Indiana home health agency license: IDOH steps, surveys and the Medicare squeeze
Any business that sends nurses, therapists, medical social workers or home health aides into Indiana homes needs a home health agency license from the Indiana Department of Health (IDOH). You apply on State Form 4008 with a $250 fee, IDOH issues a 90-day provisional license, and you must be caring for patients before the survey that leads to a full license. Since July 1, 2026, Indiana Medicaid also requires home health agencies to be enrolled in Medicare.
Contents11 sections
Key takeaways
- You cannot open, operate, manage or advertise a home health agency in Indiana without an IDOH license. An agency based in another state needs Secretary of State authorization and a branch office located in Indiana.3
- The license is cheap ($250, nonrefundable, as published on 2026-10-12) but slow. IDOH says to allow 30-60 days for application review, and it asks for corrections only three times before it denies the application.12
- The first license is a 90-day provisional license. Before the licensure survey you must be caring for at least three active patients. Since July 1, 2025, IDOH grants only one 90-day extension.2
- Since July 1, 2026, Indiana Medicaid (IHCP) requires home health agencies to be enrolled in Medicare. CMS stopped enrolling new home health agencies in Medicare nationwide on May 13, 2026, so a new Indiana agency has no clear route to either program until that freeze ends.810
- A licensed home health agency can add personal (non-medical) services to its existing license instead of getting a separate personal services agency license.111
Quick facts
| Agency | Indiana Department of Health, Division of Home and Community-Based Care, Indianapolis |
|---|---|
| Law | IC 16-27-1 (licensing), IC 16-27-2 (criminal history), IC 16-27-2.5 (drug testing); 410 IAC 17 |
| Application | State Form 4008, mailed with supporting documents |
| Fee | $250 initial and $250 each annual renewal, nonrefundable (as published on 2026-10-12) |
| First license | 90-day provisional; full license after survey, dated back to the first provisional day |
| Term | One year; renewal due 60-90 days before expiration |
| Medicaid | IHCP requires Medicare enrollment since July 1, 2026 |
| Medicare | New enrollments frozen nationwide since May 13, 2026 |
Fees and procedures as shown on the IDOH Home Health Agency program page and the IDOH initial licensure instruction letter (revised June 13, 2025), checked October 12, 2026.
Home health agency, personal services agency, or no license at all
IDOH’s Home Health Agency Licensing and Certification Program licenses agencies that send nursing, physical therapy, occupational therapy, speech therapy, medical social work, home health aide and other therapeutic services into a patient’s temporary or permanent residence.1 Under 410 IAC 17-10-1(a), no home health agency may be opened, operated, managed, maintained or otherwise conduct business without that license.3
Every licensed agency must provide skilled nursing. IDOH’s instruction letter cites IC 16-27-1-2 and 42 CFR 484.105(f) for that rule. It also warns that Indiana Medicaid counts medication set-up as a skilled service while Medicare does not, so an agency that plans to be certified by both programs needs skilled nursing as Medicare defines it.2
Indiana splits in-home care into two licenses, and the line between them is a professional’s order. Personal services (attendant care, homemaker and companion services) are licensed under IC 16-27-4 as a personal services agency. Services that need a health care professional’s order to be lawfully performed are excluded from that definition, so they belong in a home health agency.11 If you only plan non-medical help, see the Indiana personal services agency license.
You can also run both lines of business from one company. A licensed home health agency that offers personal services must meet the IC 16-27-4 requirements, but it does not need a separate personal services agency license.11 IDOH adds personal services to an existing license after you send:1
- a letter on agency letterhead with your license number, the request and the intended start date
- a basic attendant job description
- a training and evaluation policy that sets a competency method and a passing score
- page 2 of the initial application with Section E completed
You may not offer the new service until IDOH approves it in writing.1
410 IAC 17-10-1(m) lists who does not need a home health license. The exempt list includes:3
- licensed physicians
- a person who lives in the patient’s home or is immediate family
- incidental services that a licensed health facility gives its own patients
- employees of a licensed agency
- local health departments
- a health care professional who provides one service under contract with a licensed agency
- equipment suppliers and drugstores that provide no services in the home
- unpaid volunteer aides
- an individual health care professional who provides professional services in a patient’s residence
- early intervention services for children under the IDEA-funded state program
The individual-professional exemption covers a nurse or therapist who provides professional services personally. Staff who make visits are exempt only as employees of a licensed agency.3
Out-of-state agencies. An agency whose parent office is in another state needs an Indiana license to serve Indiana patients. It must also be authorized by the Indiana Secretary of State and have a branch office located in Indiana.3 A branch must share administration, supervision and services with the parent agency and be within 120 minutes’ driving time of it.3 Branches are added with the Branch Questionnaire, State Form 53209.1
Medicaid now requires Medicare, and Medicare is frozen
This is the fact that most affects a new Indiana agency in late 2026, so plan around it first.
Indiana Medicaid’s Medicare rule. On June 26, 2025, the Indiana Health Coverage Programs (IHCP) announced that starting July 1, 2026, both new and existing home health agencies (provider type 05) must be recognized and enrolled as Medicare providers.8 Senate Enrolled Act 222 (2026) carved out one exception, explained in a March 31, 2026 bulletin. An agency without Medicare enrollment could stay in IHCP after June 30, 2026 only if it had sent a CMS-855A to CMS before April 1, 2026, or had started the process with a CMS-approved accrediting organization. Those agencies must finish Medicare enrollment by June 30, 2027 or be deactivated. Every other non-Medicare agency was to be deactivated from IHCP on July 1, 2026.9 A company forming now does not qualify for that exception.
The federal freeze. Effective May 13, 2026, CMS stopped enrolling new home health agencies, branches and practice locations in Medicare anywhere in the country. Only applications that a Medicare contractor received before that date are still being processed.10 The moratorium runs for six months and can be extended in six-month increments.10 As of October 12, 2026, a search of the Federal Register found no notice extending or lifting it, so the first period ends in mid-November 2026. CMS left it to each state to decide whether to freeze Medicaid enrollment of home health providers.10 Buying a young agency is not a workaround. Under 42 CFR 424.550, an agency that changes majority ownership within 36 months of its initial enrollment must, with limited exceptions, enroll again as a new agency.10
What that means in Indiana. Read together, these two rules leave a new agency with no clear way to bill either Medicare or Indiana Medicaid until CMS lifts the moratorium. The IHCP bulletins do not address the interaction.89 Neither bulletin says whether IHCP will enroll a newly licensed agency that cannot enroll in Medicare because of the federal moratorium, and CMS left Medicaid-side moratoria to each state.910 Ask IHCP provider enrollment (Gainwell, 800-457-4584, option 2) before you build a budget on Medicaid revenue.8
The state license itself is not frozen. IDOH still accepts State Form 4008, and a private-pay agency can be licensed and operate.1 Plan your opening census with that in mind, because you need real patients before IDOH will survey you.
Who runs the agency: administrator and clinical supervisor
IDOH checks the résumés of four people with the application: the administrator, the alternate administrator, the clinical supervisor and the alternate clinical supervisor. It applies these minimums:2
| Role | Minimum IDOH applies | Source |
|---|---|---|
| Administrator and alternate | Licensed physician, registered nurse or holder of an undergraduate degree, and at least 1 year of supervisory or administrative experience in home health or a related health care program (42 CFR 484.115(a)(2)) | Instruction letter 2 |
| Clinical supervisor and alternate | Physician, or registered nurse with 2 years of nursing experience including at least 1 year of supervisory or administrative experience (410 IAC 17-12-1(d)) | Instruction letter, rule 23 |
Experience at a personal services agency, or at an assisted living facility that provides non-medical care, does not count as relevant experience for these roles.2 Each résumé must show dates, positions, health-related experience, and the type of staff supervised and for how long.2
The administrator does not have to be an employee or work full time at the agency, and may also serve as the supervising nurse. The administrator must produce records the department asks for within 72 hours, or by the time a surveyor leaves if the request comes during a survey. A qualified person must be authorized in writing to act in the administrator’s absence.3 The clinical supervisor or alternate must be on the premises or reachable immediately.3 A governing body holds full legal responsibility. It appoints the administrator, adopts bylaws and oversees finances, and administrative and supervisory duties may not be handed to another agency.3
Background checks, drug tests and health screening
Criminal history. Owners, officers, the administrator, the nursing supervisor and both alternates need a national criminal history check or an expanded criminal history check (defined in IC 16-27-2), and copies go in the application. Every employee must be checked too, and surveyors review this.25 IDOH requires a lifetime search with no limit in years, and it does not accept an FBI “Identity History Summary.”25 IDOH’s letter lists the convictions that bar an owner from operating, or a worker from serving patients at home, under IC 16-27-2-3 and -5: rape, criminal deviate conduct, exploitation of an endangered adult, failure to report battery, neglect or exploitation of an endangered adult, and theft.5
To use Indiana State Police inkless fingerprinting before you are licensed, email [email protected] to have the agency added. After the license is issued, you must email ISP a copy within 180 days or the agency is dropped from the inkless site, and ISP will not remind you.2
Drug testing. IC 16-27-2.5, effective July 1, 2017, applies to applicants and employees who have direct patient contact and are not licensed under IC 25. Each one must pass a drug test at hire before caring for any patient.6 Each year (July 1 to June 30) you must randomly test at least 50% of those employees, and you must also test on reasonable suspicion. IDOH treats a five-panel test (amphetamines, cocaine, marijuana, opiates, PCP) as the minimum.6 If a confirmation test is positive, you must fire the employee or keep them away from patient care for at least six months.6
Health screening. Each employee with direct patient contact needs a physical exam by a physician or nurse practitioner no more than 180 days before first patient contact.3 The rule’s tuberculosis section calls for a baseline two-step skin test or QuantiFERON assay and then annual screening.3 Since December 1, 2019, an IDOH blanket waiver exempts agencies from that section if they formally adopt a nationally recognized TB standard and follow it as written.7 Medical files must be kept separate from personnel files.3
Aides and clinical operations IDOH will survey
- Aides. Before patient contact, every home health aide must have passed a competency evaluation covering the subjects listed in 410 IAC 17-14-1(h) and be in good standing on the state aide registry.3 Aides need at least 12 hours of continuing education each calendar year, including at least 8 hours in 8 of the listed subjects, prorated in the aide’s first year on the registry. That training must be given by or under the general supervision of a registered nurse.3
- Supervision. A registered nurse (or a therapist in therapy-only cases) assigns aides and makes a supervisory visit at least every 30 days.3
- Plans of care. Care follows a written medical plan of care. The ordering physician, dentist, chiropractor, optometrist or podiatrist reviews it at least every two months and gets a written summary report at least that often. Orders may come from practitioners licensed in Indiana or another state.3
- Nursing. Nursing is provided by a registered nurse or licensed practical nurse. Except in therapy-only cases, the RN makes the initial evaluation visit.3
- Personnel files. Each file holds the job description, qualifications, criminal history check, license and annual evaluations. The supervising nurse’s evaluations fall every 9-15 months.3
- Quality and infection control. You need an ongoing quality assurance program and written communicable disease policies.3
Assembling the State Form 4008 packet
Mail the full packet with a $250 check or money order payable to IDOH to: Indiana Department of Health, 2 North Meridian Street, Attention: Cashier’s Office, Indianapolis, IN 46204.2 IDOH’s page and instruction letter ask for:12
Cover letter
Give the legal and dba names, a contact person, the physical and mailing addresses and the phone number. Also say whether IDOH should do only the state licensure survey, with an accrediting organization doing the federal survey, or both.
State Form 4008
Check only the services you will provide at the time of survey, not future ones. Fill in Section IIE (personal services) only if you will provide them under the home health license. List office hours, and use a general agency email address rather than a personal one.
Ownership disclosure
List everyone with 5% or more ownership or controlling interest, plus officers, directors, managing agents and employees, any management company, and that company’s CEO and board chair. Rule 410 IAC 17-10-1(d) requires this.3
Secretary of State documents
Send the documents for your entity type: articles and certificate for a corporation or LLC, registration documents for a limited partnership, a Certificate of Authority for an out-of-state corporation, and a Certificate of Assumed Business Name for any dba.
IRS document
Send an IRS-issued document that shows the legal name and EIN, not the request form you filled out.
Staff documents
Send licenses, criminal history checks and résumés for leadership staff.
Attached forms
Include the Notice of Affiliation and the Geographic Area Served form. Add the CMS-1572 survey report (or the state-license-only version) and, if applicable, the CLIA application (HCFA-116).
Signature
An officer, director, partner or sole proprietor signs. Anyone else needs a notarized affidavit of permission.
Do not bind the packet, use sheet protectors, tabs or staples. IDOH suggests colored separator sheets or paper clips instead.2 It reviews applications in the order received and will not speed one up for a walk-in, call or email. You may call for status.2 If the packet is incomplete, you get 30 days to answer each request. After three requests, an application that is still incomplete is denied.2
From provisional license to full license
Provisional license
Once IDOH has a complete application, the fee and the ownership disclosure, it may issue a 90-day provisional license pending an on-site inspection.3 It weighs the applicant’s history: revocations, denied or probationary licenses, civil penalties, orders, injunctions or surrendered licenses at agencies the applicant owned or ran, and substantial violations of the rules at any time within the prior two years.3 Paying the fee does not let you admit patients. The provisional license does.2
Build a census
Before the licensure survey, IDOH wants at least three active patients. You must have provided each service listed on your application, and an aide service cannot be replaced by another discipline.2 No pseudo patients, and no borrowing or sharing patients or staff with other providers, including personal services agency clients.2
Ask for the survey
Email [email protected] 30 days before the provisional license expires. Include your facility ID, the number of patients and the services you have provided. If you do not, IDOH may deny the license and you will have to reapply.2
Unannounced survey
Someone must be available within two hours of the surveyors’ arrival. Surveyors make at least three home visits, so spread patient visits across the week.2 For good cause, IDOH may give you up to 24 hours to produce requested documents.3
Full license or extension
If you comply, IDOH issues a full license dated back to the first day of the provisional license. If not, it may extend the provisional license 90 days.3 Since July 1, 2025, only one extension is available.2 After that, IDOH may ask for more information, investigate further or deny.3
The Medicare and Medicaid certification track
Indiana licensure is mandatory, and you must be licensed before you can be Medicare certified.4 Once the federal moratorium lifts, the IDOH sequence runs as follows:24
NPI
Get an NPI from NPPES.
Medicare application
File the CMS-855A through PECOS or on paper. Indiana’s Medicare contractor is Palmetto GBA.8
Contractor approval
The contractor must approve before IDOH or an accrediting organization can do the initial federal survey. IDOH says this can take three to six months.
Federal survey
The survey is done by IDOH or by ACHC, CHAP or The Joint Commission. An accrediting organization’s survey cannot happen until you have passed the state licensure survey and received your provisional license.
Patient count
CMS and FSSA require skilled care for 10 patients, 7 of them active, before the initial Medicare or Medicaid survey.
Recommendation
IDOH sends a CMS-1539 to the contractor, FSSA and Gainwell. Your Medicare (PTAN) and Medicaid billing numbers arrive separately.
New agencies must also show they can submit OASIS assessments. Since January 1, 2020, they have done this by sending test files through the iQIES OASIS Validation Utility Tool.1 Medicaid home health services need prior authorization under 405 IAC 5-16-3. Under 405 IAC 5-16-3.1 they must be ordered in writing by a physician and be intermittent or part time (except for ventilator-dependent patients). Homemaker, chore and companion services are not covered except under waiver programs.2
Renewal, changes and enforcement
A license lasts one year and cannot be transferred.3 File the renewal on State Form 48851 with $250 at least 60 days, and no more than 90 days, before expiration (410 IAC 17-11-3). IDOH sends no reminders.12 You must also file an annual activity report on an IDOH form.3 IDOH may survey annually without notice and investigate complaints. In a year when an accrediting organization surveys you, IDOH may accept that report instead of a licensing survey if it shows substantial compliance.3
Buying an agency. A buyer files a new State Form 4008 with $250, the signed purchase agreement and letters of intent from buyer and seller, at least 30 days before the effective date.12 The seller must give IDOH 30 days’ written notice before closing or selling.3 Staff and service changes are reported to IDOH as they occur.1
Enforcement. The commissioner may issue a letter of correction, a probationary license, a resurvey, a denial or a revocation, and may impose civil penalties of up to $10,000 per violation.3 A probationary license lasts three months, and no more than three may be issued in 12 months.3 An agency on a probationary license may not run an aide continuing education program.3
410 IAC 17 was last readopted in a filing dated September 10, 2020.3 The newest change for founders is the IHCP Medicare requirement in effect since July 1, 2026, together with the federal moratorium. Check both before you file.
Sources
- 1
- 2
- 3 Indiana Department of Health, 410 IAC 17, Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
- 4 Indiana Department of Health, Process of Initial Medicare Certification Checked 12 Oct 2026 · Back to text ↑
- 5
- 6
- 7
- 8
- 9
- 10
- 11 Indiana Department of Health, Personal Service Agency License Requirements Checked 12 Oct 2026 · Back to text ↑
Was this information accurate? Report an error
Related guides
Indiana and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| Indiana (this guide) | Home Health Agency (HHA) license | Sending your own nurses, therapists or aides into homes | $250 initial and $250 each annual renewal, nonrefundable |
| Illinois | Home Health Agency license (Home Nursing Agency license for shift nursing) | Skilled nursing plus one other home health service in clients' homes | $1,500 per two-year license, initial or renewal |
| Ohio | Skilled Home Health Services license | Sending your own nurses, therapists or aides into clients' homes | $250, non-refundable |
| Kentucky | Home Health Agency License | Own nurses, therapists or aides into homes; license plus certificate of need | $500 initial and annual |
Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.