Caregiver Background Check Requirements: A Guide for Agencies
Most states require a criminal check before client contact, many fingerprint-based through the FBI. Five states' rules, FCRA steps, exclusion lists and rechecks.
By Caregiver Scheduling Team ·
Most states require a criminal background check on every caregiver before they have contact with clients, and many require fingerprint-based checks through the state police and the FBI. The scope, the list of disqualifying offenses and how often you recheck depend on your state and your payers. If you bill Medicaid, you also have to screen against federal and state exclusion lists.
Is there a federal background check requirement for caregivers?
Not a single one. Section 6201 of the Affordable Care Act created the National Background Check Program, under which CMS awarded more than $65 million to 28 states to build statewide checks for direct patient access employees at long-term care providers, including home health agencies and personal care providers.
For Medicaid, the federal rule that reaches you is exclusion screening. State Medicaid agencies must check the OIG’s List of Excluded Individuals/Entities at least monthly (42 CFR 455.436), and most states pass that duty to providers in their enrollment agreements. OIG says an excluded person’s work can receive no federal health care program payment, and the employer may face civil monetary penalties.
What does a caregiver background check include?
A criminal history check, registry searches and, for Medicaid work, exclusion lists.
| Check | What it covers | Often required by |
|---|---|---|
| State criminal history | State repository, name-based or fingerprint-based | State licensing |
| FBI fingerprint check | National criminal history | Many states for licensed care |
| Sex offender registry | National and state registries | Most programs |
| Abuse and neglect registries | Adult protective services, nurse aide and employee misconduct registries | Many states |
| OIG exclusion list (LEIE) | Exclusion from federal health programs | Medicaid and Medicare providers |
| State Medicaid exclusion list | State-level exclusions | Medicaid providers |
How do state rules differ?
Mostly on fingerprints, whether work may start while results are pending, and how often you recheck. Five examples from the states’ own statutes and rules:
| State | Requirement | Pending results | Source |
|---|---|---|---|
| California | Home care aides submit fingerprints to the Department of Justice for state and FBI records | Clearance required for the registry | HSC 1796.23 |
| Illinois | Livescan fingerprint check through the Illinois State Police; employment offer is conditional on the IDPH report; no hire with a registry finding of abuse, neglect or theft | Conditional offer only | 225 ILCS 46 |
| Texas | Criminal history check under Health and Safety Code Chapter 250; search the Nurse Aide Registry and Employee Misconduct Registry before hire or first face-to-face contact, then every 12 months | Not addressed; immediate discharge if listed as unemployable | 26 TAC 558.247 |
| Florida | Level 2 screening: fingerprints through FDLE and the FBI, plus sex offender registry checks, with a statutory list of disqualifying offenses | Screening is a condition of employment | F.S. 435.04 |
| Washington | Fingerprint check through the Washington State Patrol and FBI for long-term care workers hired after Jan 7, 2012; the state pays the FBI fee | May work pending FBI results if the state check is clear, under DSHS rules | RCW 74.39A.056 |
Our background check requirements tool lists every state’s checks, recheck cycle and source.
Can a caregiver start work before the results come back?
Only where the state says so. Washington allows unsupervised work while the FBI result is pending if the state check is clear. Texas requires the registry searches before hire or first client contact. Illinois makes the offer conditional on the state report. When your state is silent, the safe policy is no solo visits until clearance is complete. Build that gate into your hiring process.
Each state also publishes its own list of disqualifying offenses; Florida’s names murder, kidnapping, sexual battery, child abuse and domestic violence. Follow the state list, not your own judgment.
What does the FCRA require when you use a screening company?
Four steps. The FTC’s guide for employers sets them out:
- Standalone disclosure. Tell the applicant in writing, in a document by itself, that you may use a consumer report. It cannot sit inside the application.
- Written permission, which can be on the same page as the disclosure.
- Pre-adverse action notice. Before rejecting someone based on the report, give them a copy and “A Summary of Your Rights Under the Fair Credit Reporting Act.”
- Adverse action notice with the screening company’s contact details, a statement that it did not make the decision, and the right to dispute and get a free copy within 60 days.
Fair-chance laws in many states and cities also limit when you can ask about criminal history; care roles are often exempt, but check first.
How often do you have to recheck?
Follow your state’s cycle, then add Medicaid screening. Texas requires registry searches every 12 months. Some states run “rap back” programs that notify you of new arrests. If you bill Medicaid, check the LEIE and your state’s exclusion list monthly and keep the proof. See caregiver credential tracking.
How Caregiver Scheduling handles this
Credentialing records each caregiver’s background check, registry searches and exclusion screenings with dates and expiry alerts. On Growth and up, a missing or expired required credential blocks assignment until it is cleared. $199/month for up to 10 caregivers or $299/month for up to 50, free for 30 days.
FAQ
Do caregivers need fingerprints? In many states, yes. California, Illinois, Florida and Washington all require fingerprint-based checks for caregivers at licensed agencies.
How long does a caregiver background check take? From a day for name-based checks to a few weeks for fingerprint checks in some states.
Who pays for the background check? Usually the agency. Washington covers the FBI fee for long-term care workers. Some states allow charging applicants; many agencies don’t, to help recruiting.
This article is general information, not legal advice. Check your state’s licensing rules and your payer contracts.