Medicaid readiness checklist for home care agencies
By Scott McKenzie, founder of Home Care Agency Blueprint · Updated
Work through seventeen questions on whether Medicaid fits your agency, whether you can pass enrollment screening, and whether you are ready to operate under Medicaid rules. Each item names its federal source or marks it as your own planning. It is a self-check, not a prediction of approval.
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Mark each item Ready, In progress, Not yet or Does not apply. Blank items stay Not checked.
Is Medicaid the right payer?
1. I know which Medicaid program in my state pays for the services I plan to offer (state plan personal care, a 1915(c) waiver, or another home and community-based services option).
Source: Medicaid.gov, HCBS authorities
2. I have read the provider qualifications my state set for that service in its waiver or state plan.
Source: Medicaid.gov, HCBS 1915(c) waivers
3. I know whether the program is delivered through Medicaid managed care plans in my state, which would mean credentialing with each plan as well as enrolling with the state.
Source: 42 CFR 438.214 (managed care credentialing)
4. I have found the state’s published payment rate or fee schedule for the service and compared it with my own cost per hour of care.
Source: Your state Medicaid agency (Medicaid.gov state contacts)
5. My budget covers payroll and other costs while I wait for enrollment and for the first claims to be paid.
Your own planning
6. I have decided how Medicaid clients will fit alongside any private-pay clients.
Your own planning
Licensing and screening
7. My agency holds any state license or certification the program requires, and it is current with no limitations.
Source: 42 CFR 455.412 (license verification)
8. I have checked every owner and managing employee against the OIG List of Excluded Individuals and Entities.
Source: HHS OIG exclusions list (LEIE)
9. Everyone with an ownership or control interest is ready to give the disclosures the state asks for and to cooperate with screening.
Source: 42 CFR 455.104 (ownership and control disclosures)
10. I know whether my state will require fingerprint-based criminal background checks for owners of my provider type.
Source: 42 CFR 455.434 (background checks, fingerprints)
11. I know whether my state requires a National Provider Identifier (NPI) for my provider type, and how to apply through NPPES if it does.
Source: CMS NPPES
12. I am ready for a pre-enrollment site visit if the state screens my provider type at moderate or high risk.
Source: 42 CFR 455.432 and 455.450 (site visits, risk levels)
Operating as a Medicaid provider
13. I know which electronic visit verification (EVV) system my state uses for personal care or home health visits, and how my caregivers will use it.
Source: Medicaid.gov, EVV (21st Century Cures Act § 12006)
14. I have a way to deliver and document services according to each client’s person-centered plan of care.
Source: Medicaid.gov, HCBS 1915(c) waivers
15. I know how claims are submitted in my state (through the state, its fiscal agent, or each managed care plan) and who will do our billing.
Source: Your state Medicaid agency (Medicaid.gov state contacts)
16. I have a process to report ownership changes to the state promptly.
Source: 42 CFR 455.104 (ownership and control disclosures)
17. I have put revalidation on our calendar; states must revalidate every provider’s enrollment at least every five years.
Source: 42 CFR 455.414 (revalidation)
How to use the checklist
Mark an item Ready only when you have confirmed it, ideally in writing from your state Medicaid agency or the program’s published provider requirements. Use Not yet for gaps you know about and In progress for work underway. Items you leave blank are shown as Not checked, never as Ready.
- Mark each item Ready, In progress, Not yet or Does not apply.
- Use the source under each item to check what the rule says.
- Confirm anything state-specific with your state Medicaid agency.
- Review the items marked Not yet first.
- Print the checklist or download a CSV to keep with your planning notes.
What the checklist does not do
It does not tell you whether your state will approve your agency, how long enrollment takes, or what Medicaid will pay. Those depend on your state and your program. It helps you find the questions to ask before you apply.
Where your entries are stored
Your entries are saved only in this browser on this device so you can come back to them. They are never sent to us. Printing and CSV download happen on your device, CSV cells are protected against spreadsheet formulas, and Reset erases only this checklist’s saved entries.
Your state sets the details. Federal rules set minimum screening steps. Each state Medicaid agency decides its own provider types, forms, fees, order of steps and payment rates. Confirm every requirement with your state Medicaid agency; Medicaid.gov lists contacts for each state.
Frequently asked questions
Why does the checklist not give me a score?
A score would suggest a prediction we cannot make. Approval depends on your state’s requirements and its review of your application, so the checklist shows counts and the items marked Not yet instead.
Do I need every item marked Ready before I apply?
Not necessarily. Some items depend on your state and provider type. Use Does not apply for items that truly do not apply, and confirm the rest with your state Medicaid agency.
Want to talk through your options?
A free 15-minute clarity call with Home Care Agency Blueprint. It helps people start home care agencies, so expect that perspective. You do not need to finish the checklist first.
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