Last verified: September 2026. Rules and fees change, so confirm every figure with the NC Division of Health Service Regulation before you file.
North Carolina has a fast-growing senior population and a reasonable license fee, but it asks more of your leadership team than most states: a qualified agency director, an RN on call whenever aides are working, and state-approved training before you apply. This guide covers what it takes to open a non-medical home care agency in North Carolina in 2026, with a source for each rule.
Quick facts: North Carolina home care licensing
| License name | Home Care Agency license |
| Issued by | NC DHHS, Division of Health Service Regulation (DHSR), Acute and Home Care Licensure and Certification Section |
| Governing law | G.S. 131E-135 to 131E-142; 10A NCAC 13J |
| License fee | $510, nonrefundable |
| Renewal | $510 every year; all licenses expire December 31 |
| Certificate of Need | Not required for a licensed-only (non-Medicare) agency |
| Required before applying | DHSR-approved licensure applicant training |
Do you need a license for home care in North Carolina?
Yes. G.S. 131E-138 says no one may operate a home care agency or a “home assistance services provider” without a license.
- In-home aide services with hands-on care make you a home care agency.
- Companion, sitter, respite or homemaker services with no hands-on care were given their own category, “home assistance services provider,” by Session Law 2023-150. Those providers still need a license, must carry liability insurance, must tell clients they give no hands-on care, and may not bill insurance.
As of September 2026, DHSR’s application form still lists companion/sitter/respite as a home care license category, and we couldn’t find a separate application for the new home assistance category. If you plan to offer companion care only, call DHSR (919-855-4620) before you apply. Don’t assume companion-only care is license-free in North Carolina.
Step-by-step: how to get a home care license in NC
- Complete DHSR-approved licensure applicant training. It’s required unless you’ve previously owned or operated a home care agency. DHSR lists approved trainers.
- Mail the application (DHSR-4204), one per site, with the $510 fee and proof of training to DHSR in Raleigh.
- Submit policies, procedures and personnel records when DHSR asks, using the Initial Home Care Survey Checklist.
- Initial survey. DHSR reviews your documents, then emails an approval letter and license access.
- Finish within 12 months of your application date.
Who you need on your team
- Agency director: a health care practitioner, or 2+ years of supervisory or management experience in home care or a similar licensed provider, or a bachelor’s degree in health, business or public administration plus 1 year of that experience.
- RN: an agency with in-home aides must have an RN available for supervision whenever aides are working. Only an RN, not an LPN, can do assessments and supervisory visits.
- Premises: an office with the license posted and a sign on the public door.
Your in-home aide service area is limited to your county, neighboring counties, or 90 minutes’ drive, whichever is larger.
How much does it cost?
- Initial license: $510
- Annual renewal: $510 (renew before December 31)
- Change of ownership: $510
- Each site needs its own license
Also budget for the applicant training course, your RN, and insurance. The applicant training cost varies by provider.
Caregiver requirements in North Carolina
- Criminal background check within 5 business days of a conditional offer, plus a national fingerprint check if the person has lived in NC less than 5 years (G.S. 131E-265).
- Health Care Personnel Registry check before hire. You can’t hire anyone with a substantiated finding.
- Nurse Aide Registry listing for aides whose clients need extensive assistance. Aides giving limited assistance need an RN to verify their core personal-care skills.
- Supervision: RN supervisory visits every 90 days, plus once a year with the aide present.
- Health: baseline TB skin test for hands-on staff, Hepatitis B vaccination or a signed declination, and annual bloodborne pathogen training.
How long does it take?
DHSR says it’s “not possible to establish specific time frames.” The only fixed limit is that you must finish within 12 months of applying.
Medicaid in North Carolina
Medicaid Personal Care Services (Clinical Coverage Policy 3L, amended January 1, 2026) require a DHSR-licensed home care agency in the counties you serve. You also enroll in NCTracks and use the Sandata electronic visit verification system.
Starting in a different state? Compare home care licensing by state.
Want the full playbook?
I built and run a licensed home care agency in California. North Carolina’s licensing is its own process, but getting clients, hiring caregivers and managing cash flow work the same way everywhere. The Home Care Agency Blueprint covers that side in 49 lessons. You can see the syllabus or start with the $29.99 Startup Workbook.
FAQ
How much is a home care license in NC?
$510 to apply and $510 each year to renew.
Do I need a Certificate of Need?
Only if you want to become a Medicare-certified home health agency. A licensed-only home care agency doesn’t need one.
Do I need to be a nurse to own a home care agency in NC?
No, but your agency must have an RN available whenever in-home aides are working, and your director must meet the experience or education standard.
Sources
- DHSR Home Care Licensure, how to apply, fee schedule, FAQ, approved training
- G.S. 131E-136, 131E-138, 131E-256, 131E-265
- Session Law 2023-150
- 10A NCAC 13J
- NC Medicaid Personal Care Services
This article is general information, not legal advice. Confirm current requirements with DHSR or a licensing attorney before you apply.
Want help getting licensed in North Carolina?
We write the policy binder North Carolina asks for, prepare your home care license application for you to sign, and answer correction letters until the state decides. The full PremiumCare Academy course is included.