How to Start a Home Care Business in Virginia (2025 Update): New Licensing Requirements, Best Cities to Launch, and Market Opportunities

If you’re planning to start a home care business in Virginia in 2025 & beyond, you’re entering one of the strongest markets in the country for non-medical and skilled in-home care. But before launching your agency, you need to understand that the licensing process in Virginia has changed, and these updates will impact your timeline, budget, and staffing structure.

This comprehensive guide breaks down what’s new, what’s required, and where the biggest opportunities are for new Home Care Organization owners.


1. Major Licensing Changes for Virginia Home Care Organizations (2025)

Virginia’s Department of Health (VDH) updated the Home Care Organization licensing process in 2025. Here are the most important changes entrepreneurs need to know:

Updated Licensing Fee

  • Previous fee: $500

  • New fee (as of May 22, 2025): $1,500 for a three-year license

This change aligns Virginia with other multi-year licensing states such as Maryland, Illinois, Texas, and Georgia.

Administrator Requirements Have Tightened

VDH no longer accepts general management experience outside of healthcare.
To satisfy the Administrator requirement:

Option 1 (Preferred by VDH):

  • Appoint your Registered Nurse (RN) as the Administrator for Year One

  • List the Owner as the Alternate Administrator

  • After one full year of operational experience, the owner may request to become the Administrator

This is the most common pathway for:

  • CNAs

  • Family caregivers

  • Administrative professionals

  • Aspiring entrepreneurs with no healthcare management background

RN Requirement for ALL Agencies

Even non-skilled home care agencies must list an RN on their application.
The RN will:

  • Conduct initial needs assessments

  • Confirm that non-medical services are appropriate

  • Oversee client care plans

The RN may be part-time or contractual.

2. The Updated Two-Part Licensing Process in Virginia

Virginia breaks its Home Care Organization licensing process into two phases:

Part A: Application, Roles, Document Approval

Before your application can move forward, VDH must approve:

  • Administrator & Alternate Administrator

  • RN credentials (RN Supervisor or Director of Clinical Services)

  • LLC/INC formation & office lease

  • Insurance (quotes allowed initially)

  • Business Plan

  • One-Year Operating Budget

  • Ownership documents

  • EIN

Part B: Policies, Letter of Readiness, and Survey

After Part A is approved:

  1. You submit a Letter of Readiness

  2. You finalize all state-specific policies and procedures

  3. VDH schedules your in-person survey

Your policies must match the Virginia Administrative Code and meet the state’s survey checklist standards.

Policy examples include:

  • Admissions & discharges

  • Complaint resolution

  • Personnel

  • Client rights

  • Quality improvement

  • Emergency preparedness

3. Best Cities in Virginia to Start a Home Care Agency in 2025

Virginia is one of the strongest U.S. home care markets. Below are the top regions where new agencies are thriving:

Northern Virginia (Loudoun, Fairfax, Prince William)

  • High-income private pay market

  • High demand for dementia care, companion care, and 24/7 support

Richmond Metro (Henrico, Chesterfield, Hanover)

  • Strong long-term clientele

  • Growing population of seniors aging in place

Virginia Beach / Hampton Roads (Chesapeake, Norfolk, Suffolk, Newport News)

  • Large senior population

  • Strong opportunities for VA benefits and Medicare Advantage clients

Charlottesville & Albemarle County

  • High concentration of retirees

  • Demand for premium-level care services

Fredericksburg, Stafford, Spotsylvania

  • Growing suburban senior population

  • Ideal for private-pay and companion care services

Roanoke & Southwest Virginia

  • Less competition

  • Strong need for personal care and long-term clients

Even if you live in the outskirts of these cities, you can serve high-demand counties that urgently need home care providers.

4. Market Opportunity: Private Pay Rates & Insurance Programs in Virginia

Understanding your revenue sources is key to building a profitable home care agency.

Private Pay Hourly Rates (2025 Averages)

  • Northern Virginia: $32–$40/hr

  • Richmond: $28–$35/hr

  • Hampton Roads: $27–$34/hr

  • Charlottesville: $29–$36/hr

  • Fredericksburg area: $27–$34/hr

  • Roanoke region: $24–$30/hr

Live-in care ranges from $250 to $480 per day, depending on location.

5. Virginia Medicaid Waiver Programs

The main Medicaid waiver programs that fund in-home care in Virginia include:

  • CCC Plus Waiver

  • Community Living (CL) Waiver

  • Family & Individual Supports (FIS) Waiver

  • Building Independence (BI) Waiver

These programs pay for:

  • Personal care

  • Respite care

  • Companion care

  • Attendant care

  • Skilled nursing (if applicable)

6. Virginia Medicaid Managed Care Organizations (MCOs)

Agencies serving Medicaid clients will work with one or more of the following Virginia MCOs:

  • Anthem HealthKeepers Plus

  • Aetna Better Health of Virginia

  • UnitedHealthcare Community Plan

  • Optima Health (Sentara)

  • Molina Complete Care

  • Virginia Premier (Sentara Health Plans)

7. Medicare Advantage Plans in Virginia

Medicare Advantage plans increasingly offer home care benefits such as ADL support, in-home aide hours, nutrition, transportation, and post-hospital care.

Major MA carriers include:

  • UnitedHealthcare

  • Humana

  • Anthem HealthKeepers

  • Aetna

  • Sentara/Optima Medicare

  • Cigna

  • Kaiser Permanente (select areas)

This is one of the fastest-growing referral categories for new home care agencies.

2026 Is One of the Best Years to Start a Home Care Agency in Virginia

With updated regulations, higher private-pay rates, new Medicare Advantage benefits, and a rapidly aging population, Virginia remains one of the top states for home care start-ups.

The key is understanding the licensing process — and starting with the right guidance.

Ready to Action

If you want the complete step-by-step checklist, including:

  • Updated 2025 licensing rules

  • Administrator & RN requirements

  • Policy and survey requirements

  • Private pay rate chart

  • Medicaid waivers & MCOs

  • Medicare Advantage payer list

  • The best cities to launch in Virginia

Download my free How to Start a Home Care Organization in Virginia (Home Care and Home Healthcare) click here:

Or, if you're ready to start your agency the right way:

Home Care or Home Healthcare Kickstarter Program (for beginners who want mentorship)


Home Healthcare Kickstarter - SKILLED

DIY Home Care Licensing Kits (skilled & unskilled versions)

DIY Kit - Virginia Skilled Agency

DIY Kit - Virginia Non-Skilled Agency

Whether you want hands-on guidance or a do-it-yourself roadmap, you can start your agency this year with clarity, confidence, and a proven plan.+



Client Success Stories from Virginia Home Care & Home Health Care CEOs


One of the strongest indicators that you are entering a thriving industry is the success of those who have walked this path before you. Here are just a few of the many Virginia home care and home health care entrepreneurs who have used my DIY Kits, Home Care Kickstarter Program, or Licensing Program to launch, license, and grow their agencies.


Fatamata & Sherri – Hayven Home Health Care, Northern Virginia

Both Registered Nurses, Fatamata and Sherri have built a thriving skilled Home Health Care Agency in Northern Virginia. They credit their success to having clear, state-specific policies and procedures and the structure they received during the licensing process. Their agency is now growing and serving clients confidently across the region.

Reneta (RN) & Pauline (Respiratory Therapist) – Northern Virginia

Reneta and Pauline entered the Home Care Licensing Program seeking guidance on their policies and procedures. Today, they are fully licensed, serving clients through Medicaid, private insurance, and private pay, and are now pursuing Medicare Certification. Their growth demonstrates what’s possible when clinical expertise is paired with strong compliance systems.

Asha – DAAR Home Care (Hampton Roads Area)

Asha, an IT Security Specialist with no prior healthcare background, started a non-skilled agency using the DIY Home Care Licensing Kit. Her pre-licensing survey was a success, with surveyors specifically noting the clarity and thoroughness of her policies and procedures. She is now operating her agency with confidence and compliance.

Owner of Vital Home Care Agency – Northern Virginia

This CEO started as a CNA working for another agency. After using the RN Supervisor as the Administrator for the first year (per VDH guidelines), she now serves as the official Administrator of her own agency. She is successfully operating in Northern Virginia with private pay clients and growing her business every month.

RN Agency Owner – Hampton Roads, Virginia

Another Registered Nurse launched her non-skilled Home Care Organization in the Hampton Roads region using the DIY Kit. During her survey, the surveyor commended the quality and detail of her policies and procedures. She passed with excellence and is now building her agency in one of Virginia’s strongest markets.

The Results Speak for Themselves

Entrepreneurs from all backgrounds—RNs, CNAs, Respiratory Therapists, IT professionals, caregivers, and corporate employees—have used:

  • The Home Care & Home Healthcare Kickstarter Program

  • The Virginia DIY Licensing Kits (skilled & unskilled)

  • The Home Care Licensing Program

to successfully get licensed, pass the survey, open their doors, and serve private pay, Medicaid, and insurance clients.

Our policies and procedures are:

  • State-specific

  • Survey-ready

  • User-friendly

  • Designed for both clinical and non-clinical agency owners

We stand behind every document. All you have to do is complete your information and submit with ease.

When you're ready, you can join the next group of successful Virginia Home Care CEOs who trusted this process and are now thriving.


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