How to Start a Medicaid Home Care Agency in Illinois
Start a Medicaid home care agency in Illinois: licensing, Medicaid enrollment, HCBS waivers, EVV, disability waiver and VA provider steps.
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Sagar Kumar, COO and Co-Founder, Verveware
Illinois has three distinct Medicaid paths for home care agencies: IDoA's Community Care Program, the DHS-DRS (DORS) Home Services Program, and HealthChoice Illinois MCOs.
Starting a Medicaid home care agency in Illinois means getting through state licensing, Medicaid provider enrollment, waiver program contracting and electronic visit verification (EVV) before you bill your first visit. I'm Sagar Kumar, COO of Verveware, an EVV and home care software company. Our team builds software for Medicaid home care agencies and works with them every day. This guide sums up what we know about the Illinois process and links to the official sources. Rules and fees change, so confirm every step with the agency linked.
1. Licensing: Which Agency and What License
Licensing agency: Illinois Department of Public Health (IDPH), Office of Health Care Regulation.
License type(s): Home Services Agency license (non-medical); Home Nursing Agency license; Home Health Agency license. Every home services worker must also clear the Health Care Worker Background Check and be listed on the Health Care Worker Registry.
What this means in Illinois: Illinois requires a Home Services Agency license from the Illinois Department of Public Health (IDPH) for non-medical in-home services under the Home Health, Home Services, and Home Nursing Agency Licensing Act. Caregivers must clear the Health Care Worker Background Check and be listed on the Health Care Worker Registry.
Non-medical (personal care, homemaker, companion) and skilled home health are usually regulated separately. Home health that bills Medicare also needs CMS certification, typically through a state survey or an approved accrediting organization. Fees, policy and procedure requirements, administrator qualifications and survey timelines change, so confirm current requirements with the Illinois Department of Public Health (IDPH).
2. Medicaid Provider Enrollment
Medicaid in Illinois is run by Illinois Department of Healthcare and Family Services (HFS). Typical steps:
Form your legal entity, then get an EIN and a Type 2 organizational NPI from NPPES.
Get your state license or certification (see above) before you apply.
Submit the Medicaid provider enrollment application through the state's provider portal, including ownership disclosures, screening and any site visit. Make sure no owner or staff member appears on the HHS-OIG exclusion list.
Get approved or contracted for specific waiver services with the operating agency, and credential with managed care plans where LTSS is delivered through MCOs.
Set up EVV and billing (see below).
Managed care in Illinois: Most Medicaid members, including many seniors and people with disabilities, are enrolled in HealthChoice Illinois managed care plans, so MCO contracts matter alongside state program contracts.
3. HCBS Waiver Programs in Illinois
Home- and community-based services (HCBS) waivers pay for most Medicaid personal care in the state. The main programs are:
Community Care Program (CCP) – Persons Who Are Elderly Waiver – administered/operated by Illinois Department on Aging (IDoA). Funding: Medicaid (federal/state).
Home Services Program (HSP) – Persons with Disabilities, HIV/AIDS, Brain Injury Waivers – administered/operated by IDHS Division of Rehabilitation Services (DORS). Funding: Medicaid (federal/state).
Adults with Developmental Disabilities Waiver – administered/operated by IDHS Division of Developmental Disabilities (DDD). Funding: Medicaid (federal/state).
Supportive Living Program Waiver – administered/operated by HFS. Funding: Medicaid (federal/state).
Program names and operating agencies change through waiver renewals, so check the current waiver list with the Medicaid agency.
4. Human Services and Aging Programs
The state's human services department is Illinois Department of Human Services (IDHS). Aging services are coordinated by Illinois Department on Aging (IDoA), together with local Area Agencies on Aging. Area Agencies on Aging also run Older Americans Act programs such as homemaker and respite. Funding: these are federal Older Americans Act grants plus state funds. They are not Medicaid. Many agencies combine Medicaid waiver referrals with these programs.
Illinois-specific: IDoA Community Care Program (CCP)
The Illinois Department on Aging Community Care Program serves adults 60+ who need help to stay at home, with in-home services, adult day service and emergency home response. Most CCP participants are funded through the Medicaid Persons Who Are Elderly waiver, with some state general revenue funding for non-Medicaid participants. In-home service providers contract with IDoA and must hold an IDPH Home Services Agency license. Care coordination is handled by Care Coordination Units (CCUs). It helps adults 60 and older stay safely in their homes. Separately, the IDHS DORS Home Services Program (HSP) serves people under 60 with disabilities.
5. Disability Services: DHS-DRS (DORS) Home Services Program
Illinois runs Medicaid home care for people under 60 with disabilities through the Illinois Department of Human Services, Division of Rehabilitation Services (DHS-DRS, often called DORS) Home Services Program (HSP), which serves people under 60 with severe disabilities through homemaker agencies and individual providers. Homemaker agencies enroll with Illinois Department of Human Services (IDHS), Division of Rehabilitation Services to serve HSP customers, and HSP can be a strong second payer next to the IDoA Community Care Program. Funding: Medicaid waiver (federal/state).
DORS also runs vocational rehabilitation (IDHS Division of Rehabilitation Services (DORS) – Vocational Rehabilitation), which helps people with disabilities find and keep jobs. VR is funded under the federal Rehabilitation Act, is not Medicaid, and is a minor referral source for most home care agencies.
6. VA Home Care for Veterans (Federal, Not Medicaid)
Veterans may get in-home care through the U.S. Department of Veterans Affairs. Funding: these are federal VA benefits. They are not Medicaid and not a state program.
Homemaker and Home Health Aide (H/HHA) Care: personal care purchased by the VA from community agencies.
Veteran-Directed Care: Veterans manage a budget and hire their own workers, often through an Aging and Disability Network partner.
VA Community Care: the authority the VA uses to buy care from community providers.
How to become a VA provider: join the Community Care Network (CCN) through the regional third-party administrator, or sign a local agreement with your VA medical center. Start at the VA community care provider page.
7. EVV Requirements
The federal 21st Century Cures Act requires EVV for Medicaid personal care services and home health services (CMS EVV guidance). Every visit must record the service type, the member, the date, the location, the worker, and the start and end times. Illinois EVV system/aggregator: HHAeXchange (HFS state EVV aggregator/system). If you use your own EVV system, confirm it can integrate with the state aggregator before you go live. Claims without a matching EVV record may be denied.
8. Background Checks and Training
Expect fingerprint-based criminal background checks, state abuse and neglect registry checks, and monthly OIG/state exclusion screening for all direct care staff. Training and competency requirements differ by license type: home health aides need federal 75-hour aide training (42 CFR 484.80), and non-medical caregiver training hours are set by state rule, so confirm current requirements with the Illinois Department of Public Health (IDPH).
Startup Checklist
Choose your service line (non-medical, skilled or both) and the matching license
Build policies, hire an administrator, and set up insurance and bonding
Get licensed, enroll in Medicaid and contract for waiver services
Connect EVV and billing, then add disability program and VA referral sources
FAQ
Do I need a license to provide non-medical home care in Illinois?
Illinois requires a Home Services Agency license from the Illinois Department of Public Health (IDPH) for non-medical in-home services under the Home Health, Home Services, and Home Nursing Agency Licensing Act. Caregivers must clear the Health Care Worker Background Check and be listed on the Health Care Worker Registry. Confirm with Illinois Department of Public Health (IDPH).
Who pays for home care under Illinois waivers?
Medicaid (federal/state) through the HCBS programs above. Older Americans Act services, vocational rehabilitation and the VA are separate funding sources.
Is VA home care part of Medicaid?
No. VA Homemaker/Home Health Aide care and Veteran-Directed Care are federal veterans benefits paid by the VA.
Is EVV required for private-pay clients?
The federal EVV mandate covers Medicaid-funded personal care and home health. Many agencies still use EVV for every client to keep operations consistent.
How long does it take to start billing Medicaid?
It typically takes several months to cover licensing, enrollment and waiver contracting. Confirm current processing times with the Illinois Department of Public Health (IDPH) and Illinois Department of Healthcare and Family Services (HFS).
Launch Your Illinois Agency on Verveware
Verveware is home care agency management software built by operators who run a Medicaid home care agency. It brings EVV, scheduling, care plans, billing and state program compliance into one platform. Book a Verveware demo to see how it can help you launch in Illinois and grow your Medicaid census.
