Southeast
North Carolina Home Care, Home Health & Hospice Licensing
Every home care agency needs a state license. Medicare home health and hospice also need a Certificate of Need.
RegulatorNC DHSR AHCLCS
Typical timeline2 to 18 months
License routes4
Delivery100% Virtual
Licensing in North Carolina
North Carolina licenses every home care agency, even companion, sitter, and non-medical respite providers, through the Division of Health Service Regulation (DHSR). Medicare-certified Home Health and Hospice programs also need a Certificate of Need (CON) through the annual State Medical Facilities Plan (SMFP). CON need must exist in your county first.
Your regulator
North Carolina Division of Health Service Regulation, Acute and Home Care Licensure and Certification Section (NC DHSR AHCLCS)
Official licensing page →License routes we cover in North Carolina
Home Care Agency License (Non-Medical / Companion-Sitter-Respite)
Companion, sitter, respite, or homemaker care at home; no CON. G.S. 131E-135 through 142; 10A NCAC 13J.
Home Care Agency License (In-Home Aide / Skilled Services)
In-home aide, nursing, therapy, or skilled care. Same state license, but higher administrator qualifications.
Certified Home Health Agency (CON Required)
Medicare/Medicaid-certified skilled nursing, therapy, and aide care. Needs a CON through the SMFP first.
Hospice Agency License (CON Required)
Palliative, end-of-life care at home. CON needed where the SMFP identifies county need. G.S. 131E-200 through 207; 10A NCAC 13K.
How we get you licensed
- 1Check CON status first
Home Care agencies skip this. Home Health or Hospice: check the SMFP for county need. No need means no CON.
- 2Register your business and get an EIN
Form an LLC or corporation with the NC Secretary of State, get an EIN, and register for NC taxes.
- 3Write policies and hire qualified staff
Write a policy manual from DHSR's checklist. Hire an administrator who meets a 10A NCAC 13J .1001 pathway. Run SBI checks.
- 4Send the application and fee
Mail the application and the $510 nonrefundable fee to DHSR AHCLCS. Supporting documents are reviewed at the survey, not now.
- 5Pass the in-office survey
A DHSR surveyor checks your manual, files, and office against the 10A NCAC 13J checklist. Finish within 12 months or lose the application and fees.
- 6Get Medicare/Medicaid certification (Home Health only)
After DHSR licenses you, apply to CMS through the NC Medicaid intermediary. This is a separate federal survey and enrollment.
How long does it take?
Typical time to a live license in North Carolina. Times assume a complete, accurate application; missing items add time.
- Home Care Agency (no CON)
- 60 to 90 days
- Home Health or Hospice (needs a CON)
- Add 6 to 18 months for CON review
Key North Carolina requirements
- Every paid home care provider needs a DHSR license; only unpaid volunteer services are exempt.
- Home Health and Hospice need a CON; 2026 identifies no new home health statewide.
- Administrator must meet one 10A NCAC 13J .1001 pathway: licensed health care practitioner (G.S. 90-640(a)); or two years supervisory or management experience in home care or a G.S. 131E or 122C provider; or a bachelor's in health, business, or public administration plus one year of such experience.
- First-timers without prior agency ownership must finish a DHSR-approved training course (10A NCAC 13J .0903).
- SBI background checks are required for the administrator, owners, and direct care staff.
- Licenses expire midnight December 31 and renew yearly; the 12-month application window is hard.
Traps that catch new owners
- Filing before the manual and administrator are ready; the 12-month clock starts when fees arrive.
- Chasing a Home Health CON in 2026, when none is available, wastes the $5,000 minimum fee (plus 0.3% of capital over $1 million, up to $50,000).
- Confusing the state license with Medicare certification. Billing Medicare without CMS certification is a federal violation.
North Carolina licensing packages
Fixed price, agreed in writing before any work begins. Each package is prepared and submitted for you, fully online.
North Carolina Home Health Agency license (Certificate of Need): Fixed-Price Application Support
$3,995.00
View detailsNorth Carolina licensing FAQs
Do I need a license for a companion or non-medical home care agency?
Yes. North Carolina licenses all home care agencies, including companion, sitter, respite, and homemaker services. Only unpaid, voluntary services are exempt. Any agency paid by or for a client needs a DHSR Home Care Agency license before serving anyone.
Can I open a Medicare-certified home health agency right now?
Only if a CON is available. The 2026 SMFP shows no new home health need in any county, so no CON cycle is open. Hospice differs: the proposed 2026 SMFP named nine counties with need, so confirm the signed plan and pursue hospice.
How long does the license take, and what causes the biggest delay?
Plan for 60 to 90 days from mailing your application and $510 fee to holding a license, if your manual and staff are ready before the survey. The biggest delay is an incomplete manual, which forces corrections and a re-survey inside the hard 12-month window.
Ready to launch in North Carolina?
Book a free discovery call and we’ll map exactly what your North Carolina licensing will take, and what it will cost.
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