HomeCareAtlas Team · Updated September 2026
Researched from primary state regulatory sources.
How to Start a Home Care Agency in Virginia
Starting a home care agency in Virginia costs roughly $45,000 - $85,000 and takes 10-12 Months. Here's every step, fee, and deadline — sourced directly from Virginia Department of Health (VDH), Office of Licensure and Certification.
Virginia requires a Home Care Organization (HCO) License to provide personal care services. Personal care means help with daily activities like bathing, dressing, and eating. The rules are in Code of Virginia Title 32.1, Chapter 5, Article 7.1 and 12VAC5-381. Apply at least 60 days before you plan to open. The license is renewed every three years. The fee is $1,500 for each initial and renewal application (rule amended May 22, 2025). The rules do not apply to agencies that offer only homemaker, chore, or companion services (12VAC5-381-30). A licensed agency that wants an exemption files a written request with a $75 fee. Running an HCO without a license is a Class 6 felony.
To start a non-medical home care agency in Virginia, you need a Home Care Organization (HCO) License from the Virginia Department of Health (VDH), Office of Licensure and Certification. The application fee is $1,500 (triennial license fee), the process takes approximately 10-12 months, and total startup costs range from $45,000 - $85,000. A VDH Home Care Organization license costs $1,500 and is renewed every 3 years. Every hire needs a sworn statement and a Virginia State Police criminal record check within 30 days. You need $1M liability coverage plus $50,000 in crime insurance or a fidelity bond.
- License Required
- Yes — Home Care Organization (HCO) License
- Regulatory Body
- Virginia Department of Health (VDH), Office of Licensure and Certification
- Application Fee
- $1,500 (triennial license fee)
- Timeline
- 10-12 Months (application to license (vdh estimate))
- Total Startup Cost
- $45,000 - $85,000
- Key Requirement
- A VDH Home Care Organization license costs $1,500 and is renewed every 3 years. Every hire needs a sworn statement and a Virginia State Police criminal record check within 30 days. You need $1M liability coverage plus $50,000 in crime insurance or a fidelity bond.
- Last Verified
- September 2026 against Virginia Department of Health (VDH), Office of Licensure and Certification regulations
Application to License (VDH estimate)
Source: VDH Office of Licensure and Certification, HCO Application Processing Update · Checked Nov 2026
Residents Age 70+
Moderate Opportunity
How Virginia compares to neighboring states
| State | License Fee | Timeline | Startup Cost |
|---|---|---|---|
| Virginia ← | $1,500 | 10-12 Months | $45,000 - $85,000 |
| Maryland | $1,000 | Up to 6 Months | $50,000 - $95,000 (our estimate) |
| North Carolina | $510 | 8-14 Weeks | $50,000 - $90,000 |
| West Virginia | $0 (no license) | 4-8 Weeks | $25,000 - $50,000 |
| Kentucky | $500 | 60-90 Days | $30,000 - $60,000 |
In This Article
Virginia Licensing Overview
The Virginia Department of Health (VDH), Office of Licensure and Certification oversees all non-medical agencies.Virginia requires a Home Care Organization (HCO) License to provide personal care services. Personal care means help with daily activities like bathing, dressing, and eating. The rules are in Code of Virginia Title 32.1, Chapter 5, Article 7.1 and 12VAC5-381. Apply at least 60 days before you plan to open. The license is renewed every three years. The fee is $1,500 for each initial and renewal application (rule amended May 22, 2025). The rules do not apply to agencies that offer only homemaker, chore, or companion services (12VAC5-381-30). A licensed agency that wants an exemption files a written request with a $75 fee. Running an HCO without a license is a Class 6 felony.
Home Care Organization License Required
Agencies that give personal care must get a VDH Home Care Organization License under 12VAC5-381. The rules do not apply to homemaker, chore, or companion-only agencies (12VAC5-381-30). A licensed agency that switches to companion-only files a written exemption request with a $75 fee.
Criminal Record Check + Sworn Statement
Every job applicant must sign a sworn statement about past convictions and pending charges. You must get a Virginia State Police criminal record report within 30 days of hire (Code of Virginia § 32.1-162.9:1; 12VAC5-381-110). Until it comes back, the worker needs direct supervision by a checked employee to work with clients. Barrier crimes under § 19.2-392.02 bar hiring, with one narrow exception for an old misdemeanor.
Insurance + Crime Coverage Required
Virginia requires malpractice insurance, general liability insurance of at least $1 million per occurrence, and third-party crime insurance or a blanket fidelity bond of at least $50,000 (12VAC5-381-210). Check Virginia workers' comp law too. A surety bond is not required.
Administrator Certification
Every Home Care Organization (HCO) License must designate a qualified administrator or agency manager.
- Training Cost:N/A
- Topics:No state course or exam. The administrator must have at least one year of training and experience in direct health care service delivery, with at least one year within the last five years of supervisory or administrative management experience in home health care (12VAC5-381-170).
Source: 12VAC5-381-170(A) · Checked Oct 2026
Estimated Startup Costs (2026)
Budget for $45,000 - $85,000 to ensure 3-6 months of runway.
| Category | Low Est. | High Est. |
|---|---|---|
| VDH License Application (3-year) | $1,500 | $1,500 |
| Business Formation (LLC with SCC; $100 filing fee) | $100 | $250 |
| Criminal Record Checks (5 initial staff) | $100 | $300 |
| General Liability Insurance ($1M) | $1,000 | $2,500 |
| Malpractice / Professional Liability Insurance | $600 | $1,800 |
| Workers' Compensation Insurance | $400 | $1,800 |
| Third-Party Crime Insurance or $50,000 Fidelity Bond | $200 | $450 |
| Automobile Liability (if transporting) | $400 | $1,200 |
| Office / Administrative Setup | $400 | $3,000 |
| Initial Marketing & Website | $1,200 | $4,500 |
| Working Capital (3-6 months) | $8,000 | $25,000 |
We map every cost and file your Virginia license for you.
How to Get a Virginia Home Care Organization License
1-2 Weeks
Form Your Business Entity
File an LLC with the Virginia State Corporation Commission (SCC). The filing fee is $100 (Va. Code § 13.1-1005). Get an EIN from the IRS, open a business bank account, and register with the Virginia Department of Taxation.
2-4 Weeks
Develop Policies and Procedures
Create written policies covering client rights and responsibilities, personnel management, service delivery procedures, quality assurance, emergency protocols, infection control, and complaint resolution.
2-4 Weeks
Hire Your Administrator and Nurse
Your administrator needs at least one year of training and experience in direct health care. They also need one year of supervisory or management work in home health care or a related health program in the last five years (12VAC5-381-170). You must also name a registered nurse to supervise personal care services (12VAC5-381-360).
1-3 Weeks
Complete Criminal Record Checks
Collect a sworn disclosure statement from every applicant. Get a Virginia State Police criminal record report within 30 days of hire. Do not accept a report dated more than 90 days before hire. Keep reports in locked files (12VAC5-381-110).
1-2 Weeks
Secure Insurance and Crime Coverage
Get malpractice insurance, general liability ($1M per occurrence), and third-party crime insurance or a $50,000 blanket fidelity bond. Add workers' comp and auto liability if you drive clients.
1-2 Weeks
Submit VDH Application
Apply through the VDH OLC Portal. New users must first ask for a portal account. The rule says to apply at least 60 days before you plan to open (12VAC5-381-40). Plan for much longer. Include everything asked for and the $1,500 fee. The fee is not refundable. An incomplete application goes inactive after six months.
Part of the 10-12 month wait
Pass Initial Inspection
VDH reviews your application and then does an on-site inspection (12VAC5-381-40 C). OLC emails you when the inspection is ready to schedule. Fix any problems it finds.
1-2 Weeks
Receive License and Begin Operations
Once approved, you get your Home Care Organization license. It is renewed every three years. Then you can begin serving clients.
We can do all of them for you in Virginia.
New 2026 Legal Mandates
Home Care Organization License (12VAC5-381)
Virginia requires VDH licensure under Code of Virginia Title 32.1, Chapter 5, Article 7.1 and 12VAC5-381 for agencies that give personal care. Licenses are renewed every three years (12VAC5-381-40).
Criminal Record Check (Code of Virginia § 32.1-162.9:1)
Every job applicant must give a sworn statement on convictions and pending charges. You must get a Virginia State Police criminal record report within 30 days of hire. Lying on the sworn statement is a Class 1 misdemeanor. People with barrier crime convictions (§ 19.2-392.02) may not be hired. One exception: one misdemeanor without abuse or neglect, if five years have passed.
Insurance and $50,000 Crime Coverage (12VAC5-381-210)
Licensed agencies must carry malpractice insurance, at least $1 million general liability per occurrence, and third-party crime insurance or a blanket fidelity bond of at least $50,000.
VDH Inspections at Least Every 2 Years (12VAC5-381-80)
VDH makes unannounced on-site inspections of each licensed Home Care Organization as needed, and at least every two years.
HIPAA Compliance
HIPAA covers health care providers that bill health plans, like Medicaid, electronically (45 CFR 160.103). If you bill Medicaid, you must follow HIPAA. Either way, keep client records private.
Our Virginia licensing team tracks the law so you do not have to.
Caregiver Mandates
Important Warning
Virginia sets real rules for home attendants (aides). Each one must meet a training or certification pathway, clear a criminal record check, and get nurse supervision. Do not send caregivers to clients before all checks and training are complete.
- Home Attendant Qualification (12VAC5-381-290): Each aide must speak, read, and write English and meet one pathway: a nurse aide program approved by the Board of Nursing, a CNA certificate, a nursing education program, a competency evaluation that meets 42 CFR 484.36(b), or the state Personal Care Aide Training Curriculum (personal care only).
- Annual In-Service Training (12 hours): Home attendants providing personal care must get at least 12 hours of in-service training each year (12VAC5-381-360).
- Nurse Supervision at Least Every 90 Days: A registered nurse must supervise personal care services. Supervisory visits happen as often as the client needs, and no less than every 90 days. An RN or LPN must be available during all hours personal care is provided.
- Criminal Record Check Clearance: Sworn disclosure statement plus a Virginia State Police criminal record report within 30 days of hire. No direct client contact until the report is received, unless supervised by a cleared staff member.
- First Aid / CPR Certification: First aid and CPR certification is recommended for all direct care staff.
Regional Billing Snapshots
*Regional rates vary by specialized care needs (Dementia, Parkinson's) and local competition.*
We launch Virginia home care agencies start to finish.
Regional Market Opportunities
Virginia has about 8.9 million people. About 1.63 million are 65 or older (Census 2025 estimate). Markets range from the wealthy DC suburbs to rural Appalachian towns. Virginia also has many military and federal retirees. The billing rates below are our estimates, not official numbers.
Northern Virginia (Fairfax, Arlington, Loudoun)
DC metro affluence with the highest billing rates in the state. Federal government retirees, Pentagon workforce, and intelligence community families. Many clients carry long-term care insurance or OPM retirement benefits.
Key: Highest wealth market but most competitive. Federal retirees with long-term care insurance are a high-value client segment.
Richmond Metro
State capital with a growing senior population, moderate competition, and strong healthcare infrastructure. VCU Health and Bon Secours drive hospital-to-home referral volume.
Key: Build relationships with hospital discharge planners — Richmond is a healthcare hub with strong referral infrastructure.
Hampton Roads (Norfolk, Virginia Beach, Newport News)
Major military presence centered on Naval Station Norfolk. Large Navy and shipyard retiree population. VA community care contracts and TRICARE beneficiary services create unique revenue streams.
Key: Military family respite care, TRICARE, and VA community care contracts are revenue streams unique to this market.
Charlottesville
University of Virginia community with affluent retirees. Smaller market but less competition and strong private-pay potential. UVA Health System creates a steady referral pipeline.
Key: Premium clients with high service expectations. Smaller volume but higher margins.
Roanoke / Southwest Virginia
Rural and small-town markets with lower competition and underserved populations. Growing retirement communities in the Blue Ridge mountain region.
Key: Lower rates but very little competition. Agencies willing to serve rural mountain areas build a loyal client base with no competitors.
Cost of care in Virginia
What agencies charge clients vs. what caregivers earn in Virginia. The difference is the agency's gross margin per billable hour — before overhead like insurance, admin, marketing, and compliance costs.
$32.5
Avg. hourly rate charged to clients
$19.27
Avg. caregiver hourly wage
$13.23
Gross margin per hour
41%
Gross margin %
What this means for agency owners
In Virginia, agencies keep roughly $13.23 per billable hour after paying the caregiver. That's a 41% gross margin.
This is a strong margin that gives you room to cover overhead costs (insurance, admin, marketing, compliance) and still run a profitable agency.
Sources: Avg. hourly rate from CareYaya and CareScout 2025 surveys (averaged). Caregiver wage from Care.com. Gross margin is before overhead costs like insurance, admin, marketing, and compliance.
Virginia Medicaid Programs
Cardinal Care Managed Care
Virginia's Medicaid program. Cardinal Care Managed Care combined the CCC Plus and Medallion 4.0 managed care programs, which ended in 2023. New health plan contracts began July 1, 2025. Most home care agencies reach Medicaid clients through these health plans.
CCC Plus Waiver
The Commonwealth Coordinated Care Plus Waiver helps people who would otherwise need a nursing facility. It pays for personal care and respite at home. Members pick agency-directed care, consumer-directed care, or both. In agency-directed care, a personal care agency hires the aide and a nurse supervises.
Managed Care Organizations (MCOs)
As of July 1, 2025, Cardinal Care has five health plans: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia, Sentara Health Plans, and UnitedHealthcare Community Plan. Molina members who did not switch were moved to Humana on July 1, 2025. You contract with each plan to serve its members. Ask each plan for its personal care rates.
Becoming a Medicaid Provider
Step 1: Obtain VDH license. Step 2: Enroll through the Virginia Medicaid provider portal (DMAS). Step 3: Credential with managed care organizations. Step 4: Sign provider agreements. Step 5: Complete MCO training requirements. Step 6: Begin accepting referrals.
Becoming a Provider
Essential 2026 Tech Stack for Owners
Tiles outlined in teal are areas HomeCareAtlas covers in our platform.
Virginia Licensing FAQ
What license do I need for home care in Virginia?
Virginia requires a Home Care Organization License from the Virginia Department of Health (VDH), Office of Licensure and Certification. You need it to give personal care. The rules are 12VAC5-381.
How much does a Virginia home care license cost?
The VDH fee is $1,500 for each initial and renewal application (12VAC5-381-70, amended May 22, 2025). The license is renewed every three years. We estimate total startup costs at $45,000 to $85,000.
How long does Virginia licensing take?
Plan on about a year. VDH says complete initial applications now take about 10 to 12 months from submission to final approval. That is because so many people are applying. Applications are handled in the order they come in. Business setup time comes on top of that.
What background checks are required in Virginia?
Every job applicant must sign a sworn statement about convictions and pending charges. You must get a Virginia State Police criminal record report within 30 days of hire (12VAC5-381-110). The HCO rule does not ask for fingerprints or FBI checks.
What insurance is required in Virginia?
Virginia requires malpractice insurance, general liability of at least $1M per occurrence, and third-party crime insurance or a $50,000 blanket fidelity bond (12VAC5-381-210). Check Virginia workers' comp law too. Add auto liability if you drive clients. A surety bond is not required.
Is Northern Virginia a good market for home care?
It can be. We estimate Northern Virginia has the highest billing rates in the state ($32-$42/hr). Many federal and military retirees live there. Competition is strong.
How do I get Medicaid clients in Virginia?
First get your VDH license. Then enroll with DMAS as a Medicaid provider. Then contract with the Cardinal Care health plans: Aetna, Anthem HealthKeepers Plus, Humana, Sentara Health Plans, and UnitedHealthcare.
Do I need a license for companion care only?
No. Agencies that provide only homemaker, chore, or companion services do not need the HCO license (12VAC5-381-30). If you already hold an HCO license and switch to companion-only, you file a written exemption request with a $75 fee (12VAC5-381-30 B, -70 D). If you add any personal care, you need the full license.
Starting in a Nearby State?
Licensing requirements vary a lot between states. Compare your options:
Maryland
$1,000 fee · Up to 6 Months
North Carolina
$510 fee · 8-14 Weeks
West Virginia
No state license required · 4-8 Weeks
Kentucky
$500 fee · 60-90 Days
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Sizing up the competition? See the 1,200 home care agencies already operating in Virginia →
Home care agencies in Virginia
Want to see the competition up close? Look at who is already open, city by city.
- Home care agencies in Virginia Beach
- Home care agencies in Richmond
- Home care agencies in Fairfax
- Home care agencies in Winchester
- Home care agencies in Blevinstown
Looking for care for a family member? Find agencies near you
Considering other states?
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Where our numbers come from
We check each fact against Virginia's own rules. Tap a source to read it yourself.
- License needed?Yes12VAC5-381-20(F); Va. Code §32.1-162.15· Oct 2026
- Who oversees itVirginia Department of Health (VDH), Office of Licensure and Certification12VAC5-381-10· Oct 2026
- License nameHome Care Organization (HCO) License12VAC5-381-20· Oct 2026
- The rules12 VAC 5-381 (Home Care Organizations)12VAC5-381· Oct 2026
- First license fee$1,50012VAC5-381-70(A)· Oct 2026
- License lasts3 years12VAC5-381-40(E)· Oct 2026
- Bond$50,000 blanket fidelity bond or third-party crime insurance (no surety bond)12VAC5-381-210(B)(3)· Oct 2026
- Owner/manager trainingNo state minimum12VAC5-381-170(A)· Oct 2026
- Caregiver trainingNo state minimum12VAC5-381-290· Oct 2026
- Background checksSworn disclosure statement plus Virginia State Police criminal record report within 30 days of hire; barrier crimes bar employmentVa. Code §32.1-162.9:1; 12VAC5-381-110· Oct 2026
- How long it takes10-12 MonthsVDH Office of Licensure and Certification, HCO Application Processing Update· Nov 2026
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This guide is for informational purposes only and does not constitute legal, regulatory, or business advice. Licensing requirements, fees, and regulations change frequently. Always verify current requirements with your state's licensing agency before making business decisions. HomeCareAtlas is not responsible for the accuracy or completeness of this information.
Researched and reviewed by
John Helmy, Founder of HomeCareAtlasBuilding tools and resources to help home care agency owners navigate licensing, compliance, and growth.