Arkansas faces significant demographic challenges that drive demand for home health services. With approximately 17% of the population aged 65 and older and a substantial rural population, the state has a growing need for home-based care options. Arkansas ranks among the states with the highest rates of chronic conditions, including diabetes, heart disease, and obesity, further increasing demand for skilled home health services.

Arkansas's approach to home health care combines state licensing with federal certification requirements. The Arkansas Department of Health (ADH) Health Facility Services oversees agency licensing, while Medicare and Medicaid certification enables agencies to serve publicly insured populations. This guide covers everything agencies and caregivers need to know about providing home health services in Arkansas, from licensing requirements to Medicaid reimbursement and strategies for building a sustainable workforce.

Arkansas Home Health Agency Licensing Requirements

The Arkansas Department of Health (ADH) Health Facility Services division oversees home health agency licensing under the Rules and Regulations for Home Health Agencies in Arkansas. These regulations establish comprehensive requirements for agencies providing skilled home health services.

Licensing authority. All home health agencies providing services to individuals in their homes or places of residence must obtain a license from the Arkansas Department of Health prior to operation. This includes agencies providing skilled nursing, therapy services, and home health aide services.

Pre-licensing requirements. Before applying for a license, agencies must obtain a Permit of Approval (POA) or Certificate of Need (CON). This establishes the geographic service area for the agency, which may extend up to a 100-mile radius from the parent agency or branch office.

License classes. Arkansas issues two classes of home health licenses. A Class A license is issued to agencies certified to participate in the Title XVIII Medicare program. A Class B license is issued to agencies not certified for Medicare participation.

Application requirements. The application process requires the name of the owner or list of persons with ownership interest, establishment of a physical business location within Arkansas that maintains healthcare records and directs patient services, cooperation with state inspections, and payment of applicable license fees.

Physical location requirements. Home health agencies must maintain a licensed, fully operational physical location within Arkansas with sufficient regional offices to adequately service administrative needs. A regional office is required for non-contiguous counties.

Geographic service area. Each agency must serve the area consistent with their CON or POA. Only under conditional emergency circumstances approved by Health Facility Services may an agency provide care outside their approved boundaries.

Inspections. Agencies applying for licensure receive an initial inspection. Subsequent inspections are conducted on one-year, two-year, or three-year survey cycles, with most agencies placed on three-year cycles based on compliance history.

Temporary licenses. The Director of the Division of Health Facilities Services may issue a temporary license for a period not to exceed six months while an agency completes requirements for full licensure.

Medicare/Medicaid certification. Agencies seeking Medicare or Medicaid certification must first obtain state licensure from ADH, then apply to the Division of Provider Services and Quality Assurance (DPSQA) for federal certification. A provisional letter from DPSQA is required before applying for a Medicaid provider identification number.

Non-medical home care. Unlike many states, Arkansas does not require non-medical home care agencies (providing only personal care, homemaking, and companionship services) to obtain a state license. However, these agencies must still adhere to federal and local regulations, obtain appropriate business licenses, and conduct background checks on employees.

Home Health Aide Certification Requirements

Arkansas home health aide certification requirements vary based on the type of employer and funding source. The state follows federal minimum standards for Medicare-certified agencies while offering additional pathways for other care settings.

Federal requirements for Medicare agencies. Home health aides working for Medicare-certified home health agencies must complete a 75-hour training program, including at least 16 hours of supervised practical training. This follows the requirements established in 42 CFR 484.80.

Age and education requirements. Prospective home health aides must be at least 18 years old and possess a high school diploma or GED equivalent. A criminal background check is mandatory for all applicants.

Training program components. State-approved HHA training programs must cover personal care skills (bathing, grooming, dressing assistance), vital signs monitoring, infection control procedures, nutrition and meal preparation, observation and reporting, emergency procedures, and communication skills.

Competency evaluation. After completing training, candidates must pass a competency evaluation demonstrating both written knowledge and practical skills. The evaluation must be performed by a registered nurse and documented in the aide's personnel file.

Alternative pathway: CNA certification. Arkansas allows Certified Nursing Assistants (CNAs) to work as home health aides without additional training, provided they maintain active CNA certification and pass the competency evaluation required by the home health agency.

Private-pay and waiver programs. For private-pay settings and certain Medicaid waiver programs, Arkansas requires 40 hours of initial training (24 hours didactic and 16 hours practical) before caregivers can provide services independently.

Continuing education. Federal regulations require home health aides to complete at least 12 hours of in-service training during each 12-month period to maintain skills and stay current with care techniques. All HHA and PCA training programs must be approved by the Arkansas Department of Health or Department of Human Services.

Supervision requirements. Home health aides must work under the supervision of a registered nurse. The RN must make supervisory visits to the patient's home at least every 14 days when aide services are provided, assessing the aide's competency and the quality of care delivered.

CNA Certification Requirements

Certified Nursing Assistants play a vital role in Arkansas's home health workforce. Many home health agencies prefer or require CNA certification due to the more comprehensive training requirements.

Training program requirements. Arkansas CNA training programs consist of 90 hours of total training, including 74 hours of classroom instruction and 16 hours of clinical hands-on training. Clinical training must occur at a long-term care facility, skilled nursing unit, rehabilitation unit in an acute care facility, or inpatient hospice unit.

Examination requirements. Candidates must pass the Nursing Assistant Competency Exam (NACE) administered by D&S Diversified Technologies (Headmaster). The exam consists of a written test and a skills demonstration. Candidates must pass both portions within 12 months of completing training or retraining is required.

Skills evaluation. The skills portion requires candidates to perform a series of tasks including handwashing, patient positioning, vital signs measurement, and assisting with mobility to demonstrate competency in patient care.

Registry placement. After passing both exams, results are automatically submitted to the Arkansas Nurse Aide Registry. No separate application is required for registry placement.

Renewal requirements. CNA certification must be renewed every two years. To maintain eligibility, CNAs must have been employed as a nursing assistant within the preceding 24 months with at least eight consecutive hours of paid employment verified by an employer.

Reciprocity. Out-of-state CNAs may transfer certification to Arkansas via reciprocity if they have active certification in another U.S. state or territory. Requirements include proof of nurse aide training (certificate, diploma, or transcript showing at least 90 training hours) and a $25 non-refundable fee submitted through TMU (Test Management Utilities).

Registry contact. For CNA Registry inquiries, contact D&S Diversified Technologies: Testing Phone: 888-401-0462, Registry Phone: 888-401-0465.

Medicaid Reimbursement in Arkansas

Arkansas Medicaid, administered by the Department of Human Services Division of Medical Services (DMS), provides home health coverage for eligible residents. The state maintains fee schedules that apply based on date of service.

Fee schedule structure. The Arkansas Department of Human Services publishes fee schedules for Medicaid providers, including home health services. Reimbursement rates are date-of-service effective, meaning the rate applied to a claim depends on when services were provided.

Coverage limitations. Fee schedules do not address various coverage limitations routinely applied before final payment, including client and provider eligibility verification, benefit limits, billing instructions, frequency of services, third party liability, age restrictions, prior authorization requirements, and applicable co-payments or coinsurance.

Provider enrollment. Home health agencies must enroll as Medicaid providers through the Division of Medical Services to receive reimbursement for services provided to Medicaid beneficiaries.

Claims submission. Arkansas Medicaid requires electronic claims submission for most providers. Claims must include appropriate procedure codes, modifiers, and documentation to support medical necessity.

Rate reviews. The Division of Medical Services maintains a Rate Review Plan and periodically evaluates reimbursement rates. Providers can access current fee schedules through the DHS website.

Key resources. The Arkansas DHS Fee Schedules page provides current reimbursement information. The Home Health Fee Schedule reflects only procedure codes that are currently payable.

ARChoices HCBS Waiver Program

Arkansas's ARChoices in Homecare Waiver is the state's primary 1915(c) Home and Community Based Services (HCBS) Medicaid waiver program for home health services. Implemented in 2016, it combined two previous waivers: Elder Choices and Alternatives for Adults with Physical Disabilities.

Program purpose. ARChoices provides long-term Home and Community Based Services to promote independent living and prevent nursing home admissions for those at risk of institutionalization.

Eligibility requirements. ARChoices serves Arkansas residents who are elderly (aged 65 and older) or physically disabled adults aged 21-64 who require a nursing facility level of care. Disabled participants who turn 65 may continue receiving waiver services.

Income limits. The applicant income limit is 300% of the Federal Benefit Rate (FBR), which was $2,901 per month in 2025. This figure adjusts annually each January.

Asset limits. The countable asset limit for a single applicant is $2,000. Certain assets are excluded from this calculation, including the primary residence and one vehicle.

Services available. ARChoices benefits include attendant care services (personal care and homemaker services), adult day health services, adult day services, in-home and out-of-home respite care, home-delivered meals, and personal emergency response systems (PERS).

Attendant care services. Direct human assistance is provided for activities of daily living including eating, dressing, bathing, meal planning, laundry, and shopping for essentials.

Independent Choices option. Program participants have the option of self-directed care through the Independent Choices program. Participants receive a cash allowance to purchase attendant care services, giving them control over who provides their care and when services are delivered.

Enrollment capacity. The ARChoices Waiver has a limited number of enrollment spots (approximately 11,400 per year). Once capacity is reached, additional applicants are placed on a waiting list.

Application process. Individuals seeking ARChoices should contact their local Arkansas Department of Human Services office. The application involves two concurrent tracks: financial eligibility determination and functional needs assessment.

Provider certification. Agencies seeking to provide ARChoices waiver services must complete provider certification through the Arkansas DHS Division of Aging, Adult, and Behavioral Health Services.

Electronic Visit Verification (EVV) Requirements

Per the 21st Century Cures Act signed into law in 2016, Arkansas is required to implement Electronic Visit Verification for all Medicaid personal care services and home health services delivered in home settings.

Implementation timeline. Arkansas implemented EVV for all self-directed clients, employers, and their employees/caregivers enrolled in Independent Choices or ARChoices programs effective April 1, 2021. Home health care services were required to implement EVV by January 1, 2023.

Covered services. EVV requirements apply to personal care services, home health care services, and other Medicaid-funded services delivered in home settings.

System requirements. Providers must use an EVV system that documents and verifies every in-home visit resulting in a claim for reimbursement. Providers may use either the EVV system furnished by the DHS EVV Vendor or a third-party EVV system certified by the DHS EVV Vendor.

Required data elements. EVV systems must capture the type of service performed, the individual receiving the service, the date of service, the location of service delivery, the individual providing the service, and the time the service begins and ends.

Visit logging methods. Visits can be logged using a mobile app on the caregiver's cell phone or through the member's landline phone. GPS-enabled tablets are also acceptable for recording visit information.

Caregiver enrollment. All caregivers who will use EVV must enroll with Arkansas Medicaid. This is a mandatory requirement for agencies to bill services.

Compliance requirements. Compliance with EVV standards is mandatory for providers to continue receiving Medicaid funding. Non-compliance can result in penalties, including potential loss of Medicaid funding and other sanctions.

Medicare Home Health Coverage

With Arkansas's growing elderly population and high rates of chronic conditions, Medicare remains a crucial payer for home health services. Medicare certification allows agencies to serve beneficiaries and typically provides better reimbursement than Medicaid programs.

Eligibility requirements. To qualify for Medicare home health coverage, beneficiaries must be homebound (leaving home requires considerable effort due to illness or injury), need skilled nursing care on an intermittent basis or require physical therapy, speech-language pathology services, or continued occupational therapy, have a physician certify the need for home health care and establish a plan of care, and receive services from a Medicare-certified home health agency.

2026 payment rates. CMS's Calendar Year 2026 Home Health Prospective Payment System Final Rule established updated payment rates for Medicare home health services. Agencies should review the current 30-day standard payment rate and PDGM case-mix adjustments.

PDGM considerations. The Patient-Driven Groupings Model (PDGM) determines Medicare payment based on patient characteristics including admission source, clinical grouping, functional level, and comorbidity adjustments.

Plan of care requirements. Medicare requires a plan of care signed by a physician specifying services needed, frequency, and duration. The plan must be reviewed at least every 60 days.

Medicare certification process. Agencies seeking Medicare certification must meet federal Conditions of Participation and undergo a state survey conducted by DPSQA. Given Medicaid rate constraints, Medicare certification and patient volume are essential for agency financial sustainability in Arkansas.

Labor Laws and Wage Requirements

Arkansas maintains state-specific labor standards that employers must follow in addition to federal requirements. Understanding these requirements is essential for compliance and competitive compensation.

Minimum wage. The Arkansas minimum wage is $11.00 per hour as of 2026, above the federal minimum of $7.25. This rate has remained unchanged since 2021. Arkansas's minimum wage requirement applies only to employers with four or more employees unless an exception or exemption applies.

Tipped employees. The tipped minimum wage in Arkansas is $2.63 per hour. Employers must ensure tipped workers earn at least the full minimum wage of $11.00 per hour when wages and tips are combined.

Overtime requirements. Arkansas does not have state laws requiring overtime compensation for more than eight hours worked in a workday. Federal Fair Labor Standards Act (FLSA) requirements apply, requiring overtime pay (1.5 times regular rate) for non-exempt employees working more than 40 hours in a workweek.

Special overtime provisions. Police, fire departments, hospitals, and residential care facilities may have special overtime provisions under federal law. Public agencies are the only employers permitted to award compensatory time off in lieu of paying required overtime.

Dual coverage. An employer covered by both state and federal laws must pay the highest applicable minimum wage. In most cases, this is Arkansas's $11.00 per hour.

Penalties. Employers who willfully or repeatedly violate minimum wage or overtime pay requirements may face civil penalties of up to $1,000 for each violation.

Future changes. As of 2026, there are no confirmed legislative changes to Arkansas minimum wage. Any future increases would require legislative action or a voter-approved ballot initiative.

Arkansas Workforce Challenges

Arkansas faces significant home health workforce challenges driven by demographic trends, geographic factors, and competition for workers. Understanding these dynamics is critical for developing effective recruitment strategies.

Demographic pressures. Arkansas has a growing elderly population with approximately 17% of residents aged 65 and older. High rates of chronic conditions including diabetes, heart disease, and obesity increase demand for home health services.

Current wages. According to ZipRecruiter data for 2026, the average annual pay for a Home Health Aide in Arkansas is approximately $27,771, working out to about $13.35 per hour. Glassdoor reports a salary range from $30,470 to $42,722 per year, with a median around $26,656 in the healthcare industry.

National comparison. The Bureau of Labor Statistics reports the national average annual personal care and home health aide salary at $34,990, with an average hourly rate of $16.82. Arkansas wages lag significantly behind the national average, creating recruitment challenges.

Rural access challenges. Arkansas has substantial rural populations with limited access to healthcare services. Geographic distances increase travel time and costs for home health providers, while reducing the pool of potential workers in rural communities.

Competition for workers. With Arkansas's $11.00 minimum wage and average caregiver wages around $13-14 per hour, home health positions compete with retail, hospitality, and warehouse jobs that may offer comparable pay with less demanding work.

Industry growth. The Bureau of Labor Statistics projects 17% growth in employment of home health and personal care aides nationally, much faster than average. This growth will intensify competition for qualified workers across all states.

Workforce pipeline. The 90-hour CNA training requirement and 75-hour HHA training create barriers to entry for prospective caregivers. Limited availability of affordable training programs in rural areas compounds this challenge.

Strategies for Arkansas Agencies

Given Arkansas's specific market dynamics, agencies must adopt targeted strategies to build sustainable operations and competitive workforces.

Maximize Medicare revenue. With Medicaid reimbursement constraints, maximizing Medicare patient volume is essential for financial sustainability. Better Medicare reimbursement provides margin to offer competitive wages and invest in recruitment. Ensure proper documentation and coding to capture appropriate PDGM payments.

Offer above-market wages. With Arkansas HHA wages averaging around $13 per hour, there is opportunity to differentiate through compensation. Offering $14-16 per hour or more can attract quality candidates who might otherwise choose other employment.

Provide free training programs. Offering free CNA or HHA training removes financial barriers to entry and builds a pipeline of certified workers. Partner with community colleges or develop in-house training programs to recruit and train new caregivers.

Leverage ARChoices partnerships. Build relationships with the ARChoices program to serve waiver participants. This provides a stable source of Medicaid-funded patients while helping address community needs for home-based care.

Address rural markets. Consider specialized strategies for rural areas including mileage reimbursement, company vehicles for home visits, or geographic clustering of assignments to reduce travel burden on caregivers.

Support self-direction. Work with the Independent Choices program to support participant-directed care. This model provides flexibility for participants while creating employment opportunities for family and community caregivers.

Ensure EVV compliance. Select an EVV system that integrates well with operations and meets DHS requirements. Train staff thoroughly on proper clock-in/clock-out procedures to avoid claim denials and compliance issues.

Invest in retention. Given workforce shortages, every retained caregiver is valuable. Provide thorough onboarding, consistent scheduling, supervisor support, and recognition programs. Consider retention bonuses tied to tenure milestones.

Build community partnerships. Partner with local organizations, churches, workforce development agencies, and educational institutions to identify potential caregivers. Word-of-mouth referral programs can be effective in tight-knit communities.

Emphasize career pathways. Create clear advancement opportunities from HHA to CNA to licensed nursing programs. Partner with nursing schools to offer tuition assistance tied to employment commitments.

Key Resources and Contacts

Agencies operating in Arkansas should maintain relationships with these key regulatory and support organizations:

Arkansas Department of Health - Health Facility Services
Home health agency licensing and inspection
Website: healthy.arkansas.gov

Arkansas Department of Human Services
Division of Medical Services (Medicaid)
Website: humanservices.arkansas.gov
Fee Schedules: humanservices.arkansas.gov/divisions-shared-services/medical-services/helpful-information-for-providers/fee-schedules/

Division of Provider Services and Quality Assurance (DPSQA)
Medicare/Medicaid certification
CNA Training Program oversight

ARChoices in Homecare Program
Division of Aging, Adult, and Behavioral Health Services
Provider certification for waiver services

Arkansas Nurse Aide Registry
D&S Diversified Technologies (Headmaster)
Testing Phone: 888-401-0462
Registry Phone: 888-401-0465
Registry Search: ar.tmutest.com/search

Electronic Visit Verification (EVV)
Arkansas DHS EVV Information
Website: humanservices.arkansas.gov/divisions-shared-services/medical-services/evv-info/

Arkansas Department of Labor and Licensing
Minimum wage and overtime enforcement
Website: labor.arkansas.gov

The Bottom Line

Arkansas presents both significant challenges and opportunities for home health agencies. The state's growing elderly population and high rates of chronic conditions ensure sustained demand for home health services. The Natural State's unique combination of urban and rural communities requires flexible approaches to service delivery and workforce recruitment.

Operating successfully in Arkansas requires understanding the distinction between licensed home health agencies and non-licensed non-medical home care providers. For skilled services, the path to Medicare certification through state licensure and DPSQA survey is essential for financial sustainability. The ARChoices waiver program provides opportunities to serve Medicaid beneficiaries needing long-term home and community-based services.

Arkansas's wage environment, with an average HHA salary of approximately $27,771 annually, presents recruitment challenges compared to national averages. Agencies that invest in above-market compensation, free training programs, and clear career pathways will be best positioned to build and retain quality workforces. EVV compliance is mandatory and requires proper systems and staff training to avoid claim denials.

The ARChoices waiver program, with approximately 11,400 enrollment slots, offers significant opportunities for agencies that complete provider certification. The Independent Choices self-direction option provides flexibility for participants and creates employment opportunities for family and community caregivers.

Agencies that understand Arkansas's regulatory environment, build strong relationships with state agencies, invest in workforce development, and maintain strict compliance with EVV and documentation requirements will be best positioned to serve the Natural State's growing home health care needs and build sustainable operations.