The short answer Delaware is among the strictest states: home health and personal assistance services agencies must obtain state and FBI fingerprint checks, screen the Adult Abuse and Child Protection Registries, and conduct pre-employment drug testing.
What Delaware requires
Delaware
Fingerprint checks. 16 Del. C. §§ 1141 and 1145 require home health agencies and personal assistance services agencies to obtain a criminal background check through the Delaware State Bureau of Identification, including FBI fingerprint records, before hiring direct care workers.
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Mandatory drug testing. 16 Del. C. § 1146 and DHSS regulations require pre-employment drug screening for home health, hospice, and personal assistance workers, a requirement unusual among states.
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Registry checks. Employers must check the Delaware Adult Abuse Registry (16 Del. C. § 8564) and the Child Protection Registry before hire, plus the CNA registry for aides.
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Conditional hire. Delaware permits conditional employment pending background check results for a limited period, provided the worker is supervised and the agency documents the pending check.
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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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