A Guide for Home Care Agencies 

Learn screening standards according to differing state guidelines, private pay vs. Medicaid and VA contracts. Get an understanding of how to match your vetting process to compliance requirements, what corners aren’t worth cutting, and a simple checklist agencies can implement immediately.  Caregiver background check rules differ by state. If you miss your state’s requirements, you could face licensing violations and penalties. 

Medicare & Medicaid Funded Contracts 

If your home care agency accepts Medicare or Medicaid, federal law requires background screening. This applies identically in all 50 states and is not optional. 

Two-Part Requirement: 

Before Hire: Check the OIG Exclusion List (Office of Inspector General federal database). Verify applicants are NOT on this list before the first day of work. The OIG check is usually included in Nationwide Criminal Search Databases.  

After Hire (Monthly): Check OIG Exclusion List for every employee every month. Someone could pass the initial check but get arrested after hire. Check with your background vendor to see if monthly monitoring is available.  

Federal OIG monthly checks are separate from state requirements. Agencies with contracts with federal funding must do both. 

Private Pay vs. VA Contracts vs. Medicaid Contracts 

Background check requirements vary drastically depending on the source of funding for care. Here’s what each requires: 

Private Pay (Individual Clients Paying Out of Pocket) 

Requirements: 

• Depends entirely on the state and whether you agency is licensed 

• Some states (California, Florida): Require fingerprint based background checks for ALL hires, even private-pay only 

• Many states: Only require background checks if you accept Medicaid or Medicare 

• Some states like Wyoming and Vermont: Minimal or no background check requirements for private-pay (but most agencies do them anyway) 

Medicaid Contracts Requirements: 

• STRICT. Federal rules + state rules apply simultaneously 

• Criminal background check (state-specific) 

• FACIS III Searches – Searches OIG, GSA, Medicaid exclusions, other federal agency sanction information. Includes disciplinary action from multiple agencies and all 50 states.  

Monthly Monitoring: 

• Mandatory monthly OIG exclusion list checks for all employees. This is on an ongoing basis and never stops.  

VA Contracts (Veterans Affairs Pays) 

VA contracts offer the strictest background check rules of all. Federal VA standards are separate and broader than state/Medicaid rules. 

• VA Security Background Investigation (SBI) + NCIC (National Crime Information Center) Comprehensive fingerprint based federal check. Pulls from multiple federal databases. Takes 30-60 days. Cannot start VA employees until approved.  

• VA OIG Exclusion List: Department of Veterans Affairs’ own exclusion database. VA-specific violations like fraud involving VA benefits, abuse of VA patients. 

• HHS OIG Exclusion List:Department of Health & Human Services’ exclusion database. Federal healthcare fraud, embezzlement, false billing. Separate from VA OIG. BOTH must be checked monthly. 

• National sex offender registry – available via private background check companies.  

• State criminal check + state registries (because VA also requires state-level checks) 

State Specific Caregiver Background Check Requirements (not exhaustive).  

COLORADO: 

• CAPS Check (Adult Protective Services abuse/neglect registry) 

• DORA Dept of Regulatory Affairs Background Checks – Required for all caregivers working in the state 

TEXAS 

• DPS (Department of Public Safety) criminal check 

• Texas Dept of Aging and Disability Employability – NAR/MAR/ EMR 

• Texas Employee Misconduct Registry + Nurse Aide Registry 

ILLINOIS 

• IL Health Care Worker Registry + Illinois State Police criminal + abuse/neglect registry 

CALIFORNIA 

• DOJ fingerprint + FBI fingerprint. Required for ALL licensed agencies. 

NEW YORK 

• Home Care Registry fingerprint (state + FBI). 

MICHIGAN 

• (i-CHAT)  – Michigan Statewide Criminal Search  

• Monitoring: One-time + monthly OIG (Medicaid) or VA/HHS OIG (VA). 

NEW JERSEY 

• Licensed Caregivers: Fingerprint + registry.  

• Non-licensed: No official mandates.  

FLORIDA 

• Level 2 fingerprint based background checks (most comprehensive) 

The Bottom Line: 

If you serve multiple funding sources (private pay + Medicaid + VA), you must use the highest standard for ALL employees. You cannot screen private-pay employees lightly and VA employees strictly. One check applies to everyone, at VA level (the strictest). An employee who passes your state’s Medicaid check might still FAIL VA screening. 

Quick SnapShot: 

Private Pay: No Federal requirements but state mandates still apply  

Medicaid: State checks + federal monthly OIG.  

VA: Most strict: state checks + federal monthly VA/HHS OIG + annual VA SBI. If you serve multiple funding sources, use the highest standard (VA) for ALL employees. 

Sure Check handles state-specific checks, monthly OIG monitoring, and VA/HHS OIG checks. Contact us to set up your state-specific background check and ensure your agency is in compliance. 

Maggie Benson is the Founder and President of Sure Check Background Screening, a woman-owned, FCRA-compliant background screening company based in Golden, Colorado. Sure Check specializes in senior care, serving organizations with fast turnaround, affordable pricing, and expert guidance on state-by-state compliance.