In a nutshell:

To bill Medicaid for home care, your agency must enroll with the state Medicaid program, obtain a provider ID, contract with each required MCO, set up EVV and billing systems, and submit claims using the correct HCPCS codes once services are authorized.

The (slightly) longer version:

Before you can bill Medicaid for home care, your agency must go through a formal enrollment and credentialing process. This usually involves both state-level approval and MCO contracting.

Here’s what that typically looks like:

1. Enroll with your state Medicaid program.

• Register your agency with the state’s Medicaid portal (e.g., TMHP in Texas, IHCP in Indiana, PROMISe in Pennsylvania).
• Submit required documentation: NPI, EIN, state license, liability insurance, and any relevant waiver certifications.
• Complete a background check and provider agreement if required.

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2. Apply for a Medicaid Provider Number or ID.

• In most states, you'll receive a Medicaid ID or LPI number after approval. This is what allows you to submit claims.
• Make sure your agency’s taxonomy code and service types match the waiver programs you want to bill under.

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3. Get credentialed with MCOs (if applicable).

• Most states use managed care, so you'll need separate contracts with each MCO (e.g., Aetna, Molina, UnitedHealthcare).
• Each MCO generally has its own application process, contract, and billing requirements.

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4. Set up EVV and billing systems.

• Some states require you to use a specific EVV platform (e.g., Sandata, HHAeXchange); others simply require you to use a system that can share data with a state-designated platform.
• Make sure your AMS or billing partner can generate compliant claims for your state's system.

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5. Begin billing once services are authorized.

• Once you're contracted and authorized, you can begin delivering services and submitting claims.
• Bill using approved HCPCS codes (usually S5125 for personal care), include modifiers as needed, and submit electronically.

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Pro Tip: Many new agencies get stuck between state approval and MCO contracting. Even after you’re "approved," you may still need to complete multiple health plan applications before you can bill.

For agencies working with Paradigm, we manage the entire enrollment and billing setup—from Medicaid ID applications to MCO contracting and EVV configuration—so you can focus on client care, not payer red tape.

Reminder: This information is not legal advice, not a guarantee, and not a substitute for checking in with your state’s Medicaid authorities and plans directly. Read our full disclaimer here.