How To Start a Home Care Agency (RSA) in Maryland: Your 2025 Step-by-Step Guide to Getting Licensed and Launched

Starting a home care business in Maryland? Whether you're focused on skilled services or personal care, one thing is clear: you need a Residential Service Agency (RSA) license to operate legally. With the Maryland Department of Health updating its application process and regulations in 2025, it’s more important than ever to ensure your submission is accurate, complete, and strategic.

As someone who started my very first home care business in Maryland, I understand the licensing process deeply. I’ve helped hundreds of new CEOs across the state get approved and launched, and in this guide, I’ll walk you through the exact steps you need to follow to get licensed fast and correctly.

Understanding the RSA License in Maryland

A Residential Service Agency (RSA) license is required for any organization that plans to offer personal care, companion services, or skilled nursing services in the state of Maryland. Whether you plan to bill Medicaid, attract private pay clients, or pursue insurance contracts, the RSA license is your legal foundation.


The license is issued by the Maryland Department of Health (MDH) and is governed under COMAR 10.07.05.

The 2025 Update: All RSAs Are Now Classified as Skilled

As of 2025, the Maryland Department of Health has eliminated the tiered RSA level system (formerly Levels 1, 2, and 3). Now, all Residential Service Agencies (RSAs) are processed under a single "Skilled" license category.

But here’s the key detail: your approved scope of services will depend entirely on the skilled policies and procedures you submit.

If your application does not include required skilled service protocols—such as:

  • Drug administration,

  • Enteral nutrition,

  • Parenteral (IV) therapy—

  • Provision of Skilled Services

Then your RSA will not be approved to offer those services, regardless of your skilled designation.

So while you're classified as a Skilled Residential Service Agency by default, your ability to provide skilled care is determined solely by the supporting documentation you submit.

👉 If you only plan to offer personal care or non-skilled services, your documentation should reflect that—but if you want the flexibility to grow into skilled services, your application needs to be built accordingly.

Additional 2025 Updates All New Maryland RSA Applicants Should Know:

✅ Non-Expiring License – All newly approved RSAs will receive a license that does not require renewal.

✅ No Survey Required (For Now) – Currently, new applicants are not required to undergo a pre-licensure survey process.

✅ No $1,000 Application Fee – Maryland has waived the traditional $1,000 application fee for new RSA license submissions.

✅ RN Not Required on Application – While you must hire an RN Supervisor post-licensure, you do not need to include an RN on your application to get approved.

These updates have been verified through the successful submission and approval of over 10 RSA applications by our team.

We stay up to date on Maryland licensing and regulatory compliance so you don’t have to.

Step-by-Step RSA Licensing Process

  1. Register Your Business with the Maryland Department of Assessments and Taxation (SDAT).

  2. Obtain a Letter of Good Standing from SDAT (you’ll likely pay a $20 fee).

  3. Develop a Business Plan + 1-Year Operating Budget that aligns with your intended services and target population.

  4. Prepare Your Policies & Procedures based on COMAR 10.07.05.

  5. Complete the RSA Certification Form (required as of January 2024).

  6. Secure Workers' Compensation Insurance (required even for small staff).

  7. Submit Your Application to the Maryland Department of Health.

Common Mistakes That Can Delay or Deny Your License

  • Failing to submit the RSA Certification form

  • Inconsistencies between your SDAT registration and application (name, punctuation, etc.)

  • Submitting incomplete or misaligned policies

  • Falling to submit a requested waiver for skilled services policies

  • Not including age groups or populations served in your business plan

  • Submitting scope of service that are skilled - although you are non-medical, and

  • Forgetting to attach proof of insurance

Fast-Track Your Approval With a Proven System

I created the Maryland DIY Licensing Kit to eliminate the guesswork. It’s been used by dozens of CEOs across the state to get licensed in 5 months or less.

The kit includes:

  • Step-by-step application checklist

  • Business plan + budget templates

  • RSA-specific policies and forms

  • RSA Certification guidance

  • Video walkthrough of the full application

  • A bonus resource vault with trainings for CEO, Administrator, and Marketing roles

After You're Licensed: What's Next?

Getting your license is just the beginning. Next, you'll need to:

  • Hire and onboard staff (Administrator, RN Supervisor, caregivers)

  • Set up your operational systems and software

  • Begin building referral pipelines

  • Launch your marketing strategy to attract clients

You don’t have to figure it all out alone.

Get Expert Support

Whether you need a second set of eyes before submitting your application or step-by-step help building your operations, I’ve got you.

✅ Book an Application Review Call
✅ Explore Home Care CEO Mentorship
✅ Join the Home Care Kickstarter On-Demand Program (12+ hours of training)

Let’s turn your idea into a licensed, profitable agency.

Ready to Start Your RSA in Maryland?
Click here to get licensed with the same tools successful CEOs are using every day:
Grab Your Home Care Starter Kit Today!

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