How to Start a Home Care Agency: State-by-State Licensing Guide (2026)

Last verified: September 2026.

Every state regulates non-medical home care differently. Some charge $50 to register, others over $5,000 to license. Some require a nurse on your team, and some don’t license companion care at all. Pick your state below for a step-by-step guide to its license, fees, caregiver rules and timeline, with links to the official sources.

Home care licensing by state

State	License	State fee	Worth knowing
California	Home Care Organization (HCO)	$5,603 per 2 years	$1M/$3M liability insurance and a $10,000 bond required
Texas	HCSSA, Personal Assistance Services	$2,625 per 3 years	Companion-only services are exempt
Florida	Companion registration or Home Health Agency	$50.75 or $1,705 + $300	Hands-on care needs the home health license
Georgia	Private Home Care Provider	$300 + $250 per service/year	RN required on the application
North Carolina	Home Care Agency	$510 per year	State-approved applicant training first
New York	Licensed Home Care Services Agency (LHCSA)	$2,000 application	County public need review; often 12-24 months
Pennsylvania	Home Care Agency or Registry	$100	Companion-only care needs a license too
Ohio	Nonmedical Home Health Services	$250 per 3 years	$20,000 surety bond for new agencies
Illinois	Home Services Agency	$1,500 per year	Provisional license first, then survey
New Jersey	Health Care Service Firm registration	$500 per year	$10,000 bond; accreditation within 12 months
Virginia	Home Care Organization	$1,500 per 3 years	Companion-only exempt; RN supervisor for personal care
Washington	In-Home Services Agency (home care)	$5,000 initial	Aides need 75 hours and a state exam
Tennessee	Personal Support Services Agency	Invoiced by TDMHSAS	Licensed by the mental health department, not HFC
Arizona	No state license (private pay)	$0	Yearly client disclosures required; AHCCCS for Medicaid
Michigan	No state license	$0	Medicaid via CHAMPS Home Help and MI Choice

More states are on the way. Wondering about total startup costs? See what it costs to start a home care agency, or get help from a home care agency consultant.

What’s the same in every state

The license is the first hurdle, not the business. Whichever state you’re in, you’ll still need to:

• Decide medical vs. non-medical. Non-medical (companion and personal care) is the easier entry point, and it’s how I got into healthcare without being a nurse.
• Screen caregivers. Every state on this list requires criminal background checks, and most add registry checks and training.
• Get insured. Even where the state doesn’t set a minimum, clients, referral sources and payers will ask for liability and workers’ comp coverage.
• Plan cash flow. You pay caregivers weekly or biweekly, and clients and payers often pay you later. Run out of cash in that gap and the business fails.
• Find your first clients. Some states, like Georgia and Texas, won’t finish licensing you until you’re actually serving clients.

Learn the whole process

I’ve run a licensed home care agency in California for 10 years (HCO license #334700237). The Home Care Agency Blueprint teaches the process we use, from licensing to hiring to getting clients, in 49 lessons. You can see the syllabus or start with the $29.99 Startup Workbook.

These guides are general information, not legal advice. Confirm current requirements with your state agency before you apply.

Home care license requirements in all 50 states (2026)

Does your state license private-pay, non-medical home care (companion, homemaker and personal care)? Here is where every state and DC stands as of October 2026. Rules change often, so confirm with your state agency before you file. Medicaid waiver programs and skilled home health have separate rules not shown here.

Last reviewed October 2026 from state health department and licensing sources. This is a summary, not legal advice. “Inspection before license” means the state surveys the agency before the license is issued.