Do you need a license to run a home care agency in Maryland?

Yes. Maryland requires a state license to run a non-medical home care agency: the Residential Service Agency (RSA) license, issued by the Maryland Department of Health, Office of Health Care Quality (OHCQ). An RSA is a business that employs or contracts with people to provide at least one home health care service, such as home health aide services, for pay. Agencies that help clients with activities of daily living need this license. The listed home health care services do not include household support tasks like light housekeeping or errands, so an agency doing only those may fall outside the definition.

What are the key facts?

How do you get licensed in Maryland?

1. Complete the typed RSA license application
2. Attach a business plan (1-year budget, marketing plan, service description), org chart, policies and procedures, SDAT letter of good standing, and workers' compensation proof
3. Complete the online RSA Certification on personal care aide worker classification
4. Submit through OHCQ's 'Submit a License Application' system

What should you confirm with the state?

The regulation lists a $1,000 license fee, but the Office of Health Care Quality's 2026 application says there is no fee to apply; confirm the current fee with OHCQ. A private agency background check can be used instead of the state check. Medical Assistance personal care providers are excluded from this license category.

What should you budget for?

The license fee is a small part of startup cost. Insurance, payroll for your first caregivers before clients pay, and office staff usually cost far more. Use the bill rate calculator to check your pricing covers it, and the intake form and care plan templates for the paperwork inspectors ask to see.