Do you need a license to run a home care agency in North Carolina?

Yes. North Carolina requires a state license to run a non-medical home care agency: the Home care agency license (hands-on in-home aide services); home assistance services provider license (companion, sitter, respite, and homemaker only), issued by the North Carolina Department of Health and Human Services, Division of Health Service Regulation (DHSR). No one may operate a home care agency or a home assistance services provider without a DHSR license. An agency whose in-home aides give hands-on care is a home care agency. Since a 2023 law, a provider that offers only in-home companion, sitter, or respite care, with or without homemaker services, is a home assistance services provider; it must carry liability insurance, tell clients it does not give health care or hands-on care, and may not bill health insurers or Medicaid.

What are the key facts?

What should you confirm with the state?

Fingerprinting is required only for agency applicants who have lived in North Carolina less than 5 years. First-time owners must complete DHSR-approved training before a home care license is issued. Confirm with the Division of Health Service Regulation whether the $510 fee also applies to home assistance services providers.

What should you budget for?

The license fee is a small part of startup cost. Insurance, payroll for your first caregivers before clients pay, and office staff usually cost far more. Use the bill rate calculator to check your pricing covers it, and the intake form and care plan templates for the paperwork inspectors ask to see.