care plan.
• Incomplete Records: Missing caregiver signatures or task documentation on timesheets.

11. Key Contacts and Resources

Providers should rely on official state websites for the most current forms, fee schedules, and training requirements.

The regional AAA is the primary point of contact for Medicaid contracting questions once the DOH license is obtained.

• DOH In-Home Services Licensing: https://doh.wa.gov/licenses-permits-and-certificates/facilities-z/home-care-agencies
• DSHS ALTSA Medicaid Contracting: https://www.dshs.wa.gov/altsa/home-and-community-services/information-potential-medicaid-contractors
• HCA ProviderOne: https://www.hca.wa.gov/billers-providers-partners/providerone
• DSHS Background Check Central Unit (BCCU): https://www.dshs.wa.gov/ffa/background-check-central-unit

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