You're Approved for Home Help — What Happens Next?

An MDHHS approval letter feels like the finish line, and in a real sense it is — it means your loved one's eligibility and approved hours are documented. But there are still a handful of concrete steps between "approved" and a caregiver actually getting paid to provide care. Here's what that stretch looks like.

Step 1: Decide (or confirm) the payment path

If you haven't already chosen between self-direction and a provider agency, this is the moment to finalize it. Self-direction keeps your loved one as the legal employer, with a Fiscal Intermediary handling payroll at the state's individual rate. A provider agency becomes the legal employer instead, generally at a higher pay ceiling, and takes on the compliance and EVV administration. See our side-by-side comparison if you're still deciding.

Step 2: Caregiver onboarding begins

Whoever has been chosen as the paid caregiver — a family member or otherwise — now goes through onboarding. This includes:

• A background check
• A brief skilled-nurse intake evaluation
• CHAMPS provider enrollment, if going the agency route

This step exists regardless of which payment path you choose, and it's required before any hours can be billed.

Step 3: EVV setup

Electronic Visit Verification is a federal requirement for all paid Home Help visits, so before the first shift, the caregiver gets set up on the required check-in system, usually a mobile app. Our EVV explainer covers exactly how the check-in and check-out process works day to day.

Step 4: The first shift

Once onboarding and EVV are both complete, care can officially begin. This is usually a good moment to walk through the approved hours together as a family — which specific ADLs and IADLs are covered, and roughly how the monthly hours will be distributed across the week.

Step 5: The first pay cycle

Depending on the payment path and employer, the caregiver's first paycheck typically follows within one to two pay cycles of hours being logged and verified through EVV. Our pay schedule breakdown covers what that timeline generally looks like.

Ongoing: staying compliant

Once care is underway, a few things become routine rather than one-time events:

• Consistent EVV check-ins at every visit
• Periodic reassessment to confirm continued eligibility and appropriate hours — see our renewal guide for how to avoid a gap in coverage
• Communication with your provider agency or Fiscal Intermediary if anything about your loved one's needs changes

What if something feels off after approval?

If approved hours don't seem to match your loved one's actual level of need, or if onboarding is taking longer than expected, it's worth raising this directly with your provider agency or MDHHS caseworker rather than waiting. A reassessment can be requested if circumstances change, and agencies exist specifically to help families navigate exactly this kind of friction.