The short answer Hawaii licenses non-medical home care agencies and skilled home health agencies through the Department of Health's Office of Health Care Assurance.
What Hawaii requires
Hawaii
Licensing agency. The Hawaii Department of Health, Office of Health Care Assurance (OHCA), licenses home care agencies under HRS ch. 321 and Hawaii Administrative Rules ch. 11-700, and home health agencies under HAR ch. 11-97.
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Home care agency license. The HAR 11-700 home care agency license covers non-medical personal care, homemaker, and companion services; agencies must meet staffing, training, and supervision standards and pay licensing fees into the OHCA special fund (HRS § 321-1.4).
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Home health agencies. Skilled home health agencies are separately licensed/certified through OHCA's Medicare section; Medicare certification with CMS Conditions of Participation is the operative standard for skilled agencies.
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Surveys. OHCA conducts initial and renewal licensure inspections and complaint investigations, publishing a public list of licensed home care agencies; deficiencies require corrective action plans.
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The federal baseline (applies in every state)
Federal
No federal home care license. There is no federal license for home care or home health agencies. Licensure is a state function: each state (and DC) decides whether and how to license home health agencies and non-medical personal care/companion agencies, so requirements vary dramatically by jurisdiction.
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Medicare certification (42 CFR Part 484). Agencies that bill Medicare for skilled home health must be certified as meeting the Medicare Conditions of Participation at 42 CFR Part 484 (patient rights, comprehensive assessment, QAPI, skilled professional services, home health aide standards, and more), on top of any state license.
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Accreditation with deemed status. Most new Medicare home health agencies obtain certification through a CMS-approved accrediting organization with deeming authority — ACHC, CHAP, or The Joint Commission — whose surveys substitute for the state agency's Medicare certification survey.
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State survey agencies enforce both. State survey agencies (usually the state health department) operate under agreements with CMS to survey Medicare-certified agencies, and most also run the state licensure survey program — initial surveys, renewal/recertification surveys, complaint investigations, and plan-of-correction enforcement per the CMS State Operations Manual.
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