“How much does it cost to start a home care agency?” It’s the question we hear more than any other, and the honest answer surprises most people: the state license fee is usually the smallest line in the budget.
Here are the real 2026 numbers for every state we work in, and what you need to budget on top of them.
State license fees, side by side
| State | State license fee | Typical all-in budget to open |
|---|---|---|
| Michigan | $0 for non-medical home care (no state license). Hospice: $2,500 | About $1,500 to $6,000 |
| Pennsylvania | $100 Home Care Agency or Registry. $250 Home Health Agency | About $2,000 to $6,000 |
| Georgia | $300 application fee, plus a state licensure activity fee | About $1,500 to $5,000 |
| Ohio | $250 home health agency. $600 hospice | About $2,500 to $7,000 |
| North Carolina | $510 Home Care Agency (one-time) | About $3,000 to $8,000 |
| Missouri | $600 Home Health Agency, plus $600 to renew. Hospice: $250 to $750 | About $2,500 to $6,000 |
| Louisiana | $600 to apply and $600 a year to renew, plus a $200 Facility Need Review fee for personal care | About $3,000 to $6,000 |
| Florida | $50.75 Homemaker and Companion registration (two years). $2,005 Home Health Agency | About $2,500 to $6,000 |
| Texas | $2,625, covering a full three-year term | About $3,500 to $6,000 |
| California | $5,603 Home Care Organization (two years). $2,946 Home Health Agency | About $8,000 to $15,000 |
| Washington, DC | $600 license, plus a Certificate of Need filing of at least $5,000 for most providers | About $7,000 to $12,000 |
Two things stand out. First, a low fee doesn’t always mean a cheap launch: Louisiana charges $600 every year, while Texas charges $2,625 once for three years. Second, the gap between the fee and the all-in budget is where most of your money actually goes.
What the license fee doesn’t cover
- Business formation. An LLC or corporation, an EIN and a registered agent. Several states won’t process your application until the entity is in good standing.
- Insurance. General and professional liability is expected everywhere, and some states set a floor. Florida, for example, requires at least $250,000 per claim.
- Background checks. Owners, administrators and care staff all need them. Florida uses Level 2 fingerprint screening; Pennsylvania requires state police checks, plus FBI checks for anyone who hasn’t lived in the state for two years.
- A surety bond, in some states and for some service types.
- Policies and procedures written to your state’s rules. Surveyors read them closely, so a generic manual tends to cost more in corrections than it saves.
- An office. Pennsylvania, for one, inspects your premises and won’t accept a P.O. box.
- Working capital. Florida asks home health applicants for CPA-prepared financials and a reserve covering at least one month of operating expenses.
The three choices that move your budget the most
- Non-medical or skilled care. Non-medical home care is the cheapest and fastest route in almost every state. Skilled nursing brings clinical staffing rules, more policies and a tougher survey.
- Medicare or private pay. Medicare means accreditation, a certification survey and months before your first payment. New Medicare enrollment for home health and hospice has also been frozen since May 13, 2026. Many founders start private-pay and add Medicare later.
- Certificate of Need states and services. Where a CON applies, it can dwarf every other cost. Washington, DC requires one for most home care providers, and Florida requires one for hospice, with a filing fee of $10,000 plus 1.5% of the proposed spend, up to $50,000.
Time costs money too
Every month you wait for a license is a month of rent, insurance premiums and, often, salaries with no revenue. Texas HHSC typically takes 45 to 90 days to review a complete application. Pennsylvania usually decides within two to three months of a clean submission, but deficiency letters can stretch that to four to six. A complete, correct application the first time is the cheapest thing you can buy.
What our help costs
We think founders deserve real numbers before they commit, so we publish ours. Our fixed-price application support starts at $1,995 for a Louisiana Personal Care Services or Missouri In-Home Services license, and $2,495 for a Texas PAS, Pennsylvania Home Care Agency or Florida Homemaker-Companion license. Every package is listed on our products page, and each state’s full cost breakdown is linked in the table above.
Want a realistic budget for your state and service type? Book a free discovery call and we’ll walk you through every cost before you spend a dollar.
This article is general information, not legal or financial advice. State fees change; we confirm the current figures for your state as part of every project.
