Startup setup (under 10 clients)
Start with Rosemark Starter at $49 a month. It's the only published, no-contract price in this category, and it covers what a new private pay agency actually needs: scheduling, a caregiver app, and QuickBooks billing. The catch is that Starter excludes Medicaid integrations. If Medicaid is in your first-year plan, start on Rosemark Standard at $11 per client instead.
ShiftCare is the alternative at roughly $9 per user a month. It's the cheapest way to run schedules and invoices, but it's lighter on US Medicaid EVV depth, so treat it as a private pay tool.
Skip everything else at this stage. Family portals, predictive analytics, and HR suites are features vendors sell to agencies your size that you won't use until you pass 20 clients. Every dollar of software overhead at this stage comes out of your first caregiver's wages.
Growing agency setup (10 to 50 clients)
This is where AxisCare earns the default pick. Per-client pricing means your software bill grows with revenue instead of ahead of it, and the Medicaid, VA, and LTCi billing support means adding a payer doesn't mean adding a platform. Reported starting prices sit around $200 a month, and the price is negotiable, so negotiate.
Smartcare by Aaniie and CareSmartz360 both fit this stage too. Smartcare's reported floor is $195 a month and its caregiver retention tools are a real differentiator in a labor-constrained market. CareSmartz360 starts around $10 per client with EVV integrations across 45+ states.
The switch off your startup tool costs more in time than money. Budget two to four weeks of parallel running, and export your client and caregiver records before you cancel anything.
Multi-office setup (50+ clients)
AlayaCare is the pick once you're running multiple offices or coordinators. Its scheduling engine and multi-branch reporting are built for volume, with reported pricing starting near $1,000 a month. Plan for a real implementation. Six months is a realistic timeline, and the agencies that struggle with AlayaCare are the ones that treated setup as an afterthought.
WellSky Personal Care is the incumbent alternative at this scale, reported around $100 per active client. It runs many of the largest franchise networks, and reviews split between agencies that find it all-inclusive and agencies that find it expensive. Get the full fee schedule in writing before you sign.
