Anyone who wants to provide care as a new provider under the Long-term Care Act (Wlz) needs a contract with the care office for care in kind. The care office purchases care for people with a Wlz indication in its region. A new purchasing policy applies to disability care for 2027 to 2029.
According to the overview by VGN, the disability care trade association, most care offices pay a new provider a target rate percentage that is 2% lower than for existing providers. Some only contract a new provider if it fills a gap in the region. That determines your revenue before you have your first client.
In short
- A contract with the care office lasts at most five years. For Wlz care with other care workers you also need a Wtza licence (€ 725, decision period 8 weeks).
- At six of the seven care offices in the VGN overview, a new provider gets the target rate percentage minus 2%. At DSW it is 91% of the NZa maximum tariff.
- On every € 1 million of care at the full NZa tariff, each percent makes a difference of € 10,000 in revenue. Include the lower rate in your budget and your cash flow.
In this article
How does a new provider get a Wlz contract?
By taking part in the care office's purchasing. The care office concludes written agreements with care providers, covering among other things the duration, volume and price of the care. An agreement lasts at most five years (Long-term Care Act, article 4.2.2).
The care offices published their purchasing policy for 2027 to 2029 on 1 June 2026. There is a joint vision and a joint policy framework, and in addition each care office has its own rules (VGN, overview of purchasing policy 2027-2029). Questions could be asked until 15 June, and the answers followed on 1 July.
In addition, you often need an admission licence. Since 1 January 2025 this requirement also applies to care providers that provide care under the Zvw or the Wlz with fewer than eleven care workers. Solo practitioners and subcontractors are exempt (CIBG, 30 December 2024). The application costs € 725 and the decision period is in principle 8 weeks (CIBG, applying for a licence).
When does a care office contract a new provider?
Only if you add something. According to the VGN overview, Zilveren Kruis only contracts new providers if they contribute to future-proof disability care and fill a gap in the region. Menzis only contracts new care providers if they have demonstrable added value for the regional care landscape (VGN, overview of purchasing policy 2027-2029).
CZ only allows expansions if they are shown to be needed and agreed with the care office. At VGZ, providers must first submit an expansion or new building to the care office (VGN). VGN itself notes that the overview is not complete and that you should always read the care office's own purchasing documents.
The reason is in the joint vision. Demand for care is growing and becoming heavier, while staff and money are limited. Care offices therefore want to take control of the future care landscape themselves (VGN). A new provider must therefore show which gap it fills: a target group, a location or a form of care that is missing.
What rate does a new provider get?
Usually a target rate percentage that is 2% lower than for existing providers. The target rate percentage (RTP) is the share of the NZa maximum tariff that the care office pays. The NZa sets maximum tariffs for the Wlz. The care office and the provider may agree lower rates, not higher ones (NZa, policy rule on care intensity packages and full package at home 2027).
In the VGN overview, Zilveren Kruis, CZ, VGZ, Menzis, Zorg en Zekerheid and Salland apply the RTP minus 2% for new providers. At Zilveren Kruis, essential care such as crisis care and respite stays does get 100%. DSW pays a new provider 91% of the NZa maximum tariff (VGN, overview of purchasing policy 2027-2029). The care offices announced the RTP for 2027 on 4 September 2026.
How the RTP is calculated was set after a ruling by the Court of Appeal of The Hague. At least 75% of providers must be able to achieve a positive result, as must the providers that together have 75% of turnover (VGN). In that case the court ruled in 2024 that the care offices' target rates were insufficiently representative of reasonable costs (ECLI:NL:GHDHA:2024:199).
What does a lower rate mean for your budget?
The lower rate comes straight off your margin, because your costs are no lower than those of an existing provider. The RTP is calculated so that a quarter of providers may make a loss. A new provider that is a further 2% lower therefore starts with less room than average.
Worked example: what does 2% less cost?
Suppose you provide care worth € 1,000,000 at the full NZa maximum tariff. Each percent of rate is then € 10,000 of revenue. An RTP that is 2% lower costs you about € 20,000 a year. At DSW the difference depends on how far 91% is below the RTP of existing providers. The amount of € 1,000,000 is an example.
Staff are the largest cost item in disability care. The Disability Care collective agreement runs until 31 December 2026 and has been declared generally binding. What a successor will cost is not yet known. On the page about the Disability Care collective agreement you can work out what an employee costs.
Also account for time. You provide care first, then claim and wait for payment. Without a contract you have no income from care in kind during that period. How to put such a period into a forecast is covered in how reliable is a cash flow forecast.
Can you start without your own contract with the care office?
Yes, in two ways, but both with drawbacks. You can provide care to clients with a personal budget (pgb). The client then pays you from their budget, instead of care in kind through the care office (Long-term Care Act, article 3.3.3). Your revenue then depends on individual clients and their budget.
You can also work as a subcontractor of a provider that does have a contract. Subcontractors are not subject to the Wtza licence requirement (CIBG, 30 December 2024). You are then dependent on the main contractor, which itself falls under the RTP and will keep part of it.
Why does the care office steer so strongly on new providers?
Because the Wlz budget is under pressure. In the 2015 reform of long-term care, an important aim was to limit spending growth, alongside more tailored care and more care at home (Maarse and Jeurissen, 2016). The Wlz remained the insurance for residential care.
Economists later pointed to incentives that did not work out well. Because long-term care was split across three schemes, costs can be shifted and care is less well coordinated (Alders and Schut, 2019). Care offices use purchasing to decide for themselves which care goes where. For a new provider this means: start the conversation with the care office early, and support with figures which demand in the region remains unmet.
Sources
- Long-term Care Act (Wet langdurige zorg), articles 3.3.3 and 4.2.2, version of 1 January 2026. wetten.overheid.nl
- VGN, Overzicht inkoopbeleid Wlz 2027-2029 gehandicaptenzorg (Overview of Wlz purchasing policy 2027-2029 for disability care), June 2026. vgn.nl
- CIBG, Wetswijziging Wtza per 1 januari 2025 (Amendment of the Wtza from 1 January 2025), news item, 30 December 2024. toetredingzorgaanbieders.nl
- CIBG, Vergunning aanvragen (Applying for a licence), accessed 1 November 2026. toetredingzorgaanbieders.nl
- NZa, Beleidsregel prestatiebeschrijvingen en tarieven zorgzwaartepakketten en volledig pakket thuis 2027 (Policy rule on care intensity packages and full package at home 2027), BR/REG-27140, Government Gazette 2026, 24797. officielebekendmakingen.nl
- Court of Appeal of The Hague, 13 February 2024, ECLI:NL:GHDHA:2024:199. rechtspraak.nl
- Maarse, H. & Jeurissen, P. (2016). The policy and politics of the 2015 long-term care reform in the Netherlands. Health Policy, 120(3), 241-245. doi.org
- Alders, P. & Schut, F. T. (2019). The 2015 long-term care reform in the Netherlands: getting the financial incentives right? Health Policy, 123(3), 312-316. doi.org