Missouri home care license requirements
Bottom line: No (private pay) — No license; Medicaid in-home services via MMAC contract + enrollment.
WATCH Watch item: Family Care Safety Registry fee rose from $15 to $16 on Oct 1, 2026 (worker registry fee).
- License required?
- No (private pay)
- License / pathway
- No license; Medicaid in-home services via MMAC contract + enrollment
- Fees (initial / renewal)
- N/A (no license)
From the 50-state summary. Fees shown as stated in the state entry; see each entry for conditions, conflicts, and sources.
Missouri requirements, item by item
Bracketed numbers link to the official sources at the bottom of this page.
Not confirmed in official sources — check with the state agency We could not confirm this item on an official state source during our review, so we did not estimate it.
| Item | What the guide found |
|---|---|
| License required? | For private-duty/private-pay companies, Missouri does not issue a state license. Agencies serving Medicaid clients use the state-contract pathway rather than a stated separate home-care-agency license. [1] |
| License type / name | Private-pay pathway: no Missouri state home-care license is issued. Medicaid in-home services pathway: submit a proposal to MMAC for a participation agreement/state contract and subsequent Medicaid provider enrollment; services are authorized by DSDS. [1][2][3] |
| Licensing agency | Missouri Medicaid Audit and Compliance (MMAC) handles the Medicaid in-home services contract proposal and provider-enrollment pathway. [1][3] |
| Agency website | MMAC In-Home Services Proposal for Contract: https://mmac.mo.gov/providers/provider-enrollment/home-and-community-based-services/contract-proposal-information/in-home-services-proposal-for-contract/ [3] |
| Initial application / license fee | Not confirmed in official sources — check with the state agency — No state license is issued for the private-pay pathway. Medicaid provider enrollment requires an enrollment fee, but the current amount is not stated in the sources reviewed. [1][4] |
| Renewal fee | Not confirmed in official sources — check with the state agency |
| Renewal cycle | Not confirmed in official sources — check with the state agency |
| Typical approval timeline | No overall contract-processing duration is stated. A site visit is conducted before an initial contract is issued; the designated-manager test is administered once per calendar quarter. [2][5] |
| Administrator qualifications | For the Medicaid in-home services pathway, the administrative supervisor must be at least 21 and meet one of the stated qualification routes: Missouri-licensed RN, baccalaureate degree, Missouri-licensed LPN with at least one year of relevant experience, or at least two years of relevant direct-care experience. MMAC also states designated managers must meet education and experience requirements and pass its written test. [2][5] |
| Caregiver background checks | For Medicaid in-home providers, requirements include criminal background checks, Employee Disqualification List (EDL) screening, and monitoring the EDL. The current rule requires screening records to document the person screened, request and completion dates, and outcome. [2][3] |
| Caregiver training hours | For Medicaid in-home service workers, 12 hours of orientation are required within 30 days of employment, with at least 6 hours before first participant contact. After the first 12 months, 5 hours of annual in-service training are required; qualifying experienced aides may receive 2 hours of annual refresher training instead. [2] |
| Registry checks | FCSR registration applies to certain care workers, including workers at in-home services providers under contract with DHSS or DSS; the sources reviewed state registration is due within 15 days of hire. MMAC’s proposal page requires registration for individuals with direct contact with Medicaid participants. The FCSR registration fee is $16 effective October 1, 2026. [6][3] |
| General liability insurance | For Medicaid in-home providers, occurrence-based commercial general liability coverage must be at least $1 million per event and $3 million aggregate. The certificate of insurance must meet 19 CSR 15-7.021(18)(E); a quote or binder may be used during proposal review, but coverage must be in place before the participation agreement is awarded. [2][3] |
| Workers' compensation | For providers covered by the in-home services rule, workers’ compensation must be maintained at the statutory amount prescribed by Missouri law. [2] |
| Bonding (surety / dishonesty) | Medicaid in-home providers must maintain an employee dishonesty bond covering employees and volunteers connected with in-home service delivery; the proposal requires a bond meeting 19 CSR 15-7.021(18)(E). [2][3] |
| Rule changes 2025–2026 | Effective October 1, 2026, the FCSR registration fee increased from $15 to $16. This is a worker registry fee, not an agency licensing fee. [6] |
Source notes and conflicts
The 2020 rule version states 10 annual in-service hours and refers to professional liability coverage; the more recent 2023 rule version states 5 annual in-service hours (with a 2-hour refresher option for qualifying aides) and specifies commercial general liability coverage. The sources reviewed also distinguish private-pay companies, for which no state license is issued, from Medicaid in-home providers, which must use the state-contract pathway and meet applicable program requirements.
Sources
- The Three Types of Care in the Home | Missouri Department ...
https://health.mo.gov/providers/home-care/three-types-care-home - CODE OF STATE REGULATIONS
https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c15-7.pdf - In-Home Services Proposal For Contract - MMAC - MO.gov
https://mmac.mo.gov/providers/provider-enrollment/home-and-community-based-services/contract-proposal-information/in-home-services-proposal-for-contract/ - NEW PROPOSAL PROCESS FOR IN-HOME SERVICES AND ...
https://mmac.mo.gov/new-proposal-process-for-in-home-services-and-consumer-directed-services-providers/ - IHS Designated Manager & Certified CDS Manager Training/Testing
https://mmac.mo.gov/providers/hcbs-provider-certification-training/ - Family Care Safety Registry | Missouri Department of Health and ...
https://health.mo.gov/providers/family-care-safety-registry
Limits: fees and forms change often. Agencies sometimes post conflicting figures (a statute vs. an older form); those conflicts are shown, not resolved by guessing. Confirm the current fee with the agency before filing. This guide is a research reference, not legal advice.
Want to talk through your state?
A free 15-minute clarity call with Home Care Agency Blueprint, the publisher of this site. Bring your state and your questions; you do not need to finish the checklist first.
Book a free 15-minute clarity call