Start a Home Care Agency · All 50 States

Start Your Home Care Agency the Right Way — Licensed, Compliant, and Ready for Clients.

You know how to care for people. The licensing paperwork, policy manuals and business setup are what stall most new owners. Wherever you are in the U.S., we walk you through every step, guided by a nurse who built and ran her own agency.

How do you start a non-medical home care agency?

To start a non-medical home care agency, you form your business, confirm what license your state requires for the services you’ll offer, write policies and procedures that match your state’s regulations, apply for the license, set up insurance, hiring and training, and build a way to get clients. There is no federal license for non-medical home care. Each state sets its own rules, so the first step is always identifying your state’s licensing agency and requirements.

Last reviewed: October 2026 by Magna Johnston-Bucknor, RN, founder of CareOpsHQ and former home care agency owner.

Sound familiar?

Starting an agency shouldn't feel like guessing

Most people who want to open a home care agency are caregivers, nurses or family members who have seen what good care looks like. Then they hit the business side.

Every state is different

Advice online mixes rules from different states. You can’t tell what actually applies where you live, and one missing document can leave an application sitting incomplete.

The policy manual is overwhelming

You need written policies that match your state’s rules, and you’re not sure if the generic template you found online does.

You've been burned before

Maybe you paid a coach or bought a course and still don’t know your next step. You’re tired of advice from people who never ran an agency.

Good people who want to care for others shouldn’t give up on their agency because of paperwork. You deserve a clear path and someone who has walked it.

Your guide

Built by a nurse who started her own agency

Magna Johnston-Bucknor is a registered nurse with more than 25 years of experience across multiple specialties. She owned and operated a non-medical home care agency for six years, so she has filled out the forms, written the policies, hired the caregivers and chased the first clients herself.

That experience is why CareOpsHQ exists. We research your state’s rules, help you avoid the mistakes that cost time and money, and stay with you after your license so you have systems to grow.

What we help you with

Everything you need to open your doors, in any state

Licensing support

We identify your state’s licensing agency and the license your services require, prepare your application with you, and help you respond to state questions.

Policies & procedures

A written policy and procedure manual built around your state’s regulations and the services you will actually offer.

Agency setup

The operating pieces a new agency needs before the first client: forms, hiring workflow, intake process and your online presence.

Coaching

One-on-one virtual guidance from a nurse and former owner while you launch, plus a plan for getting your first clients.

The plan

Three steps from idea to open

Book a startup call

Tell us your state, the services you want to offer and where you are today. We’ll tell you honestly what it will take.

Get your state roadmap

You receive a step-by-step plan for your state covering license type, documents, policies, insurance, hiring and launch.

Launch with support

We prepare your application and policies with you and coach you through launch and your first clients.

Licensing by state

How home care licensing works across the United States

There is no federal license for non-medical home care. Each state decides whether and how to license these agencies, and the rules often depend on the services you offer. Hands-on personal care, such as help with bathing and dressing, is regulated more often than companion or homemaker services. Some states require a license and an inspection, a few require only a registration, and several don’t license private-pay non-medical agencies at all.

What we confirm for your state before you apply

Home Care Licensing Requirements

Question	Why it matters
Which agency licenses home care?	Usually a health department, but sometimes an aging, human services or other state office. You need the right forms from the right office.
Which license fits your services?	Companion, personal care and skilled nursing are often licensed differently. Offering one extra service can change your license type.
Application, fees and inspection	Forms, fees, required attachments and whether the state surveys you before or after licensing.
Required policies	Many states list specific policies they expect, such as client rights, complaints, emergency plans and caregiver supervision.
Staffing qualifications	Requirements for an administrator, and whether a nurse must supervise caregivers for certain services.
Caregiver training and screening	Training hours, competency checks, background checks and any registry requirements.
Insurance and employment	Liability coverage, workers' compensation and whether caregivers must be employees rather than contractors.
Medicaid and other payers	Accepting Medicaid or other programs usually requires a separate provider enrollment on top of your license.

Rules, fees and forms change. We confirm the current requirements with your state’s licensing agency when we build your roadmap. This page is general information, not legal advice.

Example: Maryland, where CareOpsHQ is based

Here’s what one state’s requirements look like, taken from the Maryland Department of Health’s Office of Health Care Quality (OHCQ):

Agencies that provide at least one home health care service, such as hands-on personal care, are licensed as Residential Service Agencies (RSAs) under COMAR 10.07.05.

Applicants submit OHCQ’s RSA License Application and supporting documents through its online submission form. The license costs $1,000 and lasts 3 years.

Agencies that only help with household tasks, such as light housekeeping, meals, shopping and errands, don’t need an RSA license.

To get and keep a license, the agency must complete a certification on employee vs. independent-contractor classification.

An outside trainer must be approved by OHCQ before training the agency’s caregivers.

Skilled, Medicare-style home health agencies need a separate license and a Certificate of Need first.

Your state will have its own version of each of these. That’s what your roadmap spells out.

Home care licensing requirements in all 50 states

Select your state to see who licenses non-medical home care, whether you need a license for personal care or companion services, key requirements, fees and a link to the official state source. We support founders in every state listed.

License requiredRegistrationNo state license for private payNew law or unclear

Alabama

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

No state license for private-pay non-medical home care was found on Alabama Department of Public Health (ADPH) pages or in state law.
Home health agencies count as 'health care facilities' under Alabama's Certificate of Need law (Ala. Code § 22-21-260), so they need CON review.

Skilled home health: Skilled home health agencies must get a Certificate of Need from the State Health Planning and Development Agency (Ala. Code § 22-21-260; Ala. Admin. Code r. 410-1-2-.05). Medicare-certified agencies are surveyed through ADPH.

Heads up: Alabama has no license category for non-medical home care, but no official page says so directly. Medicaid waiver providers must meet that program's own rules.

Official Alabama source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Alaska

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
License or registration: No license for private-pay agencies. Agencies paid by Medicaid need 'Personal Care Services (PCS) agency certification.'
Issued by: Alaska Department of Health, Division of Senior and Disabilities Services (SDS), for Medicaid PCS certification
Law and rules: 7 AAC 125.060 (PCS certification); 7 AAC 127.050 (CFC PCS); background checks 7 AAC 10.900–10.990. Facility licensing law AS 47.32.010(b) does not list non-medical or personal care agencies.
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

For Medicaid PCS: a new agency gets a 1-year probationary certification, then a 2-year standard certification. Some renewing providers can get up to 4 years.
The program administrator must finish the SDS agency administrator training before applying. They also need the 40-hour PCA training within 3 months unless they have a qualifying credential.
Agency-based PCS must keep a supervising nurse (7 AAC 125.170).
Staff need clearance through the state background check program (at least provisional) before they work with clients. The agency also needs a state business license, general liability coverage, and workers' comp.

Skilled home health: Home health agencies need a state license from Health Facilities Licensing and Certification (AS 47.32; 7 AAC 12.500–590). The initial provisional license fee runs $1,000–$3,000, based on staff size.

Heads up: Private-pay agencies appear to need only a business license. Agencies that bill Medicaid need SDS personal care certification.

Official Alaska source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Arizona

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
Law and rules: A.R.S. § 36-401 and § 36-402 (health care institution licensing) list no non-medical in-home care license category. Home health agencies are licensed under A.R.S. § 36-425.01.
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

State law licenses 'home health agencies,' meaning agencies that mainly provide skilled nursing and therapy under a physician or RN (A.R.S. § 36-151).
No separate state license category for non-medical personal care or companion agencies was found in A.R.S. Title 36, Chapter 4.

Skilled home health: Skilled home health agencies need an ADHS license from the Bureau of Medical Facilities Licensing (A.R.S. § 36-425.01; A.A.C. Title 9, Ch. 10, Art. 12). The application fee is $50 and non-refundable, with license fees on top. A license can last up to 2 years.

Heads up: Don't offer nursing or give medications. Arizona's definition of personal care includes intermittent nursing, which could raise licensing questions.

Official Arizona source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Arkansas

License required

Personal care (hands-on help): License required (tied to Medicaid billing; confirm for private pay)
Companion / homemaker only: Unclear, confirm with the state
License or registration: Private Care Agency license
Issued by: Arkansas Department of Health, Health Systems Licensing and Regulation (Health Facility Services)
Law and rules: Ark. Code Ann. § 20-10-2301 et seq.; Rules for Private Care Agencies in Arkansas (20 CAR Part 49, amended after Acts 643, 674 and 853 of 2025)
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

Licenses run on a calendar year and expire December 31.
The state must review or inspect the agency before licensing, then inspect again at least every 3 years.
Aides need at least 40 hours of training (classroom plus clinical) and 12 hours of in-service training each year. An RN must check each aide's skills.
The agency must carry at least $1,000,000 in liability insurance. Staff need criminal background and registry checks (Ark. Code § 20-38-101 et seq.; § 20-38-103).

Skilled home health: Home health agencies have a separate Home Health Agency license (Class A if Medicare-certified, Class B if not). They must get a Permit of Approval or Certificate of Need before they apply.

Heads up: The 2025 rules tie the license to agencies billing Arkansas Medicaid. Ask the Department of Health whether a private-pay-only agency needs it.

Official Arkansas source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

California

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: Home Care Organization (HCO) license
Issued by: California Department of Social Services, Community Care Licensing Division, Home Care Services Branch (HCSB)
Law and rules: Home Care Services Consumer Protection Act, Health and Safety Code § 1796.10 et seq. (definitions in § 1796.12; aide training in § 1796.44)
Fee: $5,603 for the Home Care Organization license (2-year term); $35 for Home Care Aide registration (2-year term)

Key requirements

Caregivers must be registered on the state Home Care Aide Registry, which includes a fingerprint background check and TB clearance, before they can work.
Aides need 5 hours of training before client contact (2 hours orientation, 3 hours safety) and 5 hours each year after that.
Agencies need $1M/$3M general and professional liability coverage, workers' comp, and an employee dishonesty bond.
HCSB makes unannounced visits to check compliance. The license lasts 2 years.

Skilled home health: Skilled home health agencies that provide nursing are licensed separately by the California Department of Public Health under Health and Safety Code § 1725 et seq.

Heads up: Companion and housekeeping services count as home care, so companion-only agencies need the license too. Caregivers must also be on the state Home Care Aide Registry.

Official California source →Verified on official state sources, October 2026.

Colorado

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: Home Care Agency license, Class B (personal care only; Class A covers skilled services)
Issued by: Colorado Department of Public Health and Environment (CDPHE), Health Facilities and Emergency Medical Services Division
Law and rules: C.R.S. Title 25, Article 27.5 (25-27.5-101 et seq.); 6 CCR 1011-1 Chapter 26 (Home Care Agencies, current version effective 07/01/2025) and Chapter 2 (General Licensing Standards)
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

Operating a home care agency that provides personal care without a CDPHE license is unlawful (misdemeanor; civil penalty up to $10,000 per violation) - C.R.S. 25-27.5-103.
Class B agencies may provide only personal care services and no skilled health care services.
Criminal history record check required for every person before hire or referral, run no more than 90 days before employment starts - C.R.S. 25-27.5-107.
First-time administrators must complete 24 clock hours of administration training within 12 months (8 hours in the first month) - 6 CCR 1011-1 Ch. 26, Sec. 6.4(D).

Skilled home health: Agencies providing any skilled service (licensed nurses, CNAs, therapists) need a Class A home care agency license instead; Medicare/Medicaid certification is a separate process.

Heads up: State law counts companionship as personal care, so companion-only agencies appear to need the Class B license.

Official Colorado source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Connecticut

Registration

Personal care (hands-on help): Registration required
Companion / homemaker only: Registration required
License or registration: Homemaker-Companion Agency (HCA) Registration
Issued by: Connecticut Department of Consumer Protection (DCP), License Services Division
Law and rules: Conn. Gen. Stat. 20-670 to 20-681 (Chapter 400o); Regs. Conn. State Agencies 20-670-1 et seq.; Public Act 26-50 (training)
Fee: $375 (application fee under C.G.S. 20-672(b); DCP also lists a $375 annual renewal; registrations expire October 31 each year)

Key requirements

Must hold a $10,000 minimum surety bond or insurance covering employee theft from clients (C.G.S. 20-672).
Comprehensive background check before hiring, including criminal history and sex offender registry search; in-person or video interview required.
Written contract or service plan given to the client within seven days of starting services.
Starting January 1, 2027 (Public Act 26-50): 8 paid hours of initial training within 90 days of hire, and 8 paid hours of continuing education at least every two calendar years.

Skilled home health: Agencies providing nursing or RN-supervised home health aide care are licensed separately by the Department of Public Health as home health care agencies or homemaker-home health aide agencies (Public Health Code 19-13-D66 to D92), which require RN supervision and 75-hour aide training.

Heads up: Registration covers non-medical homemaker services. New caregiver training rules start January 1, 2027. If you plan substantial hands-on care, confirm the scope with the Department of Consumer Protection.

Official Connecticut source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Delaware

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: Personal Assistance Services Agency (PASA) license
Issued by: Delaware Department of Health and Social Services, Division of Health Care Quality, Office of Health Facilities Licensing and Certification (OHFLC)
Law and rules: 16 Del. Admin. Code 3345 (Personal Assistance Services Agencies); fees per 16 Del.C. 122(3)x; background checks and drug testing per 16 Del. Admin. Code 3110
Fee: $250 initial licensure fee (per OHFLC PASA Part 1 Licensure Application, Rev. 10/31/2022)

Key requirements

Initial license is valid 90 days and cannot be renewed; an on-site survey is done in that period while the agency is already serving consumers, then an annual (12-month) license is issued.
A separate license is required for each office; licenses are not transferable and a change of ownership requires a new application.
Full-time agency director with at least an associate's degree and two years of health care or home care supervisory experience.
Direct care workers need orientation and a competency test before serving consumers and annually; all employees need criminal background checks, drug testing and pre-employment physicals.

Skilled home health: Home health agencies (including the medical-model Home Health Aide Only license under regulation 4406 with nurse oversight) are separate licenses; per OHFLC you cannot open a PASA and a home health agency at the same time, and PASAs cannot bill Medicare.

Heads up: The license covers companion and homemaker services too. You can't open a personal assistance agency and a home health agency at the same time.

Official Delaware source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Florida

License required

Personal care (hands-on help): License required
Companion / homemaker only: Registration required (no hands-on care allowed)
License or registration: Homemaker and Companion Services Provider registration (companion/homemaker only); Home Health Agency license or Nurse Registry license for hands-on personal care
Issued by: Florida Agency for Health Care Administration (AHCA), Bureau of Health Facility Regulation, Long Term Care Services Unit
Law and rules: Fla. Stat. 400.509 (homemaker/companion registration); Fla. Stat. 400.462-400.518, Part III, Ch. 400 (home health agencies); Fla. Admin. Code 59A-8 (incl. 59A-8.025)
Fee: $50.75 for the 2-year homemaker/companion registration (AHCA); statute sets $50 per biennium. Home health agency license fee is set by rule and capped at $2,000 per biennium (Fla. Stat. 400.471); exact current HHA fee not confirmed.

Key requirements

Homemakers and companions may not provide hands-on personal care (such as bathing, feeding or changing a client) under a homemaker/companion registration (Fla. Stat. 400.462; AHCA).
Homemaker/companion registration lasts 2 years; Level 2 background screening (fingerprints) is required for managing employees and financial officers, and Level 2 screening for all new homemakers/companions before hire.
Hands-on personal care is a 'home health aide' service, so it requires a Home Health Agency license (or Nurse Registry license); home health agencies that do not provide skilled care are exempt from the accreditation requirement (Fla. Stat. 400.471).
The AHCA registration or license number must appear in all advertising.

Skilled home health: Skilled home health uses the same Home Health Agency license, but agencies providing skilled care must obtain accreditation (Fla. Stat. 400.471).

Heads up: Companion and homemaker registrants may not give hands-on care like bathing or feeding. Hands-on personal care needs a Home Health Agency or Nurse Registry license.

Official Florida source →Verified on official state sources, October 2026.

Georgia

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: Private Home Care Provider (PHCP) license (services selected: Companion/Sitter, Personal Care, and/or Nursing)
Issued by: Georgia Department of Community Health (DCH), Healthcare Facility Regulation Division
Law and rules: Ga. Comp. R. & Regs. 111-8-65 (Rules for Private Home Care Providers); fees under 111-8-25-.03; owner background checks under 111-8-12
Fee: $300 application processing fee plus $250 per service offered (companion/sitter, personal care, nursing), maximum $750 annually; 25% discount if accredited (Rule 111-8-25-.03)

Key requirements

No operation without a license or provisional license; each location needs its own license (Rule 111-8-65-.05).
Fingerprint criminal records check required for the owner, administrator and direct-access employees before starting (GCHEXS).
Personal care assistants need a nurse aide credential or competency exam, or 40 hours of agency training (20 before serving clients, 20 within six months); 8 hours of annual training for each employee after the first year.
Supervisory home visits at least every 92 days for personal care and every 122 days for companion/sitter clients; RN/LPN supervision required for medically frail clients. Subject to unannounced inspections.

Skilled home health: Medicare-type home health agencies are licensed separately under Rule 111-8-31 and new or expanding home health agencies require a Certificate of Need from DCH.

Heads up: One license covers companion/sitter, personal care and nursing. You choose which services to offer and pay per service.

Official Georgia source →Verified on official state sources, October 2026.

Hawaii

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: Home Care Agency license
Issued by: Hawaii Department of Health, Office of Health Care Assurance (OHCA), State Licensing Section
Law and rules: HRS § 321-14.8; Hawaii Administrative Rules (HAR) Title 11, Chapter 11-700 (Home Care Agencies); fees in HAR Chapter 11-103.1
Fee: $1,500 initial licensure fee (HAR Chapter 11-103.1, Exhibit A, fee schedule dated 5/1/22)

Key requirements

License is valid for two years; renewal must be requested at least 30 days before expiration or the license automatically expires (HAR § 11-700-4).
OHCA staff may make unannounced inspection visits at any time (HAR § 11-700-4).
Background checks under HRS § 321-15.2 for employees and volunteers who give client care or supervise staff, including the administrator; TB clearance required before first client contact (HAR § 11-700-9).
A supervisory visit to each client's home is required at least once a year; no RN supervisor is required by the rule (HAR § 11-700-9).

Skilled home health: Nursing or clinical services are outside the home care agency license and are handled by separately regulated home health or private duty nursing agencies.

Heads up: The license covers both personal care and homemaker services.

Official Hawaii source →Verified on official state sources, October 2026.

Idaho

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
Issued by: Idaho Department of Health and Welfare (Bureau of Facility Standards handles facility licensing; Idaho Medicaid handles provider enrollment)
Law and rules: No state licensing statute for non-medical home care agencies was found. Idaho Code Title 39, Chapter 56 (Personal Assistance Services) was repealed by 2025 House Bill 91, effective July 1, 2025.
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

No state license was found for private-pay non-medical home care (personal care, companion, homemaker).
Agencies that want to bill Idaho Medicaid must enroll separately as Medicaid providers, which IDHW says is a separate process from state licensure.

Skilled home health: As of July 1, 2025, under the Streamlined Facilities Licensing and Inspection Act, Medicare-certified home health agencies no longer need an Idaho state license (Idaho Code § 39-1303), and IDHW issues no new home health licenses.

Heads up: Idaho repealed its personal assistance services law effective July 1, 2025. No official page says outright that no license is needed, so confirm with the Department of Health and Welfare.

Official Idaho source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Illinois

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: Home Services Agency license (a separate Home Services Placement Agency license applies to agencies that only place workers)
Issued by: Illinois Department of Public Health (IDPH), Office of Health Care Regulation, Division of Health Care Facilities and Programs (Home Services Program)
Law and rules: Home Health, Home Services, and Home Nursing Agency Licensing Act (210 ILCS 55); 77 Ill. Adm. Code 245; Health Care Worker Background Check Act (225 ILCS 46) and 77 Ill. Adm. Code 955
Fee: $1,500 license fee for a home services agency (IDPH renewal licensure form; 77 Ill. Adm. Code 245.95 says not to exceed $1,500 annually). Home services placement agency: not to exceed $500 annually. All fees are non-refundable.

Key requirements

IDPH first issues a provisional license valid for 240 days, then does an on-site licensure survey before the provisional license expires.
Workers need at least 10 hours of initial training (5 hours before the first assignment, 5 within 30 days, each with a competency evaluation) plus 10 hours of training every year (77 Ill. Adm. Code 245.71).
Supervisors and trainers must have at least 2 years of relevant experience within the last 5 years, or meet an alternate training qualification; an RN is not required (245.71).
Workers are subject to the Health Care Worker Background Check Act (225 ILCS 46; 77 Ill. Adm. Code 955).

Skilled home health: Skilled care requires a separate Home Health Agency license (fee $1,500 for a two-year license) or a Home Nursing Agency license under the same Act, and home services workers may not perform tasks that require a nurse license.

Heads up: Companion and homemaker workers are covered by the Home Services Agency license.

Official Illinois source →Verified on official state sources, October 2026.

Indiana

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: Personal Services Agency (PSA) license
Issued by: Indiana Department of Health (IDOH), Division of Home and Community-Based Care
Law and rules: IC 16-27-4 (Personal Services Agencies); 410 IAC 17-12-1 (TB testing); IC 20-26-2-1.5 (expanded criminal history check)
Fee: $250 non-refundable license application fee (IC 16-27-4-6(d))

Key requirements

License expires one year after issuance (IC 16-27-4-6(h)); renewal opens 60 days before expiration.
Applicants, and later staff changes and stock transfers above 5%, require an expanded criminal check or national background check.
The agency must employ a manager responsible for daily operations (IC 16-27-4-9), and the manager or a designee must be reachable 24 hours a day.
Attendant care staff must be evaluated as competent on each task before doing it without direct supervision (IC 16-27-4-16), and direct-contact staff need TB testing (IC 16-27-4-15).

Skilled home health: Home health agencies are licensed separately under IC 16-27-1, and a licensed home health agency running a PSA does not need a separate PSA license (IC 16-27-4-6(j)).

Heads up: Personal services agencies cover attendant care, homemaker and companion services, so all three need the license.

Official Indiana source →Verified on official state sources, October 2026.

Iowa

Confirm with the state

Personal care (hands-on help): Unclear, confirm with the state
Companion / homemaker only: Unclear, confirm with the state
Issued by: Iowa Department of Inspections, Appeals, and Licensing (DIAL), Health Facilities Division (for any licensed or registered health facility types); Iowa HHS / Iowa Medicaid for Medicaid provider enrollment
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

DIAL's official list of health facility types it regulates includes Home Health Agencies but no non-medical home care or personal care agency category.
Health care employment agencies that supply direct care staff to certain health care facilities must register with DIAL each year (Iowa Code ch. 135Q). This appears aimed at facility staffing, not in-home care for private clients.

Skilled home health: Iowa's Medicaid home health manual ties home health agency participation to Medicare certification; DIAL lists Home Health Agencies among the facility types it oversees.

Heads up: We could not confirm Iowa's rules on an official state source. Contact the Department of Inspections, Appeals, and Licensing, Health Facilities Division, at (515) 725-5341 before you plan.

Official Iowa source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Kansas

License required

Personal care (hands-on help): License required
Companion / homemaker only: Unclear, confirm with the state
License or registration: Home Health Agency license - Non-Medical Supportive Care Services level
Issued by: Kansas Department of Health and Environment (KDHE), Bureau of Facilities and Licensing
Law and rules: K.S.A. 65-5101 et seq. (esp. 65-5101, 65-5102, 65-5104, 65-5117); K.A.R. 28-51-101 et seq.
Fee: Supportive-care-only agencies: initial $250 (fewer than 100 clients) or $500 (100+); annual renewal $100 (<100) or $350 (100+). Agencies with home health or HCBS services: initial $500/$750, renewal $350/$600 (K.A.R. 28-51-101).

Key requirements

K.S.A. 65-5102: any agency providing home health, supportive care (non-medical help with bathing, dressing, eating, toileting, etc.) or HCBS attendant care services must be licensed; no services may be provided before the license is issued (K.A.R. 28-51-101).
License lasts one year and is renewed annually with an annual report and fee (K.A.R. 28-51-101; K.S.A. 65-5104).
Application must include evidence of licensure and a resume for an administrator and an alternate administrator; KDHE recommends a KDHE-approved home health administrator course.
Criminal record checks of staff are required under K.S.A. 65-5117 (KanCheck system being phased in).

Skilled home health: Skilled (medical) home health requires the higher 'Skilled Services' home health agency license level, which must include nursing services and a provider's order; it also covers HCBS and non-medical care.

Heads up: Hands-on personal care needs a license. Whether a companion- or chore-only agency needs one isn't stated, so confirm with KDHE.

Official Kansas source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Kentucky

License required

Personal care (hands-on help): License required
Companion / homemaker only: Unclear, confirm with the state
License or registration: Personal Services Agency certification
Issued by: Cabinet for Health and Family Services, Office of Inspector General (OIG), Division of Health Care
Law and rules: KRS 216.710-216.716; 906 KAR 1:180 (current version eff. 11-24-2025)
Fee: $500 initial application; $350 annual recertification; $350 change of ownership (906 KAR 1:180)

Key requirements

No personal services agency may operate, maintain or advertise without an OIG certificate (KRS 216.712); certification is renewed annually, with recertification due at least 60 days before expiration (906 KAR 1:180 Sec. 4).
Agency must employ a manager (906 KAR 1:180 Sec. 6).
Before providing direct services, staff need a criminal record check, nurse aide/home health aide abuse registry and caregiver misconduct registry checks, a drug test and a TB risk assessment (906 KAR 1:180 Sec. 6).
Pre-service training on abuse/neglect reporting, medication assistance and communication; staff serving clients with dementia need 6 hours initial and 3 hours annual dementia training (906 KAR 1:180 Sec. 7; KRS 216.713).

Skilled home health: Home health agencies are separately licensed by OIG as health facilities under KRS Chapter 216B (separate Home Health Agency application) and are excluded from personal services certification.

Heads up: Businesses offering only house cleaning, laundry, shopping or transportation are excluded. Whether a companion- or sitter-only agency needs certification depends on how the law is read, so confirm with the Office of Inspector General.

Official Kentucky source →Verified on official state sources, October 2026.

Louisiana

License required

Personal care (hands-on help): License required
Companion / homemaker only: No state license
License or registration: Home and Community-Based Services (HCBS) Provider license - Personal Care Attendant (PCA) module
Issued by: Louisiana Department of Health (LDH), Health Standards Section
Law and rules: La. R.S. 40:2120.1 et seq. (definitions at 40:2120.2); LAC 48:I, Chapters 50-51
Fee: HCBS license: $600 initial, $600 renewal (per LDH Health Standards fee page); adding the PCA module to an existing license is $200; FNR fee $200 (referenced on the same page).

Key requirements

PCA module requires Facility Need Review (FNR) approval before applying for the license (LAC 48:I.5005.H); applicants must also complete LDH's required HCBS provider training.
An announced on-site initial licensing survey is required before a license is issued; the provider must be operational and serving one client at survey time (LAC 48:I.5009).
License is valid for one year from issuance (LAC 48:I.5005.B).
Statewide criminal background checks on unlicensed direct care staff are required under R.S. 40:1203.1 et seq. (LAC 48:I.5027).

Heads up: Agencies that only provide sitter or housekeeping services are exempt. Personal care agencies need Facility Need Review approval before they can apply.

Official Louisiana source →Verified on official state sources, October 2026.

Maine

License required

Personal care (hands-on help): License required
Companion / homemaker only: Unclear, confirm with the state
License or registration: Personal Care Agency (PCA) license
Issued by: Maine Department of Health and Human Services, Division of Licensing and Certification (DLC)
Law and rules: 22 M.R.S. §1717; 10-144 CMR Ch. 129 (Personal Care Agency Licensing Rule, adopted 8/20/2024)
Fee: Statute: licensing fees set by rule at no less than $200 and no more than $2,000 (22 M.R.S. §1717(2-B)(J)); application fees are nonrefundable.

Key requirements

Since July 1, 2024, an entity may not provide home care services (help with activities of daily living and related tasks) without a personal care agency license (22 M.R.S. §1717(2-A)); operating unlicensed can bring fines of $500 to $10,000 per day.
License types: provisional (3-12 months), full (up to 24 months), conditional (up to 12 months) (22 M.R.S. §1717(2-C)).
Comprehensive background checks are required for direct access staff and their supervisors, plus a Maine Registry check before hiring direct care workers (22 M.R.S. §1717(3), (3-A)).
DHHS may enter and inspect agencies; DLC reports it is running 6-9 months behind normal processing and inspection timelines.

Skilled home health: Home health care providers licensed under 22 M.R.S. Chapter 419 are excluded from the personal care agency definition and licensed separately.

Heads up: Maine replaced registration with licensing in 2024. Detailed fee amounts come from an unofficial copy of the rule, so confirm them with the Division of Licensing and Certification.

Official Maine source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Maryland

License required

Personal care (hands-on help): License required
Companion / homemaker only: No state license
License or registration: Residential Service Agency (RSA) license
Issued by: Maryland Department of Health, Office of Health Care Quality (OHCQ)
Law and rules: Health-General §19-4A-01 et seq.; COMAR 10.07.05
Fee: $1,000 nonrefundable for a 3-year license (initial and renewal); $250 per additional pre-licensure on-site visit (COMAR 10.07.05.04)

Key requirements

License is valid for 3 years; OHCQ may do an announced or unannounced on-site inspection before approving a license (COMAR 10.07.05.04).
To get and keep an RSA license, the agency must complete OHCQ's RSA Certification on personal care aide employment classification (Health-General §19-4A-11).
Staff need a State criminal history records check or a private agency background check (COMAR 10.07.05.10), and required training includes personal care skills, CPR, infection control and abuse/neglect prevention. Outside trainers need written OHCQ approval (COMAR 10.07.05.11).
Clients needing ADL help must get a certified caregiver, with periodic on-site RN supervision (at least every 4 months, or more often when staff help with medications) (COMAR 10.07.05.10E, 10.07.05.12E).

Skilled home health: Home health agencies are licensed separately under Health-General Title 19, Subtitle 4 (and need a Certificate of Need from the Maryland Health Care Commission). They are excluded from the RSA definition.

Heads up: Agencies that only help with household tasks, such as light housekeeping, meals, shopping and errands, do not need a license. Any hands-on help requires one.

Official Maryland source →Verified on official state sources, October 2026.

Massachusetts

New law, licensing starting

Personal care (hands-on help): License required under a 2026 law (not in effect yet)
Companion / homemaker only: License required under a 2026 law (not in effect yet)
License or registration: Home care agency license (temporary licenses to be issued first during implementation)
Issued by: Executive Office of Health and Human Services (EOHHS), working with the Executive Office of Aging & Independence and the Department of Public Health
Law and rules: Chapter 180 of the Acts of 2026 ('An Act to Improve Massachusetts Home Care'), adding M.G.L. c. 6A, sections 16HH-16KK; implementing regulations not yet adopted
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

No person or entity may hold itself out as a home care agency without an EOHHS license (c. 6A, s. 16II); license term is 3 years, non-transferable.
Background checks on workers (MA criminal record, out-of-state checks for past 5 years, federal OIG exclusion list, nurse aide registry) and on owners with 5% or more ownership.
Annual ongoing training and competency requirements, plus minimum workers' compensation and liability insurance, to be set by regulation.
Penalties can include license denial, suspension or revocation and fines up to $500 per day of noncompliance.

Skilled home health: Medicare-type home health agencies (licensed under M.G.L. c. 111, s. 51K) and hospice are exempt from the new home care agency license.

Heads up: The law was signed August 6, 2026. Regulations, fees and the date agencies must be licensed haven't been set yet. Watch for state guidance.

Official Massachusetts source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Michigan

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

No state license exists for non-medical home care; the Michigan Attorney General's consumer checklist calls it 'an unregulated industry.'
Agencies serving Medicaid programs (e.g., MI Choice waiver, Home Help) must meet MDHHS provider enrollment and program standards instead of a license.

Skilled home health: LARA states that state licensing is not required even for home health agencies; skilled agencies instead seek Medicare/Medicaid certification, with LARA conducting surveys on behalf of CMS.

Heads up: The Michigan Attorney General describes non-medical home care as an unregulated industry. Agencies serving Medicaid programs must meet those programs' rules.

Official Michigan source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Minnesota

License required

Personal care (hands-on help): License required
Companion / homemaker only: Registration for housekeeping, meals or shopping; companion-only unclear
License or registration: Basic Home Care Provider License (hands-on help with dressing, bathing, grooming, toileting, etc.); Comprehensive Home Care Provider License (adds medication management, transfers, treatments); Home Management Provider Registration for chore-only services
Issued by: Minnesota Department of Health (MDH), Health Regulation Division - Home Care Provider licensing
Law and rules: Minn. Stat. chapter 144A, sections 144A.43-144A.4799 (license requirement 144A.471; licensing 144A.472; temporary license and survey 144A.473; home management registration 144A.482)
Fee: Initial temporary license application fee: $2,100 (basic) or $4,200 (comprehensive) per Minn. Stat. 144A.472, subd. 7. Home management registration: $20/year for individuals, $50/year for organizations (144A.482).

Key requirements

Home care services may not be provided without a temporary or current MDH home care provider license (144A.471, subd. 1).
New applicants receive a temporary license (up to 1 year); MDH surveys the provider within 90 days after it reports serving clients, then issues a basic or comprehensive license if in substantial compliance (144A.473). Licenses renew annually.
Owners, managerial officials and the named RN or licensed health professional must pass background studies.
Unlicensed staff must complete a training and competency evaluation, or pass written/oral and practical skills tests (144A.4795).

Skilled home health: Only comprehensive licensees may seek Medicare certification as a home health agency; Minnesota uses the same chapter 144A license framework for skilled care.

Heads up: Agencies doing only housekeeping, meal prep or shopping register instead of getting a license. Companion-only service isn't named in the law, so confirm with the Department of Health.

Official Minnesota source →Verified on official state sources, October 2026.

Mississippi

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

The Mississippi State Department of Health's Health Facilities Licensure division lists the types it licenses (hospitals, nursing homes, home health agencies, hospices, personal care homes, assisted living, etc.); non-medical in-home care agencies are not among them.
'Personal care homes' licensed by MSDH are residential facilities, not in-home agencies.

Skilled home health: Home health agencies (skilled nursing plus at least one other service) are licensed by MSDH under Miss. Code Ann. 41-71-1 et seq. and 15 Miss. Admin. Code Pt. 16, Ch. 46, with an inspection required before licensure.

Heads up: Mississippi has no license category for non-medical in-home agencies, but no official page says so directly. Medicaid waiver providers have their own requirements.

Official Mississippi source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Missouri

No state license

Personal care (hands-on help): No state license for private pay (Medicaid needs a state contract)
Companion / homemaker only: No state license
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

Missouri DHSS states that for private duty/private pay companies 'NO license issued in MO for this type of company' and 'No government oversight.'
Medicaid In-Home Care (home and community-based services) 'requires a contract with the state,' overseen by Missouri Medicaid Audit and Compliance (MMAC).

Skilled home health: Home health agencies (two or more services such as nursing, therapy or home health aide under a written plan of treatment) need a state home health license from DHSS's Bureau of Home Care and Rehabilitative Standards under RSMo 197.400-197.477.

Heads up: The Department of Health and Senior Services states there is no license for private-pay companies. Serving Medicaid clients requires a state contract.

Official Missouri source →Verified on official state sources, October 2026.

Montana

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
Issued by: Montana DPHHS, Office of Inspector General, Licensure Bureau (licenses home health agencies only)
Law and rules: Mont. Code Ann. 50-5-101 (health care facility and home health agency definitions); Home Health Agency rules (Administrative Rules of Montana, linked from DPHHS)
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

State law licenses 'home health agencies', defined as agencies whose home health services include a licensed registered nurse plus at least one other therapeutic service (MCA 50-5-101).
The list of licensed 'health care facilities' in MCA 50-5-101 has no category for non-medical personal care, companion or homemaker agencies.
Home health agencies get a 6-month provisional license and an on-site survey, and may not accept patients until licensed (DPHHS HHA letter, 2025).

Skilled home health: Skilled home health agencies (RN plus another therapeutic service) must be licensed by the DPHHS Licensure Bureau; Medicare certification is a separate process through the Certification Bureau.

Heads up: Only home health agencies with RN services are licensed. No official page says outright that non-medical agencies are exempt, so confirm with the Licensure Bureau.

Official Montana source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Nebraska

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
Issued by: No licensing agency for non-medical in-home personal services agencies. Home health agencies are licensed by Nebraska DHHS, Division of Public Health, Licensure Unit (Office of Outpatient and In-Home Care Services).
Law and rules: Neb. Rev. Stat. 71-6501 to 71-6504 (in-home personal services agencies and workers); Neb. Rev. Stat. 71-417 and 175 NAC 14 (home health agencies)
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

State law defines 'in-home personal services' (attendant, companion and homemaker services that do not require medical or nursing judgment) and sets standards for workers, not an agency license (Neb. Rev. Stat. 71-6501).
Workers must be at least 18, have no disqualifying criminal convictions, have no adverse findings on the Adult Protective Services Central Registry, and have training sufficient for the services offered (71-6502).
The agency must run a criminal background check on each worker, check the driving record if driving is part of the job, and keep the documents at its place of business (71-6503).

Skilled home health: A 'home health agency' (skilled nursing or at least one other therapeutic service, which includes home health aide services) must be licensed by DHHS under 175 NAC 14, and the statute says a home health agency may also be an in-home personal services agency.

Heads up: There is no agency license, but state law sets standards for workers. Hands-on care can be a gray area, so confirm with the DHHS Licensure Unit.

Official Nebraska source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Nevada

License required

Personal care (hands-on help): License required
Companion / homemaker only: Unclear, confirm with the state
License or registration: License to operate an agency to provide personal care services in the home (personal care agency)
Issued by: Nevada Health Authority, Health Care Purchasing and Compliance Division (Bureau of Health Care Quality and Compliance, formerly under the Division of Public and Behavioral Health); standards adopted by the State Board of Health
Law and rules: NRS Chapter 449B (Agencies to Provide Personal Care Services and Related Entities, added 2025), e.g. NRS 449B.015, 449B.050, 449B.100, 449B.465; NAC 449 (personal care agency sections incl. NAC 449.3973-449.3977)
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

No one may operate a personal care agency without first obtaining a license (NRS 449B.100). A license expires December 31 and is renewable for 1 year (NRS 449B.210).
A surety bond is required: $5,000 (fewer than 7 employees), $25,000 (7 to 25) or $50,000 (more than 25) (NRS 449B.185).
Applicants submit fingerprints for state and FBI checks. Employees and contractors are screened within 10 days of hire and re-checked at least every 5 years (NRS 449B.300, 449B.310).
Applicants need elder-abuse prevention training before licensure and every year (NRS 449B.225). Attendants must be at least 18 and get at least 8 hours of training each year (NAC 449.3975).

Skilled home health: Skilled nursing in the home falls under a separate 'agency to provide nursing in the home', classified as a medical facility under NRS 449.0151.

Heads up: In 2025 this law moved to NRS 449B and the licensing bureau moved to the Nevada Health Authority. Confirm current forms and fees. Companion-only status is unclear.

Official Nevada source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

New Hampshire

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: Home Care Service Provider Agency (HCSPA) license
Issued by: NH Department of Health and Human Services, Health Facilities Administration (Health Facilities Licensing)
Law and rules: RSA 151 (incl. RSA 151:2 and 151:9-a); N.H. Code Admin. R. He-P 822 (Home Care Service Provider Agencies)
Fee: Official DHHS page: Personal Care Providers (822), fewer than 10 clients $25.00; 10 or more clients $100.00. He-P 822.04 rule text says $250 if serving more than 10 clients (see notes).

Key requirements

A license is required for any organization that provides personal care (non-medical hands-on help with ADLs) or homemaker services, including companion services, through its employees (He-P 822.02, 822.03).
An inspection must be completed before the license is issued. The license is valid about 1 year and expires at the end of the issue month the following year (He-P 822.05, 822.06).
Criminal records check through NH Department of Safety and BEAS registry check for staff. Pre-contact orientation, annual in-service training, and a minimum 8-hour training before hands-on personal care such as bathing, dressing or transfers (He-P 822.17).
Physical or health screening and two-step TB testing are required before client contact (He-P 822.17).

Skilled home health: Skilled home health care providers are licensed separately under He-P 809 (DHHS lists a $250.00 fee).

Heads up: The state's posted fees conflict ($25/$100 on the DHHS page vs. $250 in the rule text). Confirm the fee with DHHS before you apply.

Official New Hampshire source →Verified on official state sources, October 2026.

New Jersey

Registration

Personal care (hands-on help): Registration required
Companion / homemaker only: Registration required
License or registration: Health Care Service Firm (HCSF) registration
Issued by: NJ Office of the Attorney General, Division of Consumer Affairs, Regulated Business Section
Law and rules: N.J.S.A. 34:8-43 et seq., esp. 34:8-45.1 (as amended by P.L. 2014, c. 29); N.J.A.C. 13:45B-13 (health care service firms) and 13:45B-7.1 (fees)
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

Any entity that employs, places or refers workers for companion, health care or personal care services in the home of a person with a disability or an adult 60 or older must register as an HCSF. P.L. 2014, c. 29 removed the old companion and housekeeping-only exemption.
Registered firms must get accreditation within 12 months of registration from an accrediting body recognized by the Commissioner of Human Services, and keep it (P.L. 2014, c. 29; DCA HCSF page).
A $10,000 bond is required, and the Director may waive it for firms with a net worth of $100,000 or more (N.J.A.C. 13:45B-13.3).
Hands-on aides are Certified Homemaker-Home Health Aides (CHHAs), certified by the NJ Board of Nursing. They need a criminal background check before employment and at least 76 hours of approved training (N.J.A.C. 13:37-14.4).

Skilled home health: Skilled home health agencies are licensed by the NJ Department of Health under N.J.A.C. 8:42, require a Certificate of Need first (N.J.A.C. 8:42-2.1), and are excluded from HCSF registration.

Heads up: Firms must become accredited within 12 months of registering. A 2026 law reportedly changed the registration expiration date, so confirm current dates with Consumer Affairs.

Official New Jersey source →Verified on official state sources, October 2026.

New Mexico

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
License or registration: None for non-medical agencies. The state license that exists is the Home Health Agency license (8.370.22 NMAC), which covers only agencies providing medically directed services.
Issued by: New Mexico Health Care Authority (the licensing authority named in 8.370.22 NMAC)
Law and rules: 8.370.22 NMAC (Requirements for Home Health Agencies), effective July 1, 2024; definition at 8.370.22.7(K); fees at 8.370.3 NMAC
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

Under 8.370.22.7(K), the definition of 'home health agency' excludes any business 'providing non-medically directed services in a patient/client's place of residence.'
'Medically directed services' means services provided under a plan of care that a physician reviews and approves at least annually (8.370.22.7(S)). Agencies without that physician-directed plan fall outside home health licensure.
A licensed home health agency may also provide non-medically directed services.

Skilled home health: Agencies providing medically directed (physician-approved plan of care) services need a Home Health Agency license: $300 initial or renewal (8.370.3.10 NMAC), annual term, and an initial survey requested after the agency accepts its first patient.

Heads up: New Mexico licenses only agencies providing physician-directed services. Confirm with the Health Care Authority before launch.

Official New Mexico source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

New York

License required

Personal care (hands-on help): License required
Companion / homemaker only: Unclear, confirm with the state
License or registration: Licensed Home Care Services Agency (LHCSA)
Issued by: New York State Department of Health, with approval by the Public Health and Health Planning Council (PHHPC)
Law and rules: Public Health Law Article 36 (§§ 3602, 3605, 3605-b); 10 NYCRR Part 765 (public need at 765-1.16)
Fee: $2,000 non-refundable application fee (per NYSDOH LHCSA Application Requirements FAQ)

Key requirements

Public need: if 5 or more LHCSAs are actively serving patients in a county, the state presumes no new LHCSA is needed there. Applicants must submit a data-driven rebuttal for each county.
Financial feasibility: working capital must cover at least the first two months of projected expenses. Character, competence and financial resources are reviewed (PHL § 3605(4)).
PHHPC must approve the application (it meets six times a year). The agency then submits a policies and procedures manual and passes a pre-opening survey before the license is issued.
Every LHCSA must register with DOH each year (PHL § 3605-b). Late or incomplete registration costs $500 per month, and missing registration for two annual periods triggers license revocation proceedings.

Skilled home health: Medicare-certified home health in New York is a Certified Home Health Agency (CHHA), which holds a separate certificate of approval under Article 36 instead of an LHCSA license.

Heads up: New applicants must show public need in each county they want to serve. A bill to bring back a moratorium was pending but has not become law.

Official New York source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

North Carolina

License required

Personal care (hands-on help): License required
Companion / homemaker only: Separate Home Assistance Services Provider license
License or registration: Home Care Agency license (in-home aide / hands-on personal care). Companion, sitter, respite and homemaker-only businesses: Home Assistance Services Provider license.
Issued by: NC Department of Health and Human Services, Division of Health Service Regulation (DHSR), Acute and Home Care Licensure and Certification Section
Law and rules: N.C.G.S. 131E-135 et seq. (definitions at 131E-136; licensure at 131E-138); 10A NCAC 13J; Session Law 2023-150 (home assistance services providers)
Fee: $510 initial home care license (nonrefundable); $510 annual renewal (DHSR fee schedule; G.S. 131E-138(c))

Key requirements

Home care agencies: each site needs its own license. Licenses run on a calendar year (expire December 31) and renew annually. Applicants must show prior ownership of a home care agency or complete home care provider training, and must pass an initial review against the Initial Home Care Survey Checklist.
An RN must be available for supervision and consultation whenever in-home aide services are provided. An LPN cannot do aide assessments or supervisory visits.
Home assistance services providers (companion, sitter, respite, homemaker with no hands-on care) must carry liability insurance, tell clients they do not provide health or hands-on care, run criminal background checks in every state each worker lived in during the past 7 years, verify driver records, and attest to compliance every year (131E-138(h)).
Home assistance services providers may not bill health insurers, Medicaid or health plans, and may not hire people with relevant convictions or anyone on the National Sex Offender Public Website (131E-138(i)).

Skilled home health: A home care agency that wants Medicare reimbursement (a 'home health agency') must also get a Certificate of Need. State-licensed-only home care agencies do not need a CON.

Heads up: Companion, sitter, respite and homemaker-only businesses have had their own license since 2023. Confirm the current application process with DHSR.

Official North Carolina source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

North Dakota

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
License or registration: None for non-medical agencies. State licensure applies only to Home Health Agencies (N.D.C.C. ch. 23-17.3).
Issued by: North Dakota Department of Health and Human Services, Health Facilities Unit (home health licensure); HHS Adults and Aging, Qualified Service Provider (QSP) program (Medicaid/state-funded services)
Law and rules: N.D.C.C. ch. 23-17.3; N.D. Admin. Code ch. 33-03-10.1 (home health agencies)
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

Licensure covers 'home health agencies,' whose services by law 'must include the services of a currently licensed registered professional nurse' and need the approval of a physician or allowed practitioner (N.D.C.C. 23-17.3-01). A licensed agency must provide skilled nursing plus at least one other therapeutic service (23-17.3-05).
Agencies serving public-pay (Medicaid/state-funded) clients must enroll as an agency QSP. Each direct-care worker needs a documented competency (SFN 749, valid 5 years) or a current ND CNA/LPN/RN license, and the agency must verify identity and screen workers before they provide services.
Per the QSP agency handbook, QSP agency names may not include 'home health agency,' 'home health care' or 'home health services.'

Skilled home health: Home health agencies need an HHS license before operating. They are inspected before the initial license is issued, and licenses expire December 31 each year (N.D. Admin. Code 33-03-10.1).

Heads up: Only home health agencies with RN services are licensed. Agencies serving public-pay clients must enroll as Qualified Service Providers.

Official North Dakota source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Ohio

License required

Personal care (hands-on help): License required
Companion / homemaker only: Unclear, confirm with the state
License or registration: Nonmedical Home Health Services License (a Skilled Home Health Services License also covers nonmedical services)
Issued by: Ohio Department of Health (ODH), Home Health Agency Licensure
Law and rules: Ohio Revised Code Chapter 3740 (definitions at 3740.01; license requirement at 3740.02; application at 3740.03); Ohio Admin. Code Chapter 3701-60 (rule 3701-60-03)
Fee: $250 non-refundable license fee (OAC 3701-60-03; ODH licensure page)

Key requirements

Any agency providing nonmedical home health services through employees, or holding itself out as a provider of them, must hold a nonmedical or skilled license (ORC 3740.02). Nonmedical services include hands-on bathing, help with dressing, toileting and ambulation, meal preparation and feeding, and personal care services (ORC 3740.01).
For a nonmedical license, the primary owner must submit a fingerprint impression card. A criminal records check alone is not accepted.
Applicants whose business was not operating on or immediately before September 30, 2021 must obtain a $20,000 surety bond for a nonmedical license ($50,000 for skilled).
Licenses are valid for 3 years. Renewal applications are timely if filed at least 90 days before expiration (OAC 3701-60-03).

Skilled home health: Agencies providing any skilled service (nursing, PT/OT/speech, medical social services) need a Skilled Home Health Services License, which requires CMS, accreditation or Ohio Department of Aging certification or compliance with the Medicare Conditions of Participation, plus a $50,000 bond for new businesses.

Heads up: Licensing became mandatory in 2022. The law doesn't mention companion-only services, so confirm with the Ohio Department of Health.

Official Ohio source →Verified on official state sources, October 2026.

Oklahoma

License required

Personal care (hands-on help): License required
Companion / homemaker only: Separate Companion or Sitter Service license
License or registration: Home Care Agency license (covers skilled and/or personal care); separate Companion or Sitter Service license for companion/sitter-only agencies
Issued by: Oklahoma State Department of Health (OSDH), Medical Facilities Service – Home Services Division
Law and rules: Home Care Act, 63 O.S. § 1-1960 et seq. (license required: § 1-1962; companion/sitter: § 1-1972); Okla. Admin. Code Title 310, Chapter 662 (Subchapter 8 covers sitter/companion services)
Fee: Home care agency: initial application fee up to $3,000 (nonrefundable); renewal $500; branch office $25 (63 O.S. § 1-1965(B)). Companion/sitter service: $1,000 initial, $500 renewal (OAC 310:662-8-2).

Key requirements

Home care agency licenses expire July 31 each year (63 O.S. § 1-1965(E)(4)).
Companion/sitter services (household tasks, shopping, meal prep, fellowship, non-personal care) must be licensed with OSDH; a licensed home care agency may also provide them under its existing license (§ 1-1972(C), (H)).
Supportive home assistants must complete agency-based training taught by an RN, pass independent competency testing, and clear a criminal background check and nurse aide registry check before providing services (§ 1-1962(B)).
Companion/sitter license applicants must show workers' comp and liability insurance of $100,000 per occurrence / $300,000 aggregate (OAC 310:662-8-2).

Skilled home health: Skilled and personal care both fall under the same Home Care Agency license in Oklahoma; Medicare certification for skilled home health is a separate federal process.

Heads up: Companion and sitter-only agencies need their own license from the State Department of Health.

Official Oklahoma source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Oregon

License required

Personal care (hands-on help): License required
Companion / homemaker only: Unclear, confirm with the state
License or registration: In-Home Care Agency license (classified as Limited, Basic, Intermediate, or Comprehensive)
Issued by: Oregon Health Authority (OHA), Public Health Division – Health Care Regulation and Quality Improvement
Law and rules: ORS 443.305 to 443.350 (license: ORS 443.315); OAR 333-536 (In-Home Care Agencies)
Fee: Initial: Limited $2,000; Basic $2,250; Intermediate $2,500; Comprehensive $3,000; each subunit $1,250. Renewal: Limited/Basic $1,000; Intermediate $1,250; Comprehensive $1,500; each subunit $1,000 (ORS 443.315(4)).

Key requirements

License class depends on medication/nursing services: Limited (medication reminding only), Basic (adds medication assistance), Intermediate (adds medication administration), Comprehensive (adds nursing services) (OAR 333-536-0007).
OHA must survey each agency at least once before services begin, then once every three years (OAR 333-536-0041).
License is valid for one year (ORS 443.315(5)).
Caregivers need at least 4 hours of agency orientation and 8 hours of initial training (2 before services start), plus 6 hours of annual education (OAR 333-536-0070, as amended Oct. 2023).

Skilled home health: Home health agencies are licensed separately under ORS 443.015 and do not need an in-home care license to provide personal care (ORS 443.090).

Heads up: Housekeeping-only agencies are exempt. The law was amended in 2026, so recheck fees. Companion-only status is unclear.

Official Oregon source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Pennsylvania

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: Home Care Agency license or Home Care Registry license
Issued by: Pennsylvania Department of Health, Division of Home Health
Law and rules: 28 Pa. Code Chapter 611 (Home Care Agencies and Home Care Registries); Health Care Facilities Act
Fee: $100 per application or renewal, per licensed location (28 Pa. Code § 611.2(e))

Key requirements

'Home care services' include personal care, help with IADLs, companionship, respite and specialized care, so companion-only agencies are covered (28 Pa. Code § 611.5).
The Department inspects before issuing an initial license or a renewal, and each physical location must be licensed separately (§ 611.2).
Before assignment, direct care workers must hold a PA nursing license, pass an agency competency exam, or finish an approved training program, with competency reviewed yearly (§ 611.55).
Workers need a criminal history check (State Police, or FBI plus a Dept. of Aging determination if they lived in PA under 2 years) (§ 611.52).

Skilled home health: Home health care agencies are exempt from Chapter 611 (§ 611.3(a)) and licensed separately by the Department of Health.

Heads up: Companionship is listed as a home care service, so companion-only agencies need a license. Since March 31, 2026, applications are online only.

Official Pennsylvania source →Verified on official state sources, October 2026.

Rhode Island

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required for homemaker services; companion-only unclear
License or registration: Home Care Provider license (non-skilled); Home Nursing Care Provider license (skilled)
Issued by: Rhode Island Department of Health (RIDOH), Center for Health Facilities Regulation
Law and rules: R.I. Gen. Laws Chapter 23-17 (§§ 23-17-10, 23-17-42); 216-RICR-40-10-17 (Licensing Home Nursing Care Providers and Home Care Providers); fees in 216-RICR-10-05-2
Fee: $650 annual licensure fee (216-RICR-10-05-2, Home Care Provider)

Key requirements

Licenses last no more than one year and expire December 31; renewal requires inspection and approval (216-RICR-40-10-17.4.3).
Home care provider services need RN supervision; nursing assistants must be supervised by a RI-licensed RN at least every three months (§§ 17.3.A, 17.6.6).
Homemakers need at least 20 hours of classroom training plus 5 hours of practical experience and must pass a final exam (§ 17.5.3(I)).
Criminal background checks are required under R.I. Gen. Laws § 23-17-34 (§ 17.5.3(L)).

Skilled home health: Skilled nursing/therapy at home requires a separate Home Nursing Care Provider license (same $650 annual fee), which can also be Medicare-certified as a Home Health Agency.

Heads up: Homemaker services need a license. Companion-only services aren't defined, so confirm with RIDOH.

Official Rhode Island source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

South Carolina

License required

Personal care (hands-on help): License required
Companion / homemaker only: Unclear, confirm with the state
License or registration: In-Home Care Provider license
Issued by: South Carolina Department of Public Health (DPH), Healthcare Quality
Law and rules: S.C. Code § 44-70-10 et seq. (license: § 44-70-30); Regulation 60-122, Standards for Licensing In-Home Care Providers (amended, effective 05/22/2026; formerly R.61-122)
Fee: $1,000 initial license; $800 annual renewal; $200 late fee; $50 per amendment (R.60-122)

Key requirements

Providers need liability insurance or a surety bond of at least $100,000 per occurrence / $300,000 aggregate (R.60-122 § 103.F).
Caregivers need a criminal background check under S.C. Code §§ 44-70-60(B) and 44-7-2910 before employment, plus drug testing (R.60-122 § 402).
Caregiver training on required topics happens before client contact and at least annually; no hour minimum is set (R.60-122 § 404).
Each provider must have a designated administrator, and the license is valid for a period the Department sets, with annual renewal (R.60-122 §§ 102.A, 103).

Skilled home health: Home health agencies and hospices are excluded from the in-home care provider definition and licensed separately by DPH; in-home care cannot include skilled care or therapy.

Heads up: The regulation was renumbered to R.60-122, effective May 22, 2026. Older guides citing R.61-122 are out of date.

Official South Carolina source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

South Dakota

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
Issued by: None for non-medical agencies. The South Dakota Department of Health states non-medical in-home care is not regulated by the Department.
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

The SD Department of Health says non-medical in-home care (e.g., bathing, light housekeeping, meal preparation) is not regulated by the Department.
No state licensing application, inspection or fee applies to a non-medical home care agency at this time.

Skilled home health: South Dakota does not state-license home health agencies either; the Department of Health handles federal Medicare certification surveys for agencies that provide skilled nursing plus at least one other qualifying service.

Heads up: A 2026 bill to require licensing was vetoed and the override failed. Lawmakers may bring it back, so check before each legislative session.

Official South Dakota source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Tennessee

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: Personal Support Services Agency (PSSA) license
Issued by: Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), Office of Licensure, if at least 50% of clients are older adults or have mental illness/substance use diagnosis; agencies mainly serving people with intellectual/developmental disabilities are licensed by the Department of Disability and Aging (formerly DIDD).
Law and rules: Tenn. Code Ann. § 33-2-403; Tenn. Comp. R. & Regs. Chapter 0940-05-38 (Minimum Program Requirements for Personal Support Services Agencies), plus Chapter 0940-05-02 (Licensure Administration and Procedures)
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

Personal support services include self-care help (eating, dressing, toileting, bathing, mobility) and household assistance (housekeeping, laundry, meal planning); one or more of these triggers licensure.
Applicants submit an initial application, fact sheet, background check and privacy statement form, and financial statement to the regional Office of Licensure, then pay an invoiced fee.
PSSAs do not need a fire/life safety inspection; the initial inspection is an electronic desk audit, and the initial license is issued for up to 1 year.
Medication assistance training must be provided to personal support services workers before they assist with medications.

Skilled home health: Skilled home health is licensed separately as a home care organization by the Tennessee Health Facilities Commission under Tenn. Code Ann. § 68-11-201 et seq.

Heads up: This is not the Health Facilities Commission home care license, which covers skilled care. The licensing department depends on who you mainly serve. Fee not confirmed.

Official Tennessee source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Texas

License required

Personal care (hands-on help): License required
Companion / homemaker only: No state license
License or registration: Home and Community Support Services Agency (HCSSA) license, Personal Assistance Services (PAS) category
Issued by: Texas Health and Human Services Commission (HHSC), HCSSA Licensing / Licensure and Certification Unit
Law and rules: Texas Health and Safety Code Chapter 142; 26 Texas Administrative Code Chapter 558
Fee: $2,625 initial license (three-year) for a parent agency, branch or change of ownership; $1,000 for an alternate delivery site. Renewal: $1,750 (two-year) or $2,625 (three-year) per parent/branch.

Key requirements

Before applying, complete HHSC's pre-survey computer-based training and be registered and in good standing with the Texas Comptroller and Secretary of State.
After admitting its first client, the agency must request its initial survey (Form 2020), which must be completed within six months of the initial license being issued.
PAS-only administrators need a high school diploma/GED plus one year of experience or training caring for people with functional disabilities, or two years of college in a health-related field.
PAS supervisors must be a licensed nurse or have two years of college (or equivalent supervisory experience); HHSC is phasing in a three-year license term.

Skilled home health: Skilled care uses a different category of the same HCSSA license (Licensed Home Health, or Licensed and Certified Home Health for Medicare), with federal Conditions of Participation (42 CFR Part 484) for certified agencies.

Heads up: Sitter-companion services and chores that don't involve personal care are exempt. Any hands-on help requires the license.

Official Texas source →Verified on official state sources, October 2026.

Utah

License required

Personal care (hands-on help): License required
Companion / homemaker only: Unclear, confirm with the state
License or registration: Personal Care Agency license
Issued by: Utah Department of Health and Human Services (DHHS), Division of Licensing and Background Checks, Office of Licensing (Health Facilities)
Law and rules: Utah Code Title 26B, Chapter 2, Part 2 (Health Care Facility Licensing, incl. § 26B-2-206 license requirement); Utah Admin. Code R432-725 (Personal Care Agency Rule) and R432-2 (General Licensing Provisions)
Fee: FY July 1, 2025 to June 30, 2026 schedule: $743.84 base fee + $1,430.45 agency fee + $371.92 per branch; $1,069.26 one-time new provider fee.

Key requirements

A personal care agency is two or more individuals providing personal care services (help with activities of daily living) on a visiting basis.
The administrator must be at least 21 with at least one year of managerial or supervisory experience.
Personal care aides must be at least 18 and be supervised by a licensed nurse or a certified nursing aide with at least two years of personal or home care experience.
Employees need at least six hours of in-service training per calendar year, and personnel records must include criminal background screening authorization.

Skilled home health: Skilled home health agencies are licensed separately under Utah Admin. Code R432-700 (Home Health Agency Rule), with a higher agency fee.

Heads up: The rule doesn't mention companion- or homemaker-only agencies, so confirm with the Office of Licensing. Fees shown are from the 2025-26 schedule.

Official Utah source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Vermont

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
Issued by: No state license. Agencies billing Vermont Medicaid (incl. Choices for Care) need Home Care Provider Certification from the Department of Disabilities, Aging and Independent Living (DAIL), Adult Services Division.
Law and rules: No licensing statute for non-medical agencies identified. Home health agency designation: 33 V.S.A. Chapter 63 (§§ 6302-6304).
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

Private-pay non-medical agencies need no state home care license.
To bill Medicaid, an agency needs DAIL Home Care Provider Certification: Medicaid enrollment, compliance with the Home Care Provider Standards, and an initial certification review within 30-90 days of starting services.
DAIL certification lasts up to three years; renew at least 60 days before it expires.

Skilled home health: Skilled home health agencies (part-time or intermittent skilled nursing) must be designated by the DAIL Commissioner under 33 V.S.A. § 6304, with service-area franchises and new designations going through a Green Mountain Care Board certificate of need.

Heads up: Private-pay agencies need no state license. To bill Medicaid, an agency needs DAIL Home Care Provider Certification.

Official Vermont source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Virginia

License required

Personal care (hands-on help): License required
Companion / homemaker only: No state license
License or registration: Home Care Organization (HCO) license
Issued by: Virginia Department of Health, Office of Licensure and Certification (OLC), Division of Acute Care Services, Home Care and Hospice Unit
Law and rules: Code of Virginia § 32.1-162.7 et seq.; 12VAC5-381 (Home Care Organization Regulations)
Fee: $1,500 for each initial and renewal (triennial) license application, effective 05/22/2025 (12VAC5-381-70; VDH OLC). Other fees in the rule: $50 late renewal, $250 reissue, $75 exemption request.

Key requirements

License is renewed every three years (triennially); OLC does periodic unannounced on-site inspections at least every two years (12VAC5-381-40, -80).
Criminal record report must be obtained within 30 days of employment, plus a sworn disclosure statement (12VAC5-381-110).
Personal care services must be supervised by a registered nurse, and personal care attendants need at least 12 hours of in-service training each year (12VAC5-381-360).
Administrator must have at least one year of training and experience in direct health care service delivery plus supervisory or management experience, and must be a W-2 employee (12VAC5-381-170).

Skilled home health: Skilled home health is licensed under the same HCO license and rule (Part III, skilled services); HCOs certified for Medicare/Medicaid or accredited by a CMS-recognized body may be exempt from state licensure after initial licensure (Va. Code § 32.1-162.8).

Heads up: The rule exempts agencies providing only homemaker, chore or companion services, but the statute is worded more narrowly. Companion-only agencies should confirm with OLC.

Official Virginia source →Verified on official state sources, October 2026.

Washington

License required

Personal care (hands-on help): License required
Companion / homemaker only: License required
License or registration: In-home services agency license, home care service category
Issued by: Washington State Department of Health (DOH)
Law and rules: RCW 70.127 (esp. RCW 70.127.010 and 70.127.020); WAC 246-335
Fee: Initial 12-month license fee: $5,000 per service category. Home care 24-month renewal (standard, Table 1): $2,400 (5 or fewer FTEs) up to $3,700 (101+ FTEs). WAC 246-335-990, as amended by WSR 26-04-110, effective 6/1/26.

Key requirements

A license is required to advertise, operate, manage or maintain a home care agency; operating without one is a misdemeanor (RCW 70.127.020).
Applicant must complete the DOH In-Home Services Orientation Class and pass an initial survey before the license is issued.
On-site administrator and direct care services supervisor need Washington State Patrol criminal history checks and disclosure statements dated within three months of the application (WAC 246-335-320).
Initial license is 12 months; renewals are every 24 months (WAC 246-335-990).

Skilled home health: Skilled home health is a separate service category (home health) on the same DOH in-home services agency license, with its own $5,000 initial category fee.

Heads up: One license covers personal care and homemaker services. Companionship isn't named in the law, so companion-only agencies should confirm with DOH.

Official Washington source →Verified on official state sources, October 2026.

West Virginia

Registration

Personal care (hands-on help): Registration required
Companion / homemaker only: Registration required
License or registration: Home care agency registration (for access to the central abuse registry)
Issued by: West Virginia Office of Health Facilities Licensure and Certification (OHFLAC)
Law and rules: W. Va. Code § 15-2C-7 (registration of home care agencies); see also W. Va. Code § 16-2D-8 (certificate of need)
Fee: No fee for registration (W. Va. Code § 15-2C-7).

Key requirements

Home care providers not otherwise licensed, certified or registered by the state must register with OHFLAC so they can use the central abuse registry (§ 15-2C-7).
Registration is not complete until the provider signs the registration form; it lists services offered, area served and number of homes and consumers served (§ 15-2C-7).
State law lists 'providing personal care services' and 'establishing a home health agency' as services that need a certificate of need regardless of cost (§ 16-2D-8(b)); 'personal care agency' is defined as one approved by the Bureau of Medical Services (§ 16-2D-2).

Skilled home health: A home health agency (one mainly providing professional nursing services) needs a certificate of need under § 16-2D-8 and goes through OHFLAC licensure; this research did not confirm the home health licensing rule citation.

Heads up: Registration is free. State certificate-of-need law also mentions personal care services; it appears aimed at Medicaid agencies, but confirm with the WV Health Care Authority.

Official West Virginia source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Wisconsin

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
License or registration: No state license for private-pay non-medical care. Personal Care Agency (PCA) certification is required only to bill Wisconsin Medicaid.
Issued by: Wisconsin Department of Health Services (DHS), Division of Quality Assurance (DQA)
Law and rules: Wis. Admin. Code § DHS 105.17 (Medicaid personal care provider certification); Wis. Stat. § 50.49 and ch. DHS 133 (home health agencies)
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

For Medicaid PCA certification, the application is filed through the DQA Provider Portal and includes a 'fit and qualified' review covering finances, staff qualifications, criminal background and fee payment.
PCA applicants must request an initial on-site DQA survey within 9 months of approval, must have served at least 5 personal care clients, and must show services to at least 2 clients at the survey.
An RN reviews the agency's policies and procedures, and owners and operators need entity background checks; after DQA recommends certification, the agency enrolls with Wisconsin Medicaid (ForwardHealth).
DHS tells agencies that provide only personal care (ADL help, housekeeping, escorts to appointments) not to apply for a home health agency license.

Skilled home health: Home health agencies, which mainly provide skilled nursing and therapy, need a DHS home health agency license under Wis. Stat. § 50.49 and ch. DHS 133.

Heads up: Personal Care Agency certification is only needed to bill Medicaid. Caregiver background check law still applies.

Official Wisconsin source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

Wyoming

No state license

Personal care (hands-on help): No state license
Companion / homemaker only: No state license
License or registration: None for non-medical home care (only Home Health Agency licensure exists, for skilled care)
Issued by: Wyoming Department of Health, Healthcare Licensing and Surveys (HLS)
Law and rules: Wyo. Stat. § 35-2-901 et seq. (Health Facilities Act); HLS Rules Chapter 10 (Home Health Agency) and Chapter 9 (Program Administration)
Fee: Not confirmed on an official source. Ask the licensing agency.

Key requirements

HLS's list of 24 licensed facility types includes Home Health but no personal care, companion, homemaker or other non-medical in-home category.
A licensed Home Health Agency is defined as one 'primarily engaged in arranging for and directly providing two or more health care services' at the person's home, such as nursing, therapies or home health aide services (HLS Rule Ch. 10).

Skilled home health: Skilled home health agencies need a Wyoming Department of Health license before serving any client: a provisional license first, then a permanent license after a satisfactory unannounced state survey.

Heads up: Only skilled home health agencies are licensed. Hands-on aide-type services could fall closer to home health, so confirm with Healthcare Licensing and Surveys.

Official Wyoming source →Partly verified on official sources, October 2026. Confirm details with the state before you apply.

All coaching and support is delivered virtually, so your location doesn’t limit the help you get.

Home care licensing requirements in all 50 states

A clear, written roadmap for your state

Policies written around your state’s regulations and your services

Hands-on help preparing a complete application

Coaching from someone who has run an agency

Systems to recruit caregivers and get clients after you’re licensed

What we're upfront about

Your state, not us, approves your license and sets the timeline

We are not attorneys or accountants. For entity formation, contracts, taxes and legal review, we’ll tell you when to bring one in

Policies must reflect how you actually operate. You review and own them

No one can honestly guarantee approval by a specific date

Why it matters

The cost of getting it wrong vs. getting it right

Without a plan

An application built on another state’s rules

Generic policies that don’t match your state or your services

Months of rent, insurance and fees with no clients

Licensed, but no way to find caregivers or families

With CareOpsHQ

A complete application prepared with an experienced guide

A policy manual you understand and can follow

Hiring, intake and marketing ready when your license arrives

Confidence that you’re building the agency the right way

After you’re licensed

A license doesn't bring clients. A growth system does.

When your doors open, CareOpsHQ helps you get found and stay staffed: a website and Google Business Profile built for local search and AI answers, social media and Meta ads, a 24/7 AI receptionist so you never miss an inquiry, referral-partner outreach and caregiver recruiting.

FAQ

Questions about starting a home care agency

Do I need a license to start a non-medical home care agency?

It depends on your state and the services you offer. There is no federal license; each state sets its own rules. Many states license agencies that provide hands-on personal care, a few require only a registration, and some, such as Missouri and Michigan, don't license private-pay non-medical agencies at all. See the state-by-state list on this page, and we'll confirm your state's current requirements on your first call.

Do you work with home care founders in my state?

Yes. CareOpsHQ supports new agency owners in all 50 states. Coaching and support are delivered virtually, and your roadmap and policies are built around your own state's regulations.

How long does it take to get licensed?

Timelines depend on your state, how complete your application is and the licensing agency's workload. Some states also require an inspection before or after licensing. An incomplete application is a common cause of delay. We focus on submitting a complete application, but the state controls the timeline and we won't promise a date we can't control.

Can you guarantee my license will be approved?

No. Only your state's licensing agency can approve a license. What we can do is help you understand the requirements, prepare a complete application and build policies that match your state's regulations.

Will my policies and procedures be specific to my state?

Yes. We build your manual around your state's regulations and the services you plan to offer, then walk you through it so you understand and can follow it. Because the policies govern how you operate, you review and approve them before submission.

What's the difference between home care and home health?

Non-medical home care helps with daily activities such as bathing, dressing, meals and companionship. Home health provides skilled medical services such as nursing and therapy, usually under a separate, more demanding license. Some states also require a Certificate of Need for new home health agencies. Many founders start with non-medical care.

Do I have to be a nurse to own a home care agency?

Ownership and staffing requirements vary by state and by the services you provide. Some states require a licensed nurse to supervise caregivers for certain services, or a qualified administrator. We review your state's staffing requirements with you so you know which roles you must fill before you apply.

Do you help with getting clients after I'm licensed?

Yes. CareOpsHQ provides websites, Google Business Profile management, social media and Meta ads, a 24/7 AI receptionist, referral-partner outreach and caregiver recruiting, so your agency is ready to grow when your license arrives.

Is this legal advice?

No. We provide licensing preparation, operational guidance and coaching based on clinical and agency-ownership experience. For business formation, contracts, employment law and tax questions, we recommend a licensed attorney and accountant in your state.

A license doesn't bring clients. A growth system does.

Book a startup strategy call. Tell us your state and your goals, and leave with a clear picture of what it will take to open your doors.

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