How to Start a Home Care Agency in California (2026 HCO License Guide)

Last verified: September 2026. Licensing rules and fees change, so confirm every figure with the California Department of Social Services before you file.

I have run a licensed Home Care Organization in the Inland Empire for 10 years (HCO license #334700237). When I started, I had no healthcare background and nobody to ask, and I made expensive mistakes on the licensing side. This guide lays out what California actually requires to open a non-medical home care agency in 2026, with a link to the official source for every rule.

Quick facts: California home care licensing

License name	Home Care Organization (HCO) License
Issued by	California Department of Social Services (CDSS), Community Care Licensing Division, Home Care Services Branch
Governing law	Home Care Services Consumer Protection Act (AB 1217), Health & Safety Code §1796.10 and following
License fee	$5,603, nonrefundable, covers 2 years
Renewal	Every 2 years, $5,603
Caregiver registration	Home Care Aide Registry, $35 every 2 years
Insurance	$1M per occurrence / $3M aggregate liability, $10,000 dishonesty bond, workers’ comp

Do you need a license to provide home care in California?

Yes. Since January 2016, any business that sends caregivers into clients’ homes for pay to help with non-medical needs (bathing, dressing, meals, companionship, errands) must hold an HCO license from CDSS. Medical services such as skilled nursing are a different license from the California Department of Public Health and are not covered here.

Step-by-step: how to get an HCO license

1. Form your business entity. California doesn’t require a particular structure. Partnerships, corporations and LLCs file an extra form (HCS 309) and board members must show they understand their duties.
2. Get your insurance and bond in place. You need proof of general and professional liability coverage of at least $1,000,000 per occurrence and $3,000,000 aggregate, an employee dishonesty bond of at least $10,000, and a workers’ compensation policy covering your aides.
3. Write your required documents. Personnel policies, job descriptions, a caregiver training plan and a program description. CDSS publishes an HCO inspection checklist (HCS 9201) that shows what they look for.
4. Complete the application packet. Follow the instructions on form HCS 281. Section A includes HCS 200 (application), HCS 215 (applicant information), HCS 308 (designation of responsibility), HCS 309 (entity details), HCS 402 (dishonesty bond) and HCS 9165 (board statement).
5. Mail it with the fee. The packet goes by mail to the CDSS Home Care Services Branch in Sacramento with the $5,603 fee.
6. Fingerprints and orientation. CDSS sends you an HCO number with instructions for Live Scan fingerprinting and the required CDSS orientation.
7. License decision. Once you are licensed, every caregiver you send out must already be cleared on the Home Care Aide Registry.

How much does it cost to start a home care agency in California?

The state fees are only part of it. The fixed items from CDSS:

• HCO license: $5,603 (nonrefundable, 2 years)
• Home Care Aide registration: $35 per caregiver, every 2 years
• Change of location: $100. Change of corporation: $200

On top of that, budget for liability insurance, the bond, workers’ comp, Live Scan fingerprinting, and enough cash to make payroll before your first client invoices are paid. Insurance and payroll are where most new owners underestimate.

Caregiver requirements in California

• Registry clearance before any client contact. Aides apply through the CDSS Guardian portal (form HCS 100), pay $35, and complete Live Scan fingerprinting.
• Training: 5 hours before the first client (2 hours orientation, 3 hours safety), then 5 hours every year. Both can be done online.
• TB test within 90 days before hire or 7 days after, repeated at least every 2 years if negative.
• Coming January 1, 2027: SB 412 (2025) adds required dementia-care training before aides provide services and every year after.

The state does not require caregivers to be CNAs. My agency hires only CNAs anyway, because families notice the difference and so do referral sources. It is a choice, not a rule.

How long does it take?

CDSS does not publish an official processing time. Attorneys who handle HCO applications commonly estimate 3 to 6 months. Incomplete packets are the most common cause of delay.

Can a non-medical agency get paid by Medi-Cal?

An HCO license does not enroll you in Medi-Cal. Licensed agencies can contract with Medi-Cal managed care plans to provide the CalAIM Community Supports service “Personal Care and Homemaker Services.” IHSS is a separate, county-run program.

The mistakes I see most often

• Filing before insurance and the bond are actually bound, then waiting on paperwork.
• Treating the policies and training plan as a formality. These are what your inspection is measured against.
• Planning for the license but not for the first 90 days of payroll.

Starting in a different state? Compare home care licensing by state.

Want the full playbook?

The license is step one. Getting clients, hiring caregivers and running payroll without going broke is the rest. The Home Care Agency Blueprint walks through all of it in 49 lessons, based on how we built and run a licensed California HCO. If you want to start smaller, the Home Care Agency Startup Workbook is $29.99, or see the full syllabus.

FAQ

Do I need a nursing license to open a home care agency in California?

No. CDSS sets no education or clinical requirement for HCO owners. I am not a nurse. You do need to pass a background check and complete the CDSS orientation.

Can I run a home care agency from home in California?

The application asks for a physical location and a mailing address. CDSS does not publish detailed office rules, so check your city’s zoning and business-license rules too.

Do companion-only services need a license?

If you place caregivers in clients’ homes to provide non-medical services for pay, plan on needing an HCO license. Ask CDSS about your specific model before you start.

Sources

• CDSS Home Care Services
• CDSS HCO application process
• CDSS application fees
• CDSS Home Care Aide application process
• Health & Safety Code §1796.37, §1796.44, §1796.45, §1796.49
• SB 412 (2025)
• DHCS Community Supports Policy Guide

This article is general information, not legal advice. Confirm current requirements with CDSS or a licensing attorney before you apply.