The short answer Missouri licenses only skilled home health agencies (two skilled services required); private-pay non-medical in-home care needs no license, though Medicaid in-home services providers contract with the state.
What Missouri requires
Missouri
Licensing agency. The Missouri Department of Health and Senior Services (DHSS), Bureau of Home Care and Rehabilitative Standards, licenses home health agencies under §§ 197.400-.477 RSMo and 19 CSR 30-26.
Source ↗
Skilled threshold. A licensed Missouri home health agency must offer at least two skilled services on an intermittent basis, one of which must be skilled nursing — agencies below that threshold fall outside licensure.
Source ↗
Renewal fee. Home health licenses renew annually with a $600 nonrefundable fee, and renewal is conditioned on a compliance survey including clinical record review and home visits.
Source ↗
Non-medical home care. Missouri does not license private-pay non-medical in-home care; Medicaid consumer-directed and in-home services providers instead operate under DHSS/Department of Social Services provider agreements and 19 CSR program rules.
Source ↗
☆ Rules change. We watch them for you.
Get one short email when Missouri's home care requirements change. No spam, unsubscribe anytime.
Reviewed quarterly by Vitable Health.
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.
Source ↗
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.
Source ↗
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.
Source ↗
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.
Source ↗
Primary sources for this page
More Missouri guides