Last verified: October 2026. Rules and fees change, so confirm every figure with the New York State Department of Health before you file.
New York is the hardest state in the country to open a new home care agency in. You need a Licensed Home Care Services Agency (LHCSA) license, and before the state looks at your agency it asks whether your county needs another one. This guide covers how that works, the steps, the cost and what your aides need.
Quick facts: New York home care licensing
| License name | Licensed Home Care Services Agency (LHCSA) |
| Issued by | NYS Department of Health, approved by the Public Health and Health Planning Council (PHHPC) |
| Governing law | Public Health Law Article 36 (§3605, §3605-b); 10 NYCRR Parts 765 and 766 |
| Application fee | $2,000, nonrefundable |
| Need review | Yes, a county-level public need test |
| Annual registration | Required every year; $500 per month late fee |
| Moratorium | None in effect as of October 2026 |
Do you need a license for home care in New York?
Yes, if you provide personal care, home health aide or nursing services. That is what an LHCSA license covers. Companion-only or housekeeping services with no hands-on care are generally understood not to need an LHCSA, but the statute is broad, so confirm with DOH before relying on that.
The big hurdle is public need. In counties where 5 or more LHCSAs are each already serving at least 25 patients, the state presumes there is no need for a new agency, and your application must include a data-based rebuttal.
Step-by-step: how to open a home care agency in New York
- Check your county’s need status in DOH’s “presumption of no need” report before spending money.
- File a Certificate of Need application in NYSE-CON through the Health Commerce System. DOH reviews public need, financial feasibility and the character and competence of every owner.
- Pay the $2,000 fee within 30 days of submitting.
- Wait for department review and a PHHPC agenda slot. The council meets about six times a year.
- Receive contingent approval, then submit your policy and procedure manual.
- Pass the pre-opening survey and receive your license.
- Register annually under PHL §3605-b.
A 2018 moratorium on new LHCSAs expired in 2020. Senate bill S4400 would impose a new one from 2027 to 2029; as of 2026 it had not passed. Watch it before you file.
How much does it cost?
- Application fee: $2,000.
- Working capital: DOH expects you to show at least two months of operating expenses.
- Legal and consulting help with the CON application is common because of the need rebuttal.
Budget separately for insurance, payroll for your first caregivers before clients pay, software, and marketing. Licensing is rarely the biggest line. See what it really costs to start a home care agency.
Caregiver requirements in New York
- Home health aides: a 75-hour state-approved program (59 classroom, 16 supervised practical) plus a competency evaluation, and listing on the NYS Home Care Registry.
- Personal care aides: a shorter state curriculum (commonly 40 hours); confirm the current minimum with DOH.
- Home health aides need 12 hours of in-service training a year and RN supervision.
- Criminal history checks, pre-employment health assessment, TB screening and immunizations.
How long does it take?
Expect 12 to 24 months or more, driven by the need review and PHHPC meeting schedule. This is why many New York founders buy an existing agency instead, which still requires PHHPC approval of the new owners.
Medicaid in New York
Most Medicaid personal care in New York flows through managed long-term care (MLTC) plans, so a new LHCSA must win plan contracts. Since April 2025 the CDPAP program uses a single statewide fiscal intermediary (Public Partnerships LLC), so new agencies cannot become CDPAP fiscal intermediaries.
Comparing states? See the home care license requirements for every state.
Want the full playbook?
I built and run a licensed home care agency in California. The licensing steps differ state to state, but getting clients, hiring good caregivers and managing cash flow work the same way in New York. The Home Care Agency Blueprint covers that side in 49 lessons. You can see the syllabus, start with the $29.99 Startup Workbook, or book a free call to map out your New York launch.
FAQ
Is there a moratorium on new LHCSAs in 2026?
No. The real barrier is the county public need presumption. A proposed 2027 to 2029 moratorium (S4400) had not passed as of 2026.
Can I buy an existing LHCSA instead?
The license itself cannot be transferred. A change of ownership needs a new application and PHHPC approval, though agencies already serving at least 25 patients are exempt from the need review.
How much money do I need?
At least two months of operating expenses in working capital, on top of the $2,000 fee and your start-up costs.
Leave a Reply