Submit Documents to the MDHHS Home Help Unit

The complete Home Help Agency standards and requirements can be found here within MSA 18-09.

Below information, as outlined in MSA 18-09, needs to be sent to the Home Help Unit for temporary approval of the Agency rate:

  • Letter of intent signed by the agency owner(s) specifying what services the agency will be providing. Additional items to be included in the letter are:
    • Contact information for the Home Help agency owner and managing employee. If the owner is the managing employee, note this in the letter.
    • If the agency is managed by a separate individual their contact information needs to be included.
    • Specify that these individuals will ensure that the agency and the agency's caregivers and employees have read all current MDHHS Home Help policies and procedures and will provide services in compliance with those requirements.
  • Copies of the Internal Revenue Service (IRS) form W-4 Employee's Withholding Allowance Certificate for all agency caregivers and agency employees.
  • Articles of organization or similar documents after registering the agency with the Department of Licensing and Regulatory Affairs or County Clerk's Office.
  • A Medicaid-enrolled home health agency must provide a copy of current Medicare certification.
  • All other agencies must provide each of the following:
    • A current copy of the Employer's Quarterly Federal Tax Return (IRS-941) demonstrating that the Federal Insurance Contributions Act (FICA) tax is paid on a quarterly basis; and
    • A current copy of the Employer's Quarterly Tax Report (UIA-1028) demonstrating the agency's payment of state unemployment insurance.

Submit all required documentation to


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