How to Start a Home Health Care Agency in Missouri: Step-by-Step Guide (2025)

Starting a home health care agency in Missouri can be a rewarding way to serve your community while building a sustainable business. With Missouri’s growing elderly and disabled population, the demand for in-home services continues to rise but so do the state requirements for licensing, compliance, and training.

Whether you’re just beginning your journey or ready to formalize your agency, this guide walks you through each step you’ll need to take to launch successfully.

Step 1: Understand Missouri’s Home Health Care Options

In Missouri, home health care falls under different categories depending on the services you provide. The two most common are:

• In-Home Services (IHS): Assisting clients with personal care, household tasks, and daily living activities.

• Consumer Directed Services (CDS): Clients hire their own attendants while your agency provides administrative support and oversight.

Each type has specific licensing, training, and operational requirements through the Missouri Department of Health and Senior Services (DHSS) and MO HealthNet Division.

Step 2: Create a Business Plan That Meets State Requirements

A well-written business plan is more than a formality — it’s required for your in-home proposal submission. Your plan should include:

• Company Details: Ownership, structure, and mission statement.

• Office Description: Physical location, accessibility, and equipment.

• Personnel Qualifications: Training, supervision, and background checks.

• Financial Management: Budgets, payroll systems, and Medicaid billing readiness.

A compliant business plan not only helps you get approved by DHSS but also guides your agency’s operations and growth.

Step 3: Register and Structure Your Business

You’ll need to register your agency with the Missouri Secretary of State as an LLC or Corporation. Then:

1. Apply for an EIN (Employer Identification Number) from the IRS.

2. Open a business bank account under your legal business name.

3. Obtain business insurance that meets state and Medicaid standards.

This step ensures your agency is legally recognized and ready to handle employee wages, taxes, and contracts.

Step 4: Prepare and Submit Your In-Home Proposal

The In-Home Proposal is one of the most important documents in the process. It details your operational procedures, staff training plans, quality assurance, and compliance with 13 CSR 70-91.010.

Your proposal must include:

• Policies and procedures for client care and documentation

• Advanced Personal Care (APC) training plans

• RN-supervised task competency documentation

• Policies for reporting, supervision, and record retention

Submitting a complete and compliant proposal increases your chances of quick approval by DHSS.

Step 5: Develop Your Policies and Procedures Manual

Missouri requires every home health care agency to maintain written policies and procedures covering:

• Admission and discharge

• Client rights and responsibilities

• Supervision and evaluation

• Staff training and orientation

• Incident reporting and emergency response

Having these policies professionally written and compliant ensures your agency meets audit and review standards.

Step 6: Build and Train Your Staff

Every successful agency starts with qualified, compassionate staff. Missouri requires:

• 12 hours of initial aide training

• 6 hours of Advanced Personal Care training (if providing APC services)

• RN-observed competency sign-offs for all aides performing personal care tasks

Your staff must also undergo background screenings and registry checks before working with clients.

Step 7: Set Up Your EVV (Electronic Visit Verification) System

Missouri mandates EVV compliance under 13 CSR 70-3.320, requiring all visits to be electronically verified. You’ll need a system that records the date, time, location, and type of service provided.

Some services, such as homemaker or nurse visits, may be exempt — but most personal care and CDS services are not. Setting this up early ensures you remain in compliance with state and Medicaid requirements.

Step 8: Get Ready for State Review and Contracting

Once approved by DHSS, your agency will be assigned a provider number and can apply to become a MO HealthNet provider. You’ll also undergo a readiness review, where DHSS ensures your office, records, and policies meet compliance standards.

After approval, you can begin serving clients through Medicaid or private pay arrangements.

Step 9: Market Your Agency and Build Referral Partnerships

To grow your client base:

• Build relationships with hospitals, social workers, and community organizations.

• Create a website optimized for local SEO (“home health care in [your city], Missouri”).

• Encourage client testimonials and positive online reviews.

• Use social media to highlight your services, staff, and success stories.

Consistent marketing builds credibility and drives steady referrals.

Starting a home health care agency in Missouri requires careful planning, documentation, and compliance — but the reward is building a business that truly makes a difference in people’s lives.

If you’re ready to take the next step and want expert help ensuring your proposal, business plan, and policies meet DHSS and MO HealthNet requirements:

👉 Book a consultation and get your compliant business plan started.