Washington - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Washington funds in-home personal assistance through the Medicaid Personal Care (MPC) and Community First Choice (CFC) programs, administered by the Department of Social and Health Services (DSHS) Aging and Long-Term Support Administration (ALTSA). Agencies seeking to bill for these services must first obtain an In-Home Services Agency license under the Home Care category from the Department of Health (DOH) pursuant to Chapter 70.127 RCW.

Before securing a Medicaid contract to serve MPC or CFC clients, agencies face a strict operating history requirement. DSHS contracting standards mandate that an agency hold a valid DOH in-home services license for a minimum of three consecutive years before they are eligible to contract for in-home personal care and respite services, preventing newly licensed agencies from immediately enrolling as Medicaid personal care providers.

1. Service Definition and Scope

In Washington, Medicaid Personal Care (MPC) and Community First Choice (CFC) provide assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) for elderly or disabled residents. Services are delivered in the client's own home or contracted residential settings.

The scope of personal care includes hands-on assistance with bathing, dressing, mobility, toilet use, meal preparation, and essential shopping. Services are authorized based on a functional CARE assessment conducted by a state case manager.

• Service Name: Medicaid Personal Care (MPC) and Community First Choice (CFC)
• Covered Tasks: Bathing, dressing, mobility, medication management, toilet use, meal preparation, and light housecleaning
• Setting Limits: Available in the individual's own home, adult family homes (AFH), or assisted living facilities
• Nurse Delegation: Specific nursing tasks assigned by a registered nurse to a home care aide may be included in certain settings
• Exclusions: Room and board costs in assisted living facilities are not covered by MPC
• Authorization: Services must be authorized by Home and Community Services (HCS) or Developmental Disabilities Administration (DDA) based on a CARE assessment

2. Regulatory and Oversight Agencies

Multiple state agencies oversee personal care providers in Washington. The Department of Health (DOH) handles the foundational licensure for all in-home service agencies.

The Department of Social and Health Services (DSHS) manages the waiver programs and contracts, while the Health Care Authority (HCA) operates the Medicaid payment system.

• Licensing Agency: Washington State Department of Health (DOH) at https://doh.wa.gov
• Program Administrator (Aging): DSHS Aging and Long-Term Support Administration (ALTSA) at https://www.dshs.wa.gov/altsa
• Program Administrator (Disabilities): DSHS Developmental Disabilities Administration (DDA) at https://www.dshs.wa.gov/dda
• Medicaid Agency: Washington State Health Care Authority (HCA) at https://www.hca.wa.gov
• Medicaid Portal: ProviderOne at https://www.hca.wa.gov/billers-providers-partners/become-apple-health-provider/enroll-provider

3. Gatekeeping Prerequisites: Who Can Even Apply

Washington imposes a significant structural barrier for new agencies attempting to enter the Medicaid personal care market. DSHS requires a proven track record of licensed operation before granting a Medicaid contract for these services.

Agencies cannot simply obtain a license and immediately bill Medicaid; they must survive in the private pay or commercial market for years first.

• Operating History Requirement: Applicants must hold a valid in-home services license issued by DOH for a minimum of three consecutive years before contracting with DSHS for in-home personal care
• Licensure Prerequisite: A DOH In-Home Services Agency license (Home Care category) under Chapter 70.127 RCW is strictly required before any Medicaid enrollment
• Contracting Window: DSHS home care agency contracts for in-home personal care have a maximum duration of two years once approved
• Insurance Prerequisite: Agencies must meet specific DSHS liability insurance requirements and provide proof of current certificates prior to contracting
• Orientation Prerequisite: Agency administrators must complete a DOH-approved in-home services Orientation Class before a license application is accepted

4. Licensure and Certification Requirements

Providers must be licensed as an In-Home Services Agency with a Home Care service category by the Washington State Department of Health. The licensing rules are governed by Chapter 246-335 WAC.

The application process requires proof of administrative competence, specific insurance coverages, and completion of state-mandated orientation.

• License Category: In-Home Services Agency - Home Care
• Statutory Authority: Chapter 70.127 RCW and Chapter 246-335 WAC
• Orientation Requirement: Applicants must submit a certificate of completion from the DOH in-home services Orientation Class with their application
• Financial Solvency: Providers must demonstrate the ability to meet all personal and business financial obligations per WAC 388-76-10020
• Insurance: Proof of current commercial general liability insurance is required
• Policies: Must submit evidence that specific provider qualifications and operational policies are met

5. Medicaid Provider Enrollment

Once the three-year licensure prerequisite is met and a DSHS contract is secured, agencies must enroll as billing providers through the Health Care Authority's ProviderOne system.

Agencies enroll as a Facility/Agency/Organization/Institution (FAOI) and must sign a Core Provider Agreement with the HCA.

• Enrollment System: ProviderOne portal
• Provider Type: Billing provider (Facility/Agency/Organization/Institution)
• Required Agreement: All billing providers must complete and sign a Core Provider Agreement with the HCA
• Contract Verification: Must provide proof of the active DSHS ALTSA or DDA contract during enrollment
• Supplemental Paperwork: Must complete specific supplemental forms for the Home Care Agency provider type
• Billing Agent Option: Agencies may separately enroll a Billing Agent/Clearinghouse to manage HIPAA transactions

6. Staffing, Training and Background Checks

Direct care workers employed by the agency must meet strict state certification and training standards. Washington requires most personal care workers to become certified home care aides.

Agencies are responsible for ensuring all staff pass comprehensive background checks before having unsupervised contact with vulnerable adults.

• Certification: Direct care staff must obtain and maintain Home Care Aide certification
• Age Requirement: Individual providers and agency staff must be at least 18 years old
• Background Checks: Mandatory state and federal background checks through DSHS for all staff with client contact
• Nurse Delegation Training: Staff performing delegated nursing tasks must complete specific DSHS-approved nurse delegation training
• Supervision: Agencies must have a designated administrator or supervisor responsible for overseeing care delivery
• Continuing Education: Staff must complete annual continuing education as required by DOH and DSHS rules

7. Documentation, Policies and Records

Agencies must maintain detailed records aligning with the state's CARE assessment tool. The CARE assessment dictates the exact hours and tasks authorized for each client.

Clinical and administrative records must be kept in compliance with WAC 246-335 and DSHS contract terms.

• Care Plan Alignment: Agency service plans must strictly match the tasks and hours authorized in the DSHS CARE assessment
• Communication Forms: Must utilize DSHS 14-443 (Financial/Social Service communication) or DSHS 15-345 (DDCS Communication) forms for case updates
• Personnel Files: Must maintain files proving Home Care Aide certification, background check clearance, and orientation completion
• Service Logs: Detailed timesheets and service logs documenting specific ADLs/IADLs performed during each shift
• Retention: Records must be retained for a minimum of six years per Medicaid standard requirements

8. Billing, Rates and Claims

Billing for MPC and CFC services is processed through the HCA's ProviderOne system. Rates are established by the state legislature and published by DSHS.

Payment is based on a state daily rate or hourly rate depending on the specific service code and setting.

• Billing System: ProviderOne
• Rate Structure: Paid according to the published state rate schedule for in-home personal care
• Authorization Linkage: Claims will deny if they do not match the exact date span and units authorized by the DSHS case manager in ProviderOne
• Client Participation: Case managers determine any cost of care the individual must pay, which the agency must collect
• Code Verification: Agencies must bill using the specific HCPCS codes assigned in their DSHS contract authorization

9. Approval Sequence and Timeline

Becoming a Medicaid personal care agency in Washington is a multi-year process due to the operating history requirement.

Agencies must plan for a long runway of private-pay operations before accessing Medicaid funds.

• Step 1: Complete the DOH in-home services Orientation Class
• Step 2: Submit In-Home Services Agency license application to DOH (processing takes several months)
• Step 3: Operate continuously for a minimum of three consecutive years under the DOH license
• Step 4: Apply for a DSHS home care agency contract for in-home personal care
• Step 5: Enroll in ProviderOne as a billing provider and sign the Core Provider Agreement
• Step 6: Receive client authorizations from DSHS case managers via ProviderOne

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to missing prerequisites or mismatched authorizations.

During DOH surveys, agencies often face citations for personnel file deficiencies or failing to follow the authorized care plan.

• Application Denial: Failing to provide the DOH Orientation Class certificate of completion
• Contract Denial: Applying for a DSHS contract before completing the mandatory three-year licensed operating history
• Claim Denial: Billing for dates of service prior to the payment authorization date set by the HCS/DDA financial worker
• Survey Citation: Expired Home Care Aide certifications or missing background check renewals in personnel files
• Survey Citation: Providing services outside the scope of the DSHS CARE assessment authorization

11. Key Contacts and Resources

Providers should rely on the official state portals for the most current manuals, rate schedules, and application forms.

The DOH handles licensing inquiries, while HCA manages the ProviderOne billing system.

• DOH Licensing: Washington State Department of Health In-Home Services at https://doh.wa.gov
• Medicaid Enrollment: HCA Provider Enrollment at https://www.hca.wa.gov/billers-providers-partners/become-apple-health-provider/enroll-provider
• Aging Program Admin: DSHS ALTSA at https://www.dshs.wa.gov/altsa
• Disability Program Admin: DSHS DDA at https://www.dshs.wa.gov/dda
• ProviderOne Manuals: Available via the HCA enrollment page for Facility/Agency/Organization/Institution (FAOI) types

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