Every answer was written and checked ahead of time, with the official document next to it. Nothing is made up on the spot.
Do I need a license to run a non-medical home care agency in Maryland?
Yes, if you provide personal care — a Residential Service Agency license.
No one may operate a residential service agency (RSA) in Maryland without a license from OHCQ under COMAR 10.07.05. MDH quotes the rule's definition: an entity that employs or contracts with people to provide at least one home health care service, for pay, to an unrelated sick or disabled person in their home. Medicaid personal assistance under CFC and CPAS is provided by RSAs, and OHCQ describes RSAs as typically in the business of personal care. We don't hold COMAR 10.07.05 itself, so we can't tell you whether companion-only or homemaker-only services are covered or exempt. Ask OHCQ's RSA team before deciding your services fall outside it.
Written and checked September 22, 2026
What does it cost to apply for an RSA license, and what do I send?
No application fee.
The application must be typed and sent through OHCQ's online link. Attach a business plan with a 1-year operating budget and marketing plan, an organizational chart, your policies and procedures, an SDAT letter of good standing and your workers' compensation declaration page. Every applicant must also complete the online RSA Certification on worker classification. OHCQ holds an incomplete application for 180 days, then closes it.
Written and checked September 22, 2026
Do I need a certificate of need to open a home health agency in Maryland?
Yes, or an exemption.
Before you apply to OHCQ for a home health agency license, you must get a certificate of need or an exemption from the Maryland Health Care Commission. There is no fee to apply for the license itself. After OHCQ approves the application, it schedules an on-site licensure survey.
Written and checked September 22, 2026
Do personal care aides have to be CNAs?
Not for Medicaid personal assistance.
MDH's plan-of-service manual says the RSA's registered nurse trains, supervises and evaluates personal assistance given by a CNA, a certified medication technician or an individual with no certification. If aides help clients take their own medications, the nurse must supervise on site at least every three months.
Written and checked September 22, 2026
Can I pay my aides as independent contractors?
Usually not.
OHCQ's guidance says personal care aides paid hourly and overseen by an RSA are usually employees under Maryland's wage, sick leave, unemployment and workers' compensation laws. Misclassified aides can sue for unpaid wages, and owners can be personally liable. Aides are owed overtime and travel time between clients' homes. OHCQ suggests talking to an employment lawyer.
Written and checked September 22, 2026
Do I have to report aide wages to the state?
Yes — by September 1 each year.
The Homecare Workers Employment Act of 2024 requires each RSA that pays personal care aides for Medicaid personal assistance (CFC, Community Options, CPAS and other MDH programs, not DDA) to send the Maryland Department of Labor an annual report. It must show the average, highest and lowest aide wage rates and be signed by an authorized representative.
Written and checked September 22, 2026
How does EVV work for personal assistance in Maryland?
LTSSMaryland app (or phone as a backup).
Aides clock in and out with the LTSSMaryland EVV mobile app. If the app isn't available, they use offline mode or call from a phone number authorized in the participant's profile. Missing time requests are due within 30 calendar days, and MDH approves up to 4 a month per worker unless there is a valid excuse. Medicaid pays only for direct services with the aide present, and not for errands without the participant or time spent sleeping.
Written and checked September 22, 2026
Do HealthChoice health plans pay for personal care?
No — Medicaid pays it directly.
HealthChoice health plans (MCOs) cover about 86% of Medicaid participants and are responsible for most covered services. Personal care services are on the list of services paid fee-for-service by Medicaid instead. People with both Medicare and Medicaid are not in HealthChoice.
Written and checked September 22, 2026
What is MPRIME, and when do I lose ePREP?
The new enrollment system; ePREP closes October 1.
MPRIME replaces ePREP for Medicaid provider enrollment and launches October 13, 2026. All providers lose ePREP access on October 1, so download any documents you need by 5 p.m. on September 30. Since July 1, high and moderate risk provider types, which include provider type 76, have not been able to submit applications in ePREP (new enrollments, revalidations or changes) and must wait for MPRIME.
Written and checked September 22, 2026
When is the HCBS Cost Survey due?
December 31, 2026.
All Medicaid-enrolled providers that delivered non-DDA home and community-based services in fiscal year 2026 must file it. (DDA is the Developmental Disabilities Administration.) It collects provider costs, service use, workforce data and direct care worker pay to meet a federal rule. Providers that miss the deadline face a Medicaid payment suspension from January 1, 2027.
Written and checked September 22, 2026