Washington home care agency license: the in-home services license, home care category

One license, separate service categories

Washington does not issue a free-standing “home care license.” DOH issues a single in-home services agency license, and each type of service is a separate category on it: home care, home health, hospice and hospice care center.⁠² Each category carries its own $5,000 initial fee, and you add categories later by amending the license.⁠³ This guide covers the home care category. If you plan nursing, therapy or home health aide services, read the home health guide instead. That category is defined as two or more home health services, and it ties into certificate of need rules if you seek Medicare certification.

Under RCW 70.127.010, home care services are “nonmedical services and assistance provided to ill, disabled, or vulnerable individuals that enable them to remain in their residences.” The statute lists three kinds:⁠¹

• Personal care, such as help with dressing, feeding and personal hygiene
• Homemaker help, such as housekeeping, shopping, meal planning and preparation, and transportation
• Respite care for the family

A home care agency may also perform nursing tasks delegated by a registered nurse under RCW 18.79.260(3)(e) without becoming a home health agency.⁠¹ That is the main point where Washington’s non-medical line differs from the line in many other states.

Who needs the license, and who does not

The threshold is headcount, not hours. The statute defines a “person” as an individual or entity “that employs or contracts with two or more individuals.”⁠¹ WAC 246-335-315 repeats it: anyone who employs or contracts with two or more individuals to provide in-home services is subject to licensure.⁠² You need the license before you advertise, operate, manage, open or maintain the agency.⁠¹ Separately, RCW 70.127.030 makes it unlawful to put “home care agency,” “home care services” or “home care” in a business name or advertising unless you are licensed for home care.⁠¹

RCW 70.127.040 lists who is outside the chapter. The exemptions that matter most to founders are:⁠¹

• A family member providing home care
• An individual who provides home care through a direct agreement with the client (a self-employed caregiver hired by the family)
• A person who provides only meal services in the home
• A person who provides services through a contract with a licensed agency, and employees or volunteers of a licensed agency
• An individual caring for clients through a contract with DSHS (individual providers), and the consumer directed employer described in RCW 74.39A.500
• Case management that does not include direct care, and one-time in-home assessments that do not lead to regular ongoing care
• A person who provides home care without compensation
• Adult family homes, assisted living facilities, nursing homes and similar licensed facilities, but only when serving their own residents

That last point catches residential operators. If you run an adult family home or an assisted living facility and want to send staff to people living elsewhere, the facility license does not cover it.⁠¹

Step one: the DOH orientation class

WAC 246-335-320(1) requires every initial applicant to finish a DOH-sponsored in-home services orientation class before applying.⁠² DOH states that initial applications submitted without the certificate of completion “will not be processed.”⁠⁶ As published on 2026-10-12:⁠⁶

• The class is online, takes about four hours (8:30 a.m. to about 12:30 p.m.) and is free.
• It runs monthly. The remaining 2026 dates are November 4 and December 9.
• Each session is capped at 80 participants. Login details arrive by email one week before the class.
• DOH emails the certificate within two business days. It is valid for one year.

The class covers the licensing process and the differences between the home care, home health and hospice categories.⁠⁶ You do not need to repeat it later to add a category, renew or file a change of ownership.⁠⁶

Building the application

The application is the In-Home Services License Application Packet (DOH 505-052, April 2026 edition). It contains the application form, disclosure statement and full-time equivalent (FTE) worksheet.⁠⁷ Under WAC 246-335-320(2) and DOH’s checklist, an initial home care application includes:⁠²⁠⁵⁠⁷

• The completed application, checked “New,” marking the home care category and every county you want to serve
• The orientation class certificate
• Proof of commercial general liability insurance of at least $1 million per occurrence (bodily injury, property damage and contractual liability) or $2 million combined single limit
• Washington State Patrol criminal history background checks and DOH-approved disclosure statements for the administrator and the supervisor of direct care services, all obtained within three months of the application date
• Copies of every government business license for each office (state, county or city)
• The signed FTE worksheet
• An organizational chart or narrative listing officers, the administrator, the direct care supervisor and other key positions
• A description of how you will manage and supervise home care throughout every requested service area
• A description of the services you will provide directly and those provided under contract
• The initial fee

The statute also requires you to identify officers, partners, managing employees and anyone owning 10% or more of the applicant’s assets.⁠¹ Mail the application, initial documents and a check or money order payable to the Department of Health to P.O. Box 1099, Olympia, WA 98507-1099. Send later documents to In-Home Services Credentialing, P.O. Box 47877, Olympia, WA 98504-7877. The DOH phone number in the packet is 360-236-4700.⁠⁷

Service areas are approved county by county. DOH must approve each county before you serve clients there. Approval “includes the expectation that agencies will strive to service all clients or patients within the county boundaries.”⁠⁷ RCW 70.127.080 bars DOH from limiting the number of agencies in a service area. DOH reviews whether you can supervise care across the area, not whether the market needs another agency.⁠¹ To add counties later, file an amended application and wait for approval before serving them.⁠²

Keep the policy manual out of the envelope. WAC 246-335-320(2)(g) requires policies and procedures that show compliance with the chapter. However, the April 2026 packet says not to submit the manual with the application, because the survey office requests it later.⁠²⁠⁷ DOH must review and approve the manual before it issues the license. Home care policies must not cite federal Medicare requirements. They may cite an accrediting organization’s standards only if you are accredited by it.⁠²⁠⁷ The packet also warns that policies drafted with artificial intelligence tools or templates must be reviewed for accuracy against the WAC and your actual workflows.⁠⁷

Fees as published on 2026-10-12

DOH’s fee page points to WAC 246-335-990. That section was amended by WSR 26-04-110, filed February 3, 2026 and effective June 1, 2026.⁠³

The 24-month renewal fee depends on paid FTEs (40-hour weeks of paid personnel or contractors). DOH assumes at least 2 FTEs for each approved service area in each service category.⁠³

If you withdraw an initial application, DOH refunds two-thirds of the fee, less a $50 processing fee, if no survey or technical assistance has occurred yet. After a survey or technical assistance, the refund is one-third, less $50. There is no refund after more than one on-site visit, or once nine months have passed without a license.⁠³ Neither WAC 246-335-990 nor chapter 246-335 WAC defines which counties are urban or rural, and the DOH pages reviewed do not list them. Ask DOH In-Home Services how each county you want to serve is classified before you budget a multi-county application.

The announced initial survey

DOH reviews the paper application first and notifies you in writing of missing items or fees.⁠⁷ After it accepts the materials, DOH’s Office of Investigation and Inspection contacts you to schedule the initial survey. You must pass it before DOH issues the license.⁠⁵ Initial surveys are scheduled and announced. The survey team is made up of registered nurses with home care, home health and hospice experience. The initial survey focuses on approving your policies and procedures, reviewing sample employee and client files, and testing your knowledge of the rules.⁠⁸ DOH publishes home care survey tools and checklists on the survey program page.⁠⁸

Deficiencies lead to a statement of deficiencies. You then have ten working days to return a plan of correction and sixty days to complete corrections, unless DOH allows longer.⁠² DOH does not publish a processing time. The binding clock is WAC 246-335-320(4): you have nine months from submission to finish every step. After that, DOH may close the application without a refund, and you would have to reapply with new fees.⁠²

Leadership the rules require

Administrator. The plan of operation must name an administrator who is a home care employee and has the education and experience your own policies require. The state sets no degree or license for this role. The administrator runs daily operations and fiscal affairs, designates an alternate in writing, keeps contracts current, confirms staff credentials and manages the quality improvement program.⁠²

Supervisor of direct care services. You must employ one, and that person must designate a similarly qualified alternate in writing. The supervisor or a designee must be available during all hours of client care. The supervisor and the alternate each need at least ten hours of training a year, documented in their personnel files. The supervisor must contact every client by phone or visit every six months to check compliance with the plan of care and client satisfaction.⁠²

Office. You must keep at least one in-state office where records are kept, and display the license there and at any branch.⁠² You must notify DOH in writing within thirty days of changes to the administrator or supervisor, opening or closing an office, or shrinking a service area.⁠²

The plan of operation must also cover services and hours and how you will supervise across all counties. It must include an emergency preparedness plan with a risk assessment, communication plan, coordination with emergency personnel and staff training.⁠²

Caregivers: home care aide certification and training

This is where Washington differs most from neighboring states. Under RCW 18.88B.021, a long-term care worker hired to give hands-on personal care must be certified as a home care aide by DOH within 200 calendar days of hire.⁠¹⁰ Rules adopted under RCW 18.88B.022 currently allow more time: WAC 246-980-040 requires certification within 365 calendar days of hire, or 425 days with a provisional certificate for limited-English-proficient workers. Those timelines run from August 25, 2025 through December 31, 2027 and apply to workers who submit an original application by that date.⁠¹⁰⁠¹³ A worker may give care before certification only after finishing the five hours of orientation and safety training, and must apply for certification within 14 calendar days of hire.⁠¹³ Certification requires the training in RCW 74.39A.074 plus an examination with a skills demonstration and a written or oral knowledge test.⁠¹⁰

The training is 75 hours, completed within 120 calendar days of hire:⁠¹¹

1. Before any client care

   Two hours of orientation and three hours of safety training (basic precautions, emergency procedures, infection control).

2. Within 120 days

   Seventy hours of long-term care basic training on core and population-specific competencies, using department-approved curriculum.

Certified aides then need 12 hours of continuing education every year to keep their certification.⁠¹²

Workers exempt from home care aide certification include:⁠¹⁰

• Registered nurses, licensed practical nurses, certified nursing assistants (and people in approved CNA training) and Medicare-certified home health aides
• People first hired as long-term care workers before January 7, 2012 who completed the training in effect when they were hired
• Workers caring only for certain relatives
• Workers giving 20 hours or less of non-respite care to one person in a calendar month
• Respite-only workers who work less than 300 hours a year

DOH must take enforcement action against a licensed agency that knowingly employs a worker who should be certified and is not.⁠¹⁰ A worker who is not certified within the applicable period, or who has not finished the 120-day training, can no longer work without a credential.⁠¹³ The extra time depends on RCW 18.88B.022, which expires December 31, 2027, so confirm the current deadline with DOH before you hire.

The agency rules add requirements for every worker:⁠²

• In-person orientation to your policies and documented skills verification before anyone works alone
• Washington State Patrol background checks and DOH-approved disclosure statements for all staff, contractors, volunteers and students with direct client contact, renewed every two years
• A character, competence and suitability review when a check shows non-disqualifying history
• A TB risk assessment at hire and annually, using the DOH form
• A bloodborne pathogen risk assessment, and a free Hepatitis B vaccine offer if exposure is anticipated
• Annual performance evaluations that include on-site observation of care

Back-up care that involves activities of daily living must come from credentialed or exempt workers. Uncredentialed staff may cover only household tasks or emergencies.⁠²

What your caregivers may and may not do

WAC 246-335-420 sets limits that many founders miss:⁠²

• Vital signs. Workers may only help clients take their own vital signs, using electronic devices with digital readouts. If readings decide whether a client takes a medication or what dose, you must contract with a registered nurse to decide whether nurse delegation is appropriate and to train the worker.
• Passive range of motion. This is allowed for maintenance only. The client needs a plan from a physical therapist, occupational therapist or qualified RN, dated within twelve months, that says “maintenance purposes only.” Restorative range of motion is outside home care.
• Nurse delegation. This is optional and for stable, predictable clients only. You contract with an RN delegator, and workers must first complete DSHS core delegation training. For Medicaid clients, DSHS or the AAA arranges the RN delegator.
• Food. Workers who prepare meals need a food worker card, equivalent FDA-based training or home care aide certification. They may not bring clients homemade food or baked goods.
• Medications. Policies must define staff roles in “medication self-administration with assistance.”

Client-facing requirements

At admission, each client receives a written bill of rights. Among its 19 required items are the agency’s charges and payment sources, the name of the client’s care supervisor, the back-up care and discharge policies, the DOH complaint hotline and the DSHS End Harm hotline.⁠²

Each client needs a written plan of care based on an on-site visit. It must list functional limitations, nutrition needs and food allergies, equipment, any advance directive or POLST, nurse delegation tasks, and each service with its frequency. The plan is reviewed on-site and re-signed every twelve months or sooner if needs change. For a one-time visit, a shorter record is enough.⁠²

Other timing rules:⁠²

• Start services within seven calendar days of accepting a referral, unless a documented exception applies.
• Give 48 hours’ notice before discharge. Worker safety, serious noncompliance and nonpayment are exceptions.
• Keep adult client records for three years after services end. For minors, keep them three years after age 18 or five years after discharge, whichever is longer.

Your quality improvement program must include a complaint process, a way to find and correct problems, and a client satisfaction system.⁠²

Serving Medicaid clients through DSHS and Area Agencies on Aging

Home care agencies that serve Medicaid-eligible clients do so under contracts with the Department of Social and Health Services (DSHS). DOH tells applicants to contact their local Area Agency on Aging at 1-800-562-3263, or the Division of Developmental Disabilities at 1-800-562-3022, about contracting.⁠⁴ The application asks whether you hold a DSHS/AAA home care contract and asks for a copy if you do.⁠⁷ Contracted agencies may use the DSHS CARE assessment as the plan of care when it covers the required items. They may also follow contract terms for discharge notice, start of services and record retention.⁠²

The packet also states that contracts “are not available to newly licensed home care agencies,” so plan to start with private-pay clients and ask your Area Agency on Aging when it will accept new contractors.⁠⁷ A contract also changes your DOH oversight. AAA staff monitor contracted agencies using standards equivalent to DOH’s.⁠⁴ Under RCW 70.127.085 and WAC 246-335-350, a contracted agency can be exempt from the routine DOH survey if four conditions are met:⁠¹⁠²

• DSHS or the AAA monitored the agency on site within the previous 24 months.
• The monitoring included a sample of private-pay clients, if applicable.
• DOH has a copy of the executed contract.
• DOH receives the monitoring reports.

Contracted, monitored agencies also pay the lower renewal fees in the table above.⁠³ The initial DOH survey still applies to every new applicant.⁠²

After the license: surveys, renewal and changes

The first license lasts 12 months. Later licenses last two years.⁠¹ DOH surveys each agency at least once per licensure period, and those surveys are unannounced.⁠²⁠⁸ Ongoing surveys focus on client care, interviews with clients and staff, and randomly selected files.⁠⁸

File the renewal at least 30 days before expiration. Include proof of continuing insurance, a new FTE worksheet, an organizational chart and current background checks.⁠² The late fee runs from that 30-day mark.⁠³

A change of ownership includes any change in your UBI or federal EIN, as well as mergers and dissolving a partnership or corporation. The current owner and the buyer must each file at least 30 days before the change.⁠² Licenses cannot be transferred without DOH approval.⁠¹

Penalties for operating without a license

Operating or advertising without a license is a misdemeanor, and each day counts as a separate violation. A corporation can lose its charter.⁠¹ DOH can issue a cease-and-desist order and fine you up to $5,000 for each day of unlicensed operation. The legislature has also declared unlicensed operation an unfair or deceptive practice under the Consumer Protection Act.⁠¹

What changed recently and what is pending

• Fees. DOH reopened the fee rule (CR-101, WSR 25-08-070) and held a hearing on January 6, 2026 (CR-102, WSR 25-24-044).⁠⁹ The adopted amendment, WSR 26-04-110, took effect June 1, 2026. The figures above are from that version.⁠³
• Enforcement and background checks. DOH filed a CR-101 to consider amending in-home services rules to add the uniform facility enforcement tool from ESSB 5271 (chapter 121, Laws of 2024). It is also considering standardizing background check requirements. As of 2026-10-12, the DOH page lists only the CR-101 for this project.⁠⁹
• Application packet. The April 2026 packet includes a warning about policies drafted with AI tools and states that the policy manual goes to the survey office, not in the initial mailing.⁠⁷
• Caregiver certification timing. DOH amended WAC 246-980 (WSR 26-12-065, filed June 2, 2026, effective July 3, 2026) to set the 365-day and 425-day certification timelines, which run through December 31, 2027. The extra-time authority in RCW 18.88B.022 expires on that date.⁠¹⁰⁠¹³

Sources

1. 1
   Washington State Legislature, Chapter 70.127 RCW: In-home services agencies Checked 12 Oct 2026 · Back to text ↑
2. 2
   Washington State Legislature, Chapter 246-335 WAC: In-home services agencies Checked 12 Oct 2026 · Back to text ↑
3. 3
   Washington State Legislature, WAC 246-335-990: Fees Checked 12 Oct 2026 · Back to text ↑
4. 4
   Washington State Department of Health, Home Care Agencies Checked 12 Oct 2026 · Back to text ↑
5. 5
   Washington State Department of Health, Home Care Agencies: License Requirements Checked 12 Oct 2026 · Back to text ↑
6. 6
   Washington State Department of Health, Home Care Agencies: Orientation Class Checked 12 Oct 2026 · Back to text ↑
7. 7
   Washington State Department of Health, In-Home Services License Application Packet, DOH 505-052 (April 2026) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Washington State Department of Health, In-Home Services Survey Program Checked 12 Oct 2026 · Back to text ↑
9. 9
   Washington State Department of Health, Home Care Agencies: Rules in Progress Checked 12 Oct 2026 · Back to text ↑
10. 10
    Washington State Legislature, Chapter 18.88B RCW: Home care aides Checked 12 Oct 2026 · Back to text ↑
11. 11
    Washington State Legislature, RCW 74.39A.074: Training requirements for long-term care workers Checked 12 Oct 2026 · Back to text ↑
12. 12
    Washington State Legislature, RCW 74.39A.341: Continuing education requirements for long-term care workers Checked 12 Oct 2026 · Back to text ↑
13. 13
    Washington State Legislature, Chapter 246-980 WAC: Home care aide certification Checked 12 Oct 2026 · Back to text ↑

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