The short answer Alabama is one of the few states with no statutory criminal background check mandate for home health agency employees; the state's fingerprint check law (Ala. Code § 38-13) covers DHR-licensed child care and adult care facilities, so home care agencies screen voluntarily and verify the nurse aide registry for aides.
What Alabama requires
Alabama
No statewide home health mandate. Alabama has no statute requiring criminal background checks for home health agency employees. The fingerprint-based check scheme in Ala. Code § 38-13-1 et seq., processed through the Alabama Law Enforcement Agency (ALEA) with FBI submission, applies to child care and adult care facilities licensed or approved by the Department of Human Resources — not to ADPH-licensed home health agencies. HHS OIG's 50-state review identified Alabama among the states without a home health background check requirement.
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Registry checks. Home health agencies employing aides must verify the Alabama Nurse Aide Registry maintained by the Department of Public Health for abuse, neglect, or misappropriation findings before hire.
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Disqualifying convictions. In the DHR-licensed child care and adult care settings where Ala. Code § 38-13 does apply, convictions for crimes against persons such as murder, sexual offenses, robbery, and elder abuse are disqualifying, and applicants must sign sworn statements disclosing criminal history pending suitability determinations — a useful benchmark for home care agencies designing voluntary screening policies.
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Non-medical home care. Alabama has historically not imposed a separate licensing scheme on purely private-pay non-medical home care companies, so agencies outside ADPH licensure should follow FCRA-compliant screening as a best practice and Medicaid waiver provider screening rules where applicable.
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The federal baseline (applies in every state)
Federal
No universal federal mandate. There is no federal law requiring criminal background checks for private-pay home care workers; requirements are set state by state. HHS OIG found wide variation in state home health background check requirements, and Medicare Conditions of Participation for home health agencies defer to state law on screening.
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National Background Check Program (ACA Section 6201). Section 6201 of the Affordable Care Act created the CMS National Background Check Program, which awarded grants to more than 25 states to build fingerprint-based, comprehensive background check systems for direct patient access employees of long-term care providers, including home health agencies and personal care providers.
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FCRA obligations. When an agency uses a consumer reporting agency (third-party background check vendor), the federal Fair Credit Reporting Act requires a standalone written disclosure, the applicant's written authorization, and the pre-adverse action / adverse action notice process (copy of the report and Summary of Rights) before rejecting a candidate based on the report.
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OIG exclusion list (LEIE). Home care providers that bill Medicare or Medicaid must not employ or contract with individuals excluded from federal health care programs. HHS OIG maintains the List of Excluded Individuals/Entities (LEIE); CMS and state Medicaid agencies expect screening at hire and monthly thereafter, and payments tied to excluded persons are subject to recovery and civil monetary penalties.
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