Arkansas private care agency license: the Medicaid personal care route to in-home care

A license written around Medicaid personal care

Arkansas’s private care agency license, issued by the Department of Health’s Health Facility Services (HFS), exists so that agencies can deliver Medicaid personal care in people’s homes. The State Board of Health adopted the rule under Ark. Code § 20-10-2301 et seq., and the rule’s preface says it sets minimum standards “for the licensure of private care agencies providing Medicaid Personal Care in Arkansas.”⁠¹ The rule then defines a “client” as an eligible recipient of Medicaid services and states that each agency “shall receive a license for Medicaid Personal Care.”⁠¹

Act 853 of 2025, approved April 17, 2025, rewrote the statute. The purpose section now says the subchapter allows a licensed private care agency to provide in-home personal care 24 hours a day, seven days a week, to eligible recipients, and provides for reimbursement of those services through Medicaid.⁠² The definition in § 20-10-2302 now covers a provider that furnishes in-home staffing for personal and attendant care “for which the provider seeks reimbursement through the Arkansas Medicaid Program” and carries at least $1,000,000 in liability insurance covering its employees and contractors while they deliver that care.⁠²⁠¹¹

What that means for a founder: if your business plan is Medicaid personal care or ARChoices attendant care, this license is your path. If you plan a private-pay-only companion or homemaker service, the statutory definition no longer describes you, but no ADH page or rule we found says whether any other license applies. The official sources do not say whether ADH requires any license for a private-pay-only in-home personal care agency after Act 853, so ask HFS in writing, at the address below, before you open.

“Personal care services” in the rule means assistance with activities of daily living, hygiene or grooming, and a client’s “residence” includes a private home, a nursing home, a residential care facility or a convalescent home.⁠¹

Private care agency, Class B home health, or something else

Arkansas Medicaid lets three kinds of agency deliver personal care in every state-approved location: Class A home health agencies, Class B home health agencies, and private care agencies.⁠³ A Class B home health agency enrolling for personal care must hold a Class B license that states it is licensed to perform personal care services only.⁠³ Home health licensure requires a Permit of Approval from the Health Services Permit Agency first, a step the private care rule does not contain;⁠¹⁷ see the Arkansas home health agency guide if you also plan skilled nursing or therapy.

Residential care facilities, public schools and education cooperatives can also enroll for personal care, but only inside their own facilities, and Level I assisted living facilities can enroll to serve their own residents.⁠³ If you want to house the people you care for, look at the residential care facility and assisted living facility licenses instead. A private care agency can still serve residents of a Level I assisted living facility; the manual names an enrolled private care agency as one of the providers allowed to deliver personal care there.⁠³

Owners, administrator and supervisor

The rule asks for three layers of responsibility.

• Governing board. At least one member, which may be the owner. The board is legally responsible for the agency, adopts and periodically reviews bylaws or an equivalent, approves policies, appoints the administrator and approves a plan for an alternate, and approves the annual budget.⁠¹
• Administrator. An agency employee who is a physician, a registered nurse, or someone with at least one year of supervisory or administrative experience in home health care or a related health provider program.⁠¹ The administrator runs daily operations, makes sure staff are qualified, oversees budgeting, implements the quality assurance and infection control programs, and reviews policies yearly.⁠¹
• Supervisor. A licensed nurse, or someone with two years of full-time study at an accredited college. A high school graduate or GED holder may substitute one year of full-time supervisory work in a healthcare facility or community-based agency for each year of college.⁠¹ Medicaid adds that a supervisor may not supervise another aide serving a client the supervisor personally serves.⁠³

“Employee” means anyone the agency must issue a W-2; anyone else providing services is a contractor, and contractors must follow all agency policies.⁠¹

The office and the insurance

The 2024 rule requires a licensed, fully operational primary office physically located in Arkansas, plus enough licensed regional offices to serve the agency’s administrative needs and clients.⁠¹ Act 853 removed the regional-office language from the statute, and ADH’s proposed rule amendment deletes it from the rule as well.⁠²⁠¹¹ Until the amendment is final, the regional-office sentence remains in the published rule.⁠¹⁠¹⁶

The $1,000,000 liability insurance requirement is in the statute, the rule and the Medicaid manual.⁠¹⁠²⁠³ Medicaid Provider Enrollment wants proof of the coverage on file at enrollment and, every year after, proof that coverage has stayed at or above the minimum since your last report.⁠³

Background checks and registries

HFS lists private care agencies among the providers that must run criminal background checks, under Ark. Code § 20-38-101 et seq.⁠⁶⁠⁷ You must keep evidence that checks were completed on all operators, applicants for employment and employees.⁠⁶ The 2010 rule’s applicant and employee section is worded for home health and hospice agencies, but HFS’s fingerprint instructions apply the same process to private care caregivers: a state check, and a federal fingerprint check if the person has not lived in Arkansas continuously for the past five years.⁠⁶⁠⁸ The rule repeats checks at least once every five years.⁠⁶ If you use temporary staff, your contract must make the staffing company run and keep the checks.⁠⁶

ADH now requires both state and federal checks to be run online, and you have 10 days after running the state check to add a federal fingerprint check.⁠⁸ The Medicaid manual goes further for enrolled providers: all owners, principals, employees and contract staff need national and state checks under Ark. Code §§ 20-33-213 and 20-38-101, plus checks of the Child Maltreatment Central Registry, the Adult and Long-Term Care Facility Resident Maltreatment Central Registry, and the Certified Nursing Assistant/Employment Clearance Registry.⁠³

Personnel files must hold the criminal history determination of eligibility for employment for every employee and contracted individual.⁠¹ The proposed amendment would add registry check results under Ark. Code § 20-38-103.⁠¹⁰⁠¹¹

Training your personal care aides

Here the state and Medicaid rules overlap, and you must meet both.

Under the ADH rule, aide training must be approved by Health Facility Services, supervised by a registered nurse, run at least 40 hours of classroom and clinical instruction related to the home setting, and have written objectives, expected outcomes and evaluation methods.⁠¹ Unless the Department of Higher Education has authorized you to operate a school, you may train only your own employees.⁠¹

The rule’s Table 1 lists 22 required topics, from body mechanics and infection control to transfer techniques, toileting, meal preparation, nail and skin care, and nurse delegation law. Four hours must cover Alzheimer’s disease and dementia, including communication and challenging behaviors.⁠¹

Medicaid breaks the 40 hours down:⁠³

Trainees must pass a written examination and a skills test and receive a dated certificate naming the training entity.⁠³ Certified nursing assistants and certified home health aides with current credentials count as qualified personal care aides, and a training program may waive the course for experienced aides who pass the exams.⁠³ An aide may not serve a family member as defined by Medicaid: a spouse, a minor’s parent, stepparent or foster parent (or anyone acting as one), a legal guardian, or an attorney-in-fact directing the client’s care.⁠³

After certification, each aide needs at least 12 hours of in-service training every 12 months, in sessions of at least one hour.⁠¹⁠³ A registered nurse must observe each aide performing the Table 1 skills, and you must document that evaluation.⁠¹

Policies ADH expects to see

Before the licensing review, have these written and approved by your governing board:⁠¹

• An organizational chart showing ownership and lines of authority down to the client service level, the services you offer, hours of operation, and client acceptance and termination criteria.
• Staff orientation and written procedures for all tasks.
• An infection control program, with employee work restrictions and tuberculosis prevention that follow current CDC guidance.
• Personnel records: signed job description, qualifications, application, license and work history verification, orientation and Table 1 competency, and the criminal history determination.
• An agency-wide quality assurance and improvement program covering client satisfaction surveys, supervision, outside inspection and audit results, and improvement projects.
• A complaint log recording who was involved, their relationship to the client, the complaint, the incident date and the resolution.
• A client bill of rights that includes the State Home Health Hotline number, and a written list of client responsibilities.

Client records must be kept at least five years after discharge, or two years after a minor reaches majority. Aides’ client notes are written the day of service and filed into the record at least every 14 days.⁠¹ You must also post ADH’s notice that attacking a healthcare worker is a felony under Ark. Code § 5-13-202 at public entrances and waiting areas.⁠¹

How a client’s care is set up and supervised

For each client, the agency makes an initial evaluation visit to determine needs, services and staff, then writes an individualized aide service plan setting tasks, visit frequency, nurse delegation consistent with the Arkansas State Board of Nursing, and supervision. Every aide gets a copy, and a copy stays in the home.⁠¹ The ADH rule sets supervision at least annually; a “visit” can be in person or by information technology.⁠¹

Medicaid’s supervision rules are tighter: the supervisor reviews and documents each aide’s records at least once a month, and visits the client at least once a year on site, with at least one annual visit made while the aide is not present.⁠³

Applying to Health Facility Services

1. Request the New Provider Packet

   HFS sends packets on request by mail, email or fax; say you need a new provider packet for a private care agency, which HFS lists as “licensed only,” with no Medicare certification.⁠⁴ Contact: Health Facility Services, 5800 W. 10th St., Suite 400, Little Rock, AR 72204; 501-661-2201 or 1-800-223-0340; fax 501-661-2165; [email protected].⁠⁵

2. Secure the Arkansas office and the insurance policy

   , and appoint the governing board, administrator and supervisor.⁠¹

3. Build the training program

   and submit it for HFS approval, then train and certify your first aides.⁠¹⁠³

4. Run background checks

   on operators and staff through the online state and federal process.⁠⁶⁠⁸

5. File the application

   on HFS forms. HFS’s general application instructions require notarization and a list of the board with addresses and phone numbers.⁠¹⁵ The sources do not say whether the private care packet uses that same form, so confirm with HFS when you request the packet.

6. Pass the review or inspection

   ADH conducts a review and/or inspection before issuing the license.⁠¹

7. Enroll with Arkansas Medicaid

   (see below).

ADH publishes no processing time for private care licenses.

Fees as published on 2026-10-12

HFS’s application instructions (form HFS-10A, revised June 18, 2026) list license fees for ten facility types, including $1,000 per parent home health agency, but no private care agency fee.⁠¹⁵ No ADH source states a private care agency fee, so ask HFS for the amount when you request the packet.

Medicaid enrollment, prior authorization and EVV

A license alone does not get you paid. To enroll as a Medicaid personal care provider, a private care agency must:⁠³

• Hold the ADH license and file a copy with the Medicaid Provider Enrollment Unit.
• Be enrolled in the ARChoices program.
• File proof of the $1,000,000 insurance, then annual proof that it stayed in force.
• Have DPSQA certification. The manual still says this is required, although Act 853 removed DHS certification from the licensing statute.⁠²⁠³ The sources do not settle whether DHS still requires it for private care enrollment, so ask Provider Enrollment before you apply.

Every Medicaid personal care client needs prior authorization. Registered nurses working for the DHS independent assessment contractor assess clients with the Arkansas Independent Assessment (ARIA), which assigns a tier from 0 to 3; tier 0 means personal care is not supported. Hours are set using the Task and Hour Standards.⁠³ Visits must be recorded through electronic visit verification under Section I, § 145.000 of the Medicaid manual.⁠³ DHS’s new provider sheet points personal care agencies to AuthentiCare for EVV, Acentra for prior authorization submissions, Provider Enrollment at (501) 376-2211, and [email protected] for program questions.⁠¹⁴

Renewal, changes and enforcement

Licenses are issued for the calendar year and expire December 31; you file an annual application on ADH forms.⁠¹ After the first inspection, ADH inspects at least every three years. If an inspection finds deficiencies, you have 60 days to come into compliance before the Director may move to suspend or revoke.⁠¹

Notify HFS of any change of name, location, contact details or ownership, or a closure. If you close, tell HFS in writing the effective date and how clients and records will be transferred, and return the original license.⁠¹

ADH may deny, suspend or revoke a license for rule violations, misstating a material fact, deceptive practices, altering a license, or any act that materially affects a client’s health and safety. You have 30 days after notice to request a hearing in writing; if client safety is threatened, HFS can suspend immediately and must hold a hearing within seven days.⁠¹ Under the 2010 background check rule, losing Elder Choices certification is grounds to deny or revoke a private care license.⁠⁶

Rule changes in progress

Three 2025 laws are working their way into the ADH rules. ADH’s summary of its proposed amendments lists them:⁠¹¹

• Act 853: removes DHS certification, adds the Medicaid reimbursement element to the definition, and drops regional offices.⁠²⁠¹¹
• Act 674: redefines a contractor as someone who does not receive a W-2 and applies employee requirements to contracted individuals.⁠¹¹
• Act 643: a home caregiver who already completed the required training and documents it does not have to repeat it.⁠¹¹⁠¹³

The amended rule would also require registry checks for employees and contracted individuals under Ark. Code § 20-38-103.⁠¹¹ ADH took public comment on the amended Rules for Private Care Agencies, 20 CAR Pt. 49, from July 5 to August 4, 2026, and on 2026-10-12 still listed it as a proposed amendment.⁠⁹⁠¹⁶ A parallel proposal for the background check rule would allow third-party evaluation services to run checks, count independent contractors as employees, drop the DPSQA certification reference, and move checks fully online.⁠¹² Until both rules are final, follow the 2024 private care rule and the 2010 background check rule as published.

Sources

1. 1
   Arkansas State Board of Health / Arkansas Department of Health, Health Facility Services, Rules for Private Care Agencies in Arkansas (2024) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Arkansas General Assembly, Act 853 of 2025 (HB1439): amending Ark. Code §§ 20-10-2301, 20-10-2302 and 20-10-2304 Checked 12 Oct 2026 · Back to text ↑
3. 3
   Arkansas Department of Human Services (Code of Arkansas Rules), Arkansas Medicaid Provider Manual, Personal Care, Section II Checked 12 Oct 2026 · Back to text ↑
4. 4
   Arkansas Department of Health, Health Facility Services, Applications for New Providers & Change of Ownership Checked 12 Oct 2026 · Back to text ↑
5. 5
   Arkansas Department of Health, Health Facility Services Checked 12 Oct 2026 · Back to text ↑
6. 6
   Arkansas Department of Health, Rules and Regulations for Conducting Criminal History Records Checks for Home Health, Hospice and Private Care Agencies in Arkansas (2010) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Arkansas Department of Health, Health Facility Services, HFS: Criminal Background Check Checked 12 Oct 2026 · Back to text ↑
8. 8
   Arkansas Department of Health, Health Facility Services, Step by Step Instructions for Federal (Fingerprint) Background Checks on Caregivers Working in Home Health, Hospice and Private Care Checked 12 Oct 2026 · Back to text ↑
9. 9
   Arkansas Department of Health, Notice of Public Comment Period: Rules for Private Care Agencies, 20 CAR Pt. 49 Checked 12 Oct 2026 · Back to text ↑
10. 10
    Arkansas Department of Health, Proposed Rulemaking markup: Rules for Private Care Agencies in Arkansas, 20 CAR Pt. 49 Checked 12 Oct 2026 · Back to text ↑
11. 11
    Arkansas Department of Health, Summary of proposed amendments to the Rules for Private Care Agencies (memo of October 11, 2025) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Arkansas Department of Health, Summary of proposed amendments to the criminal history records check rules (memo of October 11, 2025) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Arkansas General Assembly, Act 643 of 2025 (HB1854): amending Ark. Code § 20-77-2304 Checked 12 Oct 2026 · Back to text ↑
14. 14
    Arkansas Department of Human Services, Division of Aging, Adult, and Behavioral Health Services, New Provider Resources (Personal Care, Attendant Care, Respite) Checked 12 Oct 2026 · Back to text ↑
15. 15
    Arkansas Department of Health, Health Facility Services, Instructions for Completing an Application for License to Conduct a Hospital or Related Institution, HFS-10A (Rev. 06/18/2026) Checked 12 Oct 2026 · Back to text ↑
16. 16
    Arkansas Department of Health, Proposed Amendments to Existing Rules Checked 12 Oct 2026 · Back to text ↑
17. 17
    Arkansas Department of Health, Health Services Permit Agency, Permit of Approval Process Checked 12 Oct 2026 · Back to text ↑

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