How to Start a Home Care Agency in Maryland: OHCQ Residential Service Agency License

If you plan to send aides, nurses, therapists, or personal care workers into clients' homes for pay in Maryland, the license you will almost certainly deal with first is the Residential Service Agency (RSA) license. The Office of Health Care Quality (OHCQ) at the Maryland Department of Health handles it. This guide covers what the license applies to, what to assemble before you apply, the steps in order, and the mistakes that cost new owners the most time and money.

This is informational content, not legal or tax advice. Talk with a Maryland health care attorney and a CPA before you sign a lease, hire staff, or accept your first client.

What the OHCQ RSA License Covers

Maryland's RSA rules sit in the Health-General Article, Title 19, Subtitle 4A, and in COMAR 10.07.05. A residential service agency is a business that employs or contracts with individuals to provide at least one home health care service for compensation. The covered services include nursing, home health aide, therapy, personal care, and others. The test is the service, not the business model. If you deliver even one listed service in a client's home and get paid for it, plan on licensure.

The term "non-medical" causes the most confusion. Many search results mention a non-medical home care license in Maryland. This guide found no verified separate Maryland license by that name, and no verified exemption for companionship-only businesses. Before you market your agency as non-medical, get OHCQ's answer in writing on how your exact service list is classified.

RSA or Home Health Agency?

The RSA is not the only route. A home health agency is a licensed health care facility under Health-General Section 19-114, and establishing one requires a Certificate of Need (CON) from the Maryland Health Care Commission under Section 19-120. Section 19-4A-05 states that an RSA applicant may not be required to obtain a certificate of need. Whether your specific plan fits the RSA route is a question for OHCQ and your attorney, so settle it before you file anything.

Question	Residential service agency (RSA)	Home health agency
Governing law	Health-General 19-4A; COMAR 10.07.05	Health-General 19-114 (licensed health care facility)
Certificate of need	Section 19-4A-05: applicant may not be required to obtain one	Required under Section 19-120 from the Maryland Health Care Commission

What to Assemble Before You Start

Gather these items before you submit anything. This is a practical checklist, not the official OHCQ application packet.

• A Maryland entity, most often an LLC, with Articles of Organization filed with the State Department of Assessments and Taxation (SDAT). The LLC filing fee is $100.
• A Maryland resident agent with a Maryland street address (no P.O. box) who has agreed to serve and will sign the articles.
• A federal employer identification number (EIN) from the IRS.
• A legal name that includes one of the required endings: Limited Liability Company, L.L.C., LLC, L.C., or L C.
• Written policies for client rights, complaints, emergencies, and staff records, drafted to the standards in COMAR 10.07.05. Confirm the required list with OHCQ.
• A staffing plan that states how each worker is classified (employee or independent contractor) and why.
• Insurance quotes for general liability and workers' compensation. Confirm the scope with your insurer.
• A budget line for the $300 annual report due each April 15.
• A call to OHCQ at 410-402-8040 to ask about the application fee and renewal term. The OHCQ page does not state either one. The $1,000 triennial renewal figure that appears in secondary sources is unverified, so do not budget around it until OHCQ confirms it.

Step-by-Step: Forming and Licensing Your Agency

Step 1: Map every service you will provide

Write each service on one page: personal care, home health aide, nursing, therapy, companionship, homemaking, transportation, and anything else you plan to offer. Mark which items fall within the RSA definition. Any single listed home health care service makes you an RSA candidate. Bring this list to OHCQ, because the service list drives the licensing answer more than your company name does.

Step 2: Choose your entity and file with SDAT

Most owners form an LLC. File the Articles of Organization ($100) through Maryland Business Express at https://egov.maryland.gov/businessexpress. A corporation files Articles of Incorporation for a $120 filing fee. Both entity types owe the $300 annual report, the Annual Report and Business Personal Property Return (Form 1), due April 15 each year.

Processing times depend on how you file. A non-expedited LLC filing is reviewed during the second calendar month after submission, and paper filings take about 8 weeks. Expedited review costs an extra $50 and takes 7 to 14 business days. Online rush service costs an extra $325 and is reviewed within 3 hours when submitted by 2:30 p.m. on a business day. A same-day paper drop box costs an extra $425. Pay for speed only if your OHCQ timing requires it, because rush service speeds up SDAT review only, not OHCQ review.

If you need to hold a name while you prepare, a name reservation costs $25 and lasts 30 days. Maryland imposes no separate franchise tax on ordinary LLCs. The LLC is a pass-through for state income tax, so members report the income on their personal returns.

Step 3: Appoint your resident agent

Maryland calls this role a resident agent. The agent may be any Maryland citizen over eighteen, a Maryland corporation, or a Maryland LLC, and must have a Maryland street address. The agent must sign the Articles of Organization, and by law you must have the agent's consent before you file. Changing the resident agent or the agent's address costs $25 per entity, so choose someone who will stay put.

Step 4: Search your name and register any trade name

Search the entity records at https://egov.maryland.gov/businessexpress/entitysearch before you file. Your name must not be misleadingly similar to another LLC, corporation, trade name, limited partnership, or limited liability partnership on file with SDAT. If you will operate under a name other than your legal name, register a trade name with SDAT, not the county. The standard trade name fee is $25, or $75 with the $50 expedited fee. The form is at https://dat.maryland.gov/SDAT%20Forms/nameappl.pdf.

Step 5: Set up your tax registrations

Register with the Comptroller of Maryland at https://www.marylandcomptroller.gov/ for the tax accounts that apply to your business, such as employer withholding if you have employees. Ask the Comptroller which accounts you need. Sales tax is generally a goods issue, so confirm with the Comptroller whether any of your billing is taxable. Members of a pass-through LLC pay Maryland personal income tax at a graduated state rate of 2% to 6.5%, plus a county or Baltimore City local rate of 2.25% to 3.30% for 2026. A corporation pays a flat 8.25% of Maryland taxable income.

Step 6: Apply to OHCQ for the RSA license

Call OHCQ at 410-402-8040 and request the current application packet from the OHCQ page on the Maryland Department of Health website. Submit the packet only after your entity is on file and your resident agent is named, because the entity documents are part of the application. Ask OHCQ these questions and get the answers in writing:

• What is the application fee, and what is the renewal term? (Not published on the OHCQ page.)
• What is the expected review timeline?
• Does my service list require a certificate of need under Section 19-4A-05?
• Which documents does COMAR 10.07.05 require for my services?

An incomplete packet slows review, so treat the checklist as a gate. Do not sign client contracts or advertise home care services until OHCQ has issued the license.

Step 7: Decide how you will classify staff

The Homecare Worker Rights Act of 2024 (HB 39, Chapter 881) took effect January 1, 2026. Under that law, MDH may reimburse an RSA for personal assistance services only when those services are delivered by employee-classified workers. In practice, if you plan to bill MDH for personal assistance, those services must be performed by employees rather than independent contractors. Do not build a 1099 contractor model around MDH-funded work. Ask your attorney how the law applies to your other payers and to any existing contractors before you hire.

Step 8: Handle local rules and insurance

Maryland has no single general state business license. A trader's license from the Clerk of the Circuit Court generally applies to businesses that sell goods, and a home care agency that sells only services probably does not need one. Confirm this with your county Clerk if you also sell goods. Zoning and home occupation rules for an office are set by each county, so call your county planning or zoning office before you sign an office lease. Bind your insurance before your first client start date.

Step 9: Calendar your recurring deadlines

Mark April 15 on your calendar every year for the $300 annual report. If you need more time, file an extension request at pprextensions.dat.maryland.gov. Ask OHCQ for the renewal term and the renewal fee, then calendar the renewal date as soon as you receive your license.

Tips and Common Mistakes

• Treating 'non-medical' as 'unlicensed.' Confirm your classification with OHCQ before you advertise.
• Planning a contractor model for MDH-funded personal assistance. Under the 2026 rule, those services must be delivered by employee-classified workers.
• Skipping the resident agent's consent. Maryland requires it before filing, so get it in writing first.
• Paying rush fees for the wrong step. The $325 online rush speeds up SDAT review, not OHCQ review.
• Budgeting from secondary-source fees. The $1,000 triennial renewal figure is unverified. Confirm the real number with OHCQ.
• Missing the April 15 annual report. Put it on the calendar the day your entity is formed.
• Choosing a name without a required ending. An LLC name must include one of the approved endings.
• Underestimating the CON question. If your plan drifts toward home health agency status, a Certificate of Need from the Maryland Health Care Commission may be required, so decide your route before you sign a lease.

One practical tip: keep a single binder, digital or paper, with every SDAT confirmation, OHCQ email, and insurance binder. Regulators and payers ask for the same documents again and again, and a complete file saves days every time.

What Results to Expect

A complete, correctly filed entity package may move through SDAT on the processing times above. Once licensed, your agency may be able to accept referrals from payers that require licensure. Licensure does not guarantee referrals, reimbursement, or client volume. The OHCQ review timeline is not verified in this guide, so build a buffer into your startup budget and confirm the timeline with OHCQ. Your results will depend on your service mix, your staffing model, your payer contracts, and your local market.

Where to Confirm the Details

• Maryland Business Express: https://egov.maryland.gov/businessexpress
• SDAT business entity search: https://egov.maryland.gov/businessexpress/entitysearch
• SDAT Charter Division: https://dat.maryland.gov/businesses/Pages/default.aspx
• Comptroller of Maryland: https://www.marylandcomptroller.gov/
• OHCQ licensing questions: 410-402-8040

Important Disclaimer

This article is informational content, not legal or tax advice. Fees, processing times, and rules change, and some figures here are marked for confirmation because the agency has not published them. Verify every number with OHCQ, SDAT, or the Comptroller before you rely on it. For a licensing plan with a home health or skilled service component, or any question about the Homecare Worker Rights Act, consult a qualified Maryland health care attorney and a CPA.