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In-Home Care Business Tool Kit

In partnership with the Alaska Small Business Development Center and SREC, the following is a business tool kit for the development in-home care agencies serving elders and those experiencing disabilities.  This information is intended as a guild to start your home care business journey.   For additional support, contact the Alaska Small Business Development Center.

Step 1: Choose Your Business Model
Model Best For Key Characteristics
Consumer Directed Solo care providers Work directly with one client, fewer licensing requirements, more flexibility
Agency Business owners Hire/train multiple caregivers, manage scheduling, higher regulatory requirements such as nursing on staff, has additional billing options due to having a tier staff structure with nursing staff available
  1. Consumer Directed Model (1:1 Care)

You provide Consumer Directed Care in-home care services and personal care services a client, in their home and in the community setting.  Clients and/or their representative can participant in their care by engaging in the hiring, training, scheduling, and management of their staff.  The client will need to have decisional making capacity to the existent that they can participant in their care actively.  The agency’s role is for oversight of the Alaska Medicaid Home and Community Based services.  You assist with ensuring the employee has the appropriate background checks, onboard training, supervision, and process pay.

  1. Agency Model

You operate a business that employs multiple caregivers and matches them with seniors in need of assistance, providing services in client homes or in their community.   The agency-based model is when the agency directly monitors, manages, and supervises employees who provide in-home care.  The agency conducts the background check, onboarding training, scheduling, and professional development.  This model requires a nurse on staff who assists with the client management process and employee training.  Clients often will lack capacity to monitor and manage their own care and will need the support of a representative or they may be private pay and not receiving care through an Alaska Medicaid Wavier program.

Step 2: Register Your Business

☐ Choose a Business Structure
Decide whether you will operate as a:

  • Sole Proprietor
  • Limited Liability Company (LLC)
  • Corporation

☐ Register with the State of Alaska

  • Apply for your Alaska Business License through the Alaska Department of Commerce, Community and Economic Development Division of Corporations, Business and Professional Licensing: Alaska Business Licensing Portal
  • Check if your business name is available and register it if needed.

☐ Obtain an Employer Identification Number (EIN)

Step 3: Licensing and Certification

Before launching services, your home health care agency must meet important regulatory requirements. This section focuses on obtaining mandatory state licensures through the Alaska Department of Health (DOH) and pursuing federal certification if you plan to bill Medicare or Medicaid. These processes ensure your agency operates legally, meets healthcare standards, and qualifies for insurance reimbursements. You’ll also find guidance on optional accreditations and identifiers—such as the National Provider Identifier (NPI) number and third-party accreditations—that can strengthen your agency’s credibility and expand your payer options. Completing these steps thoroughly is essential for regulatory compliance and long-term success in Alaska’s home health care industry.

State Licensure (Mandatory)

Alaska Department of Health (DOH) regulates home health care agencies under Residential Licensing and Home Health Agency regulations.

Relevant Links and Next Steps:

Review Licensing Requirements at the Alaska, Department of Health, Home Health Agency page here. 

Complete State of Alaska Home Health Agency State Licensing Application packet. See here for State Licensure Application

Pay the associated provisional licensing fee, based on the number of full-time employees (FTEs) and number of branches/subunits. For up-to-date license fee information please visit Alaska Department of Health page here. 

Provide an electronic copy of all policies and procedures

Additional Certifications (Optional but Recommended)

These are not mandatory but can enhance credibility or meet certain payer/network requirements:

Federal Certification (if billing Medicare or Medicaid)

To provide services reimbursable by Medicare/Medicaid, you must be certified as a Medicare-certified Home Health Agency (HHA):

  •  Enroll via CMS Form 855A (Medicare Enrollment Application).
  •  Undergo a survey and certification inspection by the Alaska DHSS and/or an approved accrediting organization.
  •  Comply with CMS Conditions of Participation for Home Health Agencies (42 CFR Part 484).

Visit the Alaska Department of Health for additional information on Medicaid Approval and Requirements. A HHC Agency must meet Federal requirements and become separately certified and approved to accept Medicaid.

Step 4: Staffing Requirements and Training – Building a Qualified, Compliant Team

Hiring the right staff is critical to delivering safe, high-quality home health care. This section outlines the key licensing, training, and certification requirements for both clinical and non-clinical personnel in Alaska. From background checks and TB screenings to CPR, HIPAA, and crisis intervention training, these foundational steps help ensure your team is equipped to provide competent and compliant care. You’ll also find links to essential training programs and certifications, including Alaska’s Core Competencies for Direct Care Workers and Certified Nurse Aide (CNA) pathways. Investing in proper staffing and training not only meets state standards—it lays the groundwork for a trusted, professional agency.

Regulations related to training:
Employment of personal care assistants; qualifications 7AAC 125.090-110
Agency-based personal care services program; personal care assistant education and training requirements 7AAC 125.160-170