Business-type guide
Last updated: October 18, 2026
Starting a home health or non-medical home care business is not a one-license project. Skilled nursing, hands-on personal care, homemaker help, companionship, respite, and caregiver referral models can fall into different legal categories.
State rules control much of this field. Local office rules and employer requirements can add more layers, while Medicare certification is separate from state approval.
Bottom line
Choose the license by the services your workers will perform, not by the words on your website. Skilled nursing and therapy, personal care, companion-only work, homemaking, and referral models can follow different state paths.
Before signing a lease, hiring caregivers, advertising services, or accepting a client, identify the exact service list and confirm the state category. Then check local business and zoning rules, worker screening or credential requirements, employer registrations, and any payer enrollment you plan to use.
Quick start: do these checks in this order
- Write the exact service list. Separate companionship, homemaking, personal care, medication tasks, nursing, therapy, and other clinical services.
- Define the operating model. Will you employ caregivers, refer workers, use licensed clinicians, run from home, or open branches?
- Find the state regulator for that model. Use the official health, human-services, aging, or licensing agency and read its definitions.
- Confirm worker rules before hiring. Check background screening, registries, training, competency, supervision, and professional licenses.
- Check the office address. State care-agency approval does not automatically satisfy local business licensing, zoning, home-occupation, occupancy, fire, or sign rules.
- Separate payer approval from licensing. Medicare, Medicaid, waiver, managed-care, and private-insurance enrollment are separate questions.
- Set up employer accounts. Obtain the required EIN, state employer registrations, workers’ compensation, and payroll setup.
- Recheck before opening. Confirm the active license category matches every service you will advertise and provide.
What licenses and approvals are commonly involved?
There is no national license called the “home care business license.” Think in layers. The state industry license or registration is usually the most important layer, but it may not be the only one.
| Layer | What it may control | What to verify |
|---|---|---|
| State care-agency regulator | Home health, home care, personal assistance, companion/homemaker, registry, branch, administrator, screening, training, supervision, inspections | Your exact service category, application path, approved service area, renewal, and worker requirements |
| Professional licensing boards | Nurses, therapists, and other licensed clinicians | Individual license status, supervision, scope of practice, and whether the agency needs a separate clinical license |
| Federal / CMS | Medicare enrollment and certification for qualifying home health agencies | Whether you plan to participate in Medicare and whether state licensure must come first |
| City / county | General business license or tax certificate, zoning, home occupation, occupancy, fire, signs | The rules at the administrative office and any other fixed location |
| Tax and employer agencies | EIN, withholding, unemployment, workers’ compensation, new-hire reporting | Employer registrations before payroll and any state-specific accounts |
| Medicaid / other payers | Provider enrollment, waiver participation, network contracts, billing | Whether payer approval is required in addition to the business and agency licenses |
First classify the business: home health is not the same as non-medical home care
This guide covers agencies that arrange or provide services in clients’ homes. It covers two broad groups, but state law supplies the legal names.
1. Skilled home health
This generally means skilled nursing and other therapeutic or clinical services in the home. CMS describes a Medicare Home Health Agency as an organization primarily engaged in skilled nursing and other therapeutic services. States license home health agencies under their own laws.
If you plan nursing, physical therapy, occupational therapy, speech therapy, medical social services, or similar clinical services, do not assume a non-medical home care license is enough.
2. Non-medical home care
This can include companionship, homemaking, meals, errands, respite, and help with daily activities. Some states also place hands-on personal care such as bathing, dressing, toileting, transfers, or mobility assistance in this general field. The dividing line is not identical everywhere.
Florida’s homemaker-and-companion registration, for example, does not authorize personal care or nursing. Texas has a Personal Assistance Services category within its Home and Community Support Services Agency system. The same everyday phrase can therefore lead to different licenses.
Activities that may follow a different path
- Hospice: generally a separate regulated provider category.
- Nurse registry, staffing, or referral agency: states may distinguish referral models from agencies that employ and supervise caregivers.
- Private-duty nursing: may follow a separate service category, professional-practice rule, or payer program.
- Adult day care, assisted living, or residential care: facility-based care follows different rules.
- Home medical equipment: equipment supply can have separate state and federal requirements.
- Caregiver or aide training programs: a training school may need separate approval.
- Independent clinicians: an individual nurse or therapist is not automatically operating a home health agency.
- Child care: in-home child care and day care use different regulatory systems.
Federal layer: Medicare certification is separate from the state license
For a skilled home health business, the main federal question is whether the agency will enroll and qualify as a Medicare home health provider, not whether there is a general federal home-care business license.
CMS says a Home Health Agency seeking Medicare participation must meet federal health and safety requirements and be licensed under state or local law, or otherwise approved as meeting applicable licensing standards. The Home Health Agency Conditions of Participation are in 42 CFR Part 484.
Medicare enrollment moratorium is active as of October 2, 2026
CMS imposed a six-month nationwide moratorium on new Medicare enrollment for Home Health Agencies effective May 13, 2026. CMS says it halts new HHA providers, branches, and practice locations; applications received by the Medicare contractor before May 13 continue to be processed. The moratorium can be extended in six-month periods, so a prospective Medicare HHA should check the current CMS notice before building a launch date around Medicare enrollment.
Private-pay non-medical home care does not become a Medicare-certified HHA just because caregivers work in clients’ homes. Medicare certification and state home-care licensing are separate systems.
Medicaid is also separate. A state may require agency licensure first, then Medicaid or waiver-provider enrollment before public-program clients can be billed.
An Employer Identification Number is a federal tax ID, not a care license. The IRS says businesses may need an EIN for employees, certain entity types, tax filings, bank accounts, or license applications, and the IRS issues it directly without a fee.
How state licensing can differ
These official state examples show why a national yes-or-no answer would be unsafe. They are examples, not nationwide rules.
California
California separates non-medical Home Care Organizations from skilled Home Health Agencies. The Department of Social Services licenses HCOs and oversees the Home Care Aide Registry. The Department of Public Health licenses skilled HHAs.
Texas
Texas uses the Home and Community Support Services Agency, or HCSSA, framework. Applicants choose service categories in the Texas Unified Licensure Information Portal, including Personal Assistance Services, Licensed Home Health Services, and Licensed and Certified Home Health Services.
Florida
A provider furnishing companion or homemaker services and no home health service is exempt from HHA licensure but must register with the Agency for Health Care Administration. Florida says this category cannot provide personal care or nursing. A broader hands-on or clinical service plan requires a different analysis.
Pennsylvania
Pennsylvania separates non-skilled Home Care Agencies and Home Care Registries from Home Health Agencies. The non-skilled side includes personal care, instrumental-activity help, companionship, respite, and specialized care. The agency-versus-registry distinction can also matter.
New York
New York requires organizations providing or arranging home care to be licensed or certified. Licensed Home Care Services Agencies and Certified Home Health Agencies are different categories. NYSDOH describes LHCSAs as serving private-pay or privately insured clients and CHHAs as providing part-time or intermittent skilled services.
Use examples as a map, not a shortcut
Your state may use none of these names. Search the official regulator for the services you plan to perform, then read the definitions and exclusions before choosing an application.
Important 2026 changes to know
These developments materially change the startup path in the affected program or state. Do not apply them outside their stated jurisdiction.
Nationwide Medicare HHA enrollment moratorium
Effective May 13, 2026, CMS imposed a six-month nationwide moratorium on new Medicare enrollment for HHAs. Existing enrolled providers are not shut down by the moratorium. CMS can extend or lift it by public notice, so check the current federal status before submitting a new Medicare HHA enrollment.
California skilled HHA licensure moratorium
California Senate Bill 164 created a separate state moratorium on new Home Health Agency licensure effective June 29, 2026. CDPH says it continues until no later than 90 days after revised HHA regulations take effect. New HHA licenses and certain branch or service-area actions are restricted, with an exception process based on unmet need and geographic concentration. This does not replace California’s non-medical HCO licensing system.
Pennsylvania non-skilled home care moved online
Pennsylvania implemented an online application process for Home Care Agencies and Home Care Registries. The Department of Health says mailed or emailed HCA/HCR submissions are no longer accepted effective March 31, 2026.
Massachusetts enacted a new home care agency licensing framework
Massachusetts approved Chapter 180 of the Acts of 2026 on August 6, creating a home care agency licensing framework and directing the Executive Office of Health and Human Services to develop regulations and a future implementation date. Operators should follow the rulemaking rather than assume the new license is already available through a finished application system.
California HCO training change coming January 1, 2027
Beginning January 1, 2027, California requires annual training for affiliated Home Care Aides to include the special care needs of clients with dementia. New HCO applicants on or after that date must include the subject in the annual training plan submitted with the application.
City and county rules still matter
A state care-agency license answers the industry question. It may not answer the local office question. The SBA notes that licensing, permitting, zoning, and registration can depend on state and local government and on the business location.
For an administrative office, check for:
- a general business license, tax certificate, occupational license, or local registration;
- zoning approval or a home occupation permit;
- occupancy, building, fire, or sign approval for commercial space;
- rules affecting employee parking, customer visits, records storage, or business vehicles at a home office.
Do not assume state approval of your ownership or office address means the city approved the property use. Before signing a long lease, ask the local planning or zoning office whether a care-agency office is allowed at that exact address.
Your operating model can change the license path
Home-based office
Running scheduling and billing from home does not remove state care-agency rules. The city may also regulate a home office. Confirm state office, records, and inspection requirements plus local zoning before using a residential address.
Employees vs referrals
Some states distinguish agencies that employ and supervise caregivers from registries or referral businesses. Pennsylvania separates Home Care Agencies and Home Care Registries, and Florida separately regulates nurse registries. Worker classification does not by itself erase care-agency licensing.
Branches and service areas
A license may be tied to a location, service area, branch, or legal entity. Opening another office can require approval. California’s 2026 HHA moratorium, for example, also reaches certain branch and service-area actions.
Private pay vs public programs
A private-pay agency may still need state licensing. A skilled HHA seeking Medicare reimbursement must add federal enrollment and certification. Medicaid and waiver programs can add another enrollment layer.
Caregiver, employer, tax, and screening checks
Care businesses are labor-heavy, so worker compliance is part of the opening plan, not an afterthought.
Your state care regulator may require some combination of criminal background screening, registry checks, health screening, training, competency testing, orientation, supervision, continuing training, or individual professional licenses. California maintains a Home Care Aide Registry for its HCO system. Pennsylvania’s Home Care Agency and Registry rules include background and competency requirements. These examples show the pattern; use your own state’s rules for the actual checklist.
Separately, an employer may need state withholding and unemployment accounts, workers’ compensation coverage, new-hire reporting, payroll records, and federal employment-tax filings. An EIN is often part of that setup, but it is not the care-agency license.
Do not assume home care services are automatically subject to or exempt from sales tax. State tax treatment can depend on the exact service, payer, and business model. Use the state revenue agency for the tax answer rather than copying another state’s rule.
Real-world examples
Companion-only startup
You plan conversation, meal preparation, errands, and light housekeeping. Start with the state’s companion/homemaker or non-medical home-care definition. Do not add bathing, transfers, medication tasks, or nursing until you know whether those services change the license category.
Personal-care agency
You plan bathing, dressing, mobility, and other daily-living help. “Non-medical” is not enough to pick the license: Texas has a PAS category within HCSSA licensing, while Florida’s homemaker/companion registration does not authorize personal care.
Skilled home health agency
You plan nurses and therapists and eventually want Medicare reimbursement. Start with state HHA licensure, then map CMS enrollment and certification. In California, also account for the 2026 licensure moratorium and exception process.
Home office with field caregivers
Care happens at clients’ homes, but scheduling and records are kept at your house. State agency rules can still apply, and local home-occupation or zoning rules may govern the office address.
Common mistakes
- Using “home care” and “home health” as interchangeable terms. Regulators often do not.
- Copying another state’s license. HCO, HCSSA, PAS, HCA, HCR, LHCSA, and CHHA are jurisdiction-specific terms.
- Starting with an LLC instead of the service definition. Entity formation does not authorize care services.
- Adding personal care to a companion-only business without rechecking the license. That can cross a regulatory line.
- Assuming Medicare certification is the basic license. State licensure and Medicare participation are separate layers.
- Hiring first and checking screening or training later. Worker requirements can be prerequisites to assignment.
- Ignoring the office address. State approval does not automatically satisfy local zoning or business registration.
- Using an old application form or portal. Pennsylvania’s HCA/HCR process changed in 2026, and other states also update filing systems.
Home health and home care opening checklist
- Write a service list in plain language, task by task.
- Identify which services are clinical, personal care, homemaker, or companion-only.
- Confirm the state agency and exact license, registration, or service category.
- Read exclusions and exemptions, not just the application title.
- Confirm ownership, administrator, manager, nursing-supervision, or qualifying-person requirements.
- Confirm worker background, registry, training, competency, and professional-license rules.
- Check whether the office, branch, and service area need approval.
- Check city/county business license and zoning rules for the office address.
- Form the entity and register any DBA only after understanding that these filings do not replace the care license.
- Obtain an EIN and required state employer accounts before payroll.
- Map workers’ compensation and insurance requirements.
- If using Medicare, Medicaid, a waiver, or managed care, complete the separate payer enrollment path.
- Confirm every approval is active before advertising services that require it or accepting clients.
- Calendar renewal, training, registry, screening, and reporting deadlines.
What to ask the state licensing agency
Phone or email script
“I am starting an agency in [state] with an administrative office in [city/county]. We plan to provide [list the exact tasks] in clients’ homes. We will [employ caregivers / refer caregivers / employ licensed nurses or therapists], and we expect clients to pay through [private pay / insurance / Medicare / Medicaid]. Which agency license, registration, or service category applies to this exact model? Are there services on my list that require a different category? What must be approved before I hire workers, advertise, open a branch, or accept the first client? Please point me to the current application, rules, worker requirements, and renewal information.”
If the answer changes when you add bathing, transfers, medication tasks, nursing, therapy, or a referral model, ask the agency to explain that boundary before you put the service on your website or contract.
Official resources
- CMS: Home Health Agencies certification and compliance
- CMS: 2026 nationwide Home Health Agency Medicare enrollment moratorium
- CMS: Enroll as an institutional provider
- U.S. Small Business Administration: launch, registration, licenses, permits, and location
- IRS: Employer Identification Number guidance
- California CDSS: Home Care Services and Home Care Organizations
- California CDSS: Home Care Organization application process
- California CDPH: 2026 Home Health Agency licensure moratorium notice
- Texas HHSC: HCSSA service categories
- Florida AHCA: Homemaker and Companion Services Provider
- Florida Legislature: 2026 Statute 400.509
- Pennsylvania Department of Health: Home Care Agencies and Registries
- Pennsylvania Department of Health: Home Health Agency licensure
- Massachusetts: Acts of 2026, Chapter 180 home care agency licensing framework
- New York State Department of Health: Home Care and Hospice
- New York State Department of Health: LHCSA application information
Related business license guides
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FAQ
Is there one national home health or home care business license?
No. State law usually controls the core home health or home care agency license, registration, or service category. City and county rules may add business licensing or zoning. Medicare certification is a separate federal layer for qualifying home health agencies that participate in Medicare.
Is non-medical home care the same as home health?
No. Home health generally involves skilled nursing or other therapeutic services, while non-medical home care can involve companionship, homemaking, respite, personal care, or help with daily activities. The exact legal boundary and license name depend on the state.
Do I need Medicare certification to open a home care agency?
Not every home care business needs Medicare certification. Medicare enrollment and certification matter when a qualifying home health agency plans to participate in Medicare. State licensing or registration can still apply to both skilled and non-medical agencies even when Medicare is not part of the business model.
Can a companion-care business provide hands-on personal care?
It depends on the state and license category. Florida’s homemaker and companion registration does not authorize personal care or nursing, while Texas has a Personal Assistance Services category within HCSSA licensing. Confirm the boundary in your own state’s definitions before adding hands-on services.
Can I run a home health or home care agency from my house?
Possibly, but two rule sets may apply. The state care regulator may have office, records, inspection, or management requirements, and the city or county may have zoning or home-occupation rules. Confirm both before using a residential address as the agency office.
What should I check before hiring caregivers?
First confirm the agency license category and the worker rules tied to it. Then verify background screening, registries, training, competency, professional licenses, supervision, health screening, employer tax accounts, workers’ compensation, and new-hire reporting that apply in your state.
Update note
Last updated: October 18, 2026
Next review: January 16, 2027
This guide rechecked federal Medicare and EIN layers, representative state licensing systems for skilled and non-medical home care, local business and zoning layers, worker and employer issues, and material 2026 changes including the nationwide Medicare HHA enrollment moratorium, California’s skilled HHA licensure moratorium, Pennsylvania’s online HCA/HCR application transition, and Massachusetts’ new licensing framework. It also notes California’s January 1, 2027 HCO dementia-training requirement as a future rule.
Important note
This guide is general information, not legal, tax, employment, insurance, health-care, Medicare, Medicaid, or professional advice. Home health and home care definitions, licenses, registrations, exemptions, worker rules, payer requirements, local approvals, fees, forms, portals, and renewal rules can change. Confirm the current requirements with the official state regulator, local government, tax and employer agencies, and any payer program before you advertise regulated services, hire workers, sign a lease, accept clients, or pay a filing fee.