Hawaii home care agency license: opening a personal care or homemaker agency

One license, with personal care included

Hawaii does not split non-medical home care into a companion tier and a personal care tier. HRS 321-14.8 has required every home care agency to hold a Department of Health license since July 1, 2010 ⁠⁶. The detailed standards in HAR chapter 11-700 took effect on August 10, 2018 ⁠¹. Under that one license, an agency may offer personal care services, homemaker services or both, and it may also offer respite care ⁠¹.

What sets Hawaii apart is how much hands-on care the license allows. The rule lists personal care services as personal hygiene and grooming, bathing, skin care, oral hygiene, hair care, dressing, help with toileting, help with ambulation, mobility, transfers and positioning, and help with exercise and range of motion ⁠¹. Homemaker services cover routine housecleaning, laundry and mending, shopping, errands including picking up medication, meal preparation, escorting the client to medical care services or to nutritional or recreational programs, and “simple health care routines such as reminders to take oral medication” ⁠¹. Respite is either kind of service, given so that a family caregiver can rest ⁠¹.

The rule draws two hard limits:

• No money management. Neither personal care nor homemaker services include managing the client’s money or balancing their checkbook ⁠¹.
• No nursing. OHCA says home care excludes “nursing services or other clinical professional services normally provided by home health agencies or private duty nursing services” ⁠³. Skilled nursing or therapy needs a separate license, and in Hawaii that process starts with the State Health Planning and Development Agency. The Hawaii home health agency license guide covers that route.

Who needs the license, and who does not

HAR 11-700 defines a home care agency as a public or proprietary agency, a private nonprofit, or a subdivision of either “engaged in providing personal care services or homemaker services to clients in the client’s temporary or permanent place of residence” ⁠¹. A “client” is someone who receives those services in exchange for payment ⁠¹. Operating without a license is unlawful ⁠¹, and OHCA states that “new agencies must be licensed prior to providing services to clients” ⁠³.

The definition leaves out four groups:

The individual exception has limits. The text exempts “an individual,” including one who has incorporated, while an agency is a public or proprietary agency, nonprofit or subdivision “engaged in providing” the services ⁠¹⁠⁶. Read together, that covers one caregiver working alone, even through an LLC. A business that employs other caregivers looks like an agency. OHCA does not publish a rule on this, so ask OHCA in writing if your model is a registry or a small group of independent caregivers.

The statute adds two exemptions for agencies with a specific public payer. A service provider agency is exempt when services are provided under contract with the City and County of Honolulu’s elderly affairs division of the department of community services, or “exclusively to participants in the medicaid home and community based services waiver, pursuant to section 1915(c) of the Social Security Act, by an agency approved by the department of human services med-QUEST division” ⁠⁶. Both exemptions are narrow. A Med-QUEST-approved agency that also takes one private-pay client no longer serves waiver participants “exclusively.”

Other OHCA licenses may fit your model better than this one. Care in the client’s home is home care. Care in a home you operate is an adult residential care home or, at larger scale, an assisted living facility. Daytime group supervision in a center is an adult day care center certificate of approval.

The two people OHCA looks at first

The application must name the administrator and the supervisor and attach their qualifications ⁠¹⁠⁴. One person can hold both roles ⁠¹.

Administrator. This is the person responsible for managing the agency ⁠¹. The rule sets no degree or experience minimum, but it makes the administrator responsible for the right level of supervision and forbids letting aides or homemakers do anything outside their scope of duties ⁠¹. The administrator also has to clear a background check ⁠¹.

Supervisor. The supervisor needs either at least two years of experience or training in home care or a closely related field, or a professional license “such as a registered nurse, licensed practical nurse, social worker, physical therapist, or occupational therapist” ⁠¹. The supervisor writes each client’s service plan, visits every direct-care employee at each client’s home at least once a year, and “shall not be a client’s case manager” ⁠¹. That last rule matters if you plan to take referrals from a case management agency where your supervisor also works.

Who can do the hands-on work

HAR 11-700 sets two levels of direct-care worker:

• Personal care aide. This worker has completed “the basic nurse aide course in a state-approved nurse aide training program or an equivalent course,” or coursework that qualifies them as a certified or licensed health care professional. DOH “reserves the right to determine an equivalent course” ⁠¹. Only personal care aides may give personal care ⁠¹.
• Homemaker. This is anyone with “experience or training in the performance of homemaker services” ⁠¹. Homemakers may give homemaker services but not personal care. Personal care aides may give both ⁠¹.

In practice, every caregiver who bathes, toilets or transfers a client must have nurse-aide-level training before that first visit. Plan your hiring and pay around that requirement. A homemaker-only agency is easier to staff, but it cannot accept clients who need hands-on help.

Every employee and volunteer with direct client contact also needs:

1. TB clearance before first contact

   Tuberculosis clearance must follow the guidelines in HAR chapter 11-164 and be documented before the worker’s first contact with clients ⁠¹.

2. A background check under HRS 321-15.2

   This applies to everyone who gives client care or supervises staff, including the administrator ⁠¹. The statute lists a home care agency as a “healthcare facility” for this purpose ⁠⁷. A check covers the state adult protective services registry, child abuse and neglect records, criminal history, sex offender registries, the certified nurse aide registry, and the same records from any other state where the person lived ⁠⁷. The law also requires an annual name inquiry into state criminal history files ⁠⁷.

3. Orientation and ongoing training

   Your policies must include an orientation on agency policies for everyone who serves clients and “a continuous in-service education program” ⁠¹. The rule does not set a number of hours.

When the applicant is a company, its principals, directors, partners, managers, agents and representatives count as applicants under the background check statute if they will have contact with clients or their finances, property or records ⁠⁷. Applicants must consent to the checks ⁠⁷. Refusing to be fingerprinted is grounds for denial ⁠⁷. The FBI and Hawaii Criminal Justice Data Center fees may be passed on to applicants and employees ⁠⁷. OHCA’s application checklist asks for “Background Check Clearance including Fieldprint Determination” for pre-hire staff ⁠⁴.

Policies and paperwork to finish before you apply

OHCA reviews your written systems before it licenses the agency. The application must include policies and procedures for running the business and delivering services ⁠¹. HAR 11-700-8 and -9 list what those must cover ⁠¹:

• the scope of services, the conditions under which you offer them, and your geographic coverage;
• a ban on discrimination against clients based on “race, sex, including gender identity or expression, sexual orientation, color, religion, ethnicity, country of origin, gender, or marital status”;
• service plan rules: services follow the plan, the supervisor reviews it regularly, and staff know and follow it;
• client records: one record per client, and procedures for staff to document each service;
• the orientation and in-service education program;
• written job descriptions setting the qualifications and allowed duties of each staff category;
• written human resource policies given to every staff member, covering “wage scale, hours of work, vacation and sick leaves, and use of car if provided, or mileage allowed”;
• procedures for personnel records and client records, and a confidentiality policy.

The service plan has its own rule. The supervisor develops it with the client or the client’s representative, both sign it, and it is reviewed at least once a year and whenever the client’s condition changes. Staff must report changes in condition to the supervisor ⁠¹.

Applying to OHCA, step by step

1. Form the business and get state clearances

   The OHCA checklist asks for a General Excise Tax clearance from the Department of Taxation and a Certificate of Good Standing from the Department of Commerce and Consumer Affairs ⁠⁴.

2. Choose your service area island by island

   The application has a geographic service area form for Hawaii Island, Oahu, Molokai, Kauai, Maui and Lanai. You mark a whole island, or only the districts you will serve, such as Ewa or the Waianae Coast on Oahu, or Hilo or Kona on Hawaii Island ⁠⁴. The license list publishes each agency’s area ⁠⁵. Your office does not have to be on the island you serve: the list includes an agency with a Waipahu address licensed only for the Island of Maui ⁠⁵.

3. Assemble the packet

   OHCA’s checklist asks for the application form, a marketing or client services brochure, your client services contract and description of services, owner and governing body names, administrator and supervisor qualifications, the HAR 11-700-8 and -9 policy manual, TB documentation and background check clearances ⁠⁴. The applicant signs an attestation that they have read and will comply with chapter 11-700 ⁠⁴.

4. Mail hard copies

   The packet tells applicants to submit the completed application and supporting documents as hard copies to the Office of Health Care Assurance, State Licensing Section, 601 Kamokila Boulevard, Room 361, Kapolei, HI 96707 ⁠⁴. OHCA’s licensing contacts are [email protected] and (808) 692-7400 ⁠⁴.

5. Get surveyed

   Under HAR 11-103.1, DOH “shall conduct a survey prior to the issuance of each initial license.” Afterward, OHCA tells you in writing either that you fully comply or that you must submit a written plan of correction for listed deficiencies ⁠².

6. Pay within 10 days, then get the license

   OHCA tells you when to pay ⁠⁴. Once you have the notice of full compliance, you have 10 days to pay the initial fee ⁠². No license issues until all fees are paid ⁠². Post the license in a conspicuous place at your office ⁠¹.

OHCA does not publish a processing time for home care agency applications.

The OHCA packet is dated 2018 and still describes an initial fee of $1,200 under the old fee chapter 103. HAR chapter 11-103.1 replaced that chapter on September 16, 2022, and its fee schedule controls ⁠²⁠⁴.

Fees as published on 2026-10-12

For comparison, a home health agency license costs $2,750 initially and $2,000 to renew under the same schedule ⁠².

Pay by corporate check, bank or other financial institution check, or money order made out to “State of Hawaii OHCA SF,” or electronically where OHCA offers that option. Personal checks and cash are refused, fees are non-refundable, and a bounced check makes the application incomplete ⁠². Fingerprint fees for background checks are separate and may be passed on to applicants and staff ⁠⁷.

Keeping the license

• Two-year term. The license is valid for two years from the original issue date ⁠¹. Apply to renew at least 30 days before it expires, or the license “shall automatically expire” ⁠¹. Failing to pay the renewal fee forfeits the license as of the renewal date ⁠².
• No transfers. The license covers only the agency named in the application and cannot be transferred or assigned ⁠¹. A buyer applies for its own license.
• Client notice. Tell each client or their responsible party at least 30 days before your license expires or before you voluntarily surrender it. Return the license when you stop providing services ⁠¹.
• Unannounced inspections. DOH staff may visit “at any time” ⁠¹. OHCA’s page describes the inspections as a check on “safe levels of care in the recipient’s home” ⁠³.
• Enforcement. A rule violation carries a fine of up to $500, or the director may use the broader chapter 321 penalties ⁠¹. You have 20 days after receiving a denial, suspension or revocation decision to request a hearing in writing; otherwise the decision is final ⁠¹.
• Complaints. Anyone can report an unlicensed agency or file a complaint with OHCA’s form, by fax to (808) 692-7414 or by email ⁠³.

OHCA posts the list of licensed agencies with license numbers, service areas and effective and expiration dates. It says any agency not listed “is not licensed nor have they applied for a state license” ⁠³⁠⁵. On 2026-10-12 the list showed 133 agencies, with license numbers running to 243-HCA ⁠⁵. Referral sources and families can check your status there.

Recent change: scope of services enforcement

In the 2025 session, SB1438 aimed “to prohibit home care agencies from providing services outside the scope of their facility license.” The Senate Health and Human Services committee found that “some operators of home care agencies provide skilled nursing services to clients that are not rendered by a nurse licensed pursuant to chapter 457” ⁠⁹. DOH testified in support ⁠⁹. The statute as published by the Legislature now contains that rule: subsection (d) of HRS 321-14.8, noted as amended by L 2025, c 51, says a home care agency “shall only provide home care services or related tasks, functions, and activities in accordance with its license, and shall not provide services authorized by chapter 457 unless those services are provided by a registered nurse, a licensed practical nurse, or an advanced practice registered nurse” ⁠⁶. Violations carry the chapter 321 penalties ⁠⁶. The rule already barred aides from working outside their scope of duties ⁠¹. If clients need wound care, injections or other skilled tasks, you need a home health agency license, not more aide training.

The Medicaid route also needs checking. Agencies that serve only 1915(c) waiver participants under Med-QUEST approval are exempt from this license ⁠⁶⁠⁸. The statute and OHCA’s pages say nothing about how Med-QUEST or the QUEST Integration health plans credential a licensed home care agency that serves both private-pay and Medicaid clients. Before you build a payer mix around Medicaid, ask Med-QUEST which approval or contract applies to your agency and whether your OHCA license is a prerequisite.

Sources

1. 1
   Hawaii State Department of Health, Hawaii Administrative Rules, Chapter 11-700: Home Care Agencies (effective August 10, 2018) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Hawaii State Department of Health, Hawaii Administrative Rules, Chapter 11-103.1: Licensure and Certification Fees for Health Care Facilities and Agencies (effective September 16, 2022) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Hawaii State Department of Health, Office of Health Care Assurance, Home Care Agency Licensing Checked 12 Oct 2026 · Back to text ↑
4. 4
   Hawaii State Department of Health, Office of Health Care Assurance, Home Care Agency License Application: Requirements and Instructions Checked 12 Oct 2026 · Back to text ↑
5. 5
   Hawaii State Department of Health, Office of Health Care Assurance, Hawaii Licensed Home Care Agencies Checked 12 Oct 2026 · Back to text ↑
6. 6
   Hawaii State Legislature, Hawaii Revised Statutes section 321-14.8: Home care agencies; licensing Checked 12 Oct 2026 · Back to text ↑
7. 7
   Hawaii State Legislature, Hawaii Revised Statutes section 321-15.2: Background checks Checked 12 Oct 2026 · Back to text ↑
8. 8
   Hawaii State Legislature, SB1438 HD1 (2025 session): Relating to Home Care Agencies Checked 12 Oct 2026 · Back to text ↑
9. 9
   Hawaii State Legislature, Senate Standing Committee Report No. 501 on SB1438 (2025) Checked 12 Oct 2026 · Back to text ↑

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