Southeast
North Carolina Home Care, Home Health & Hospice Licensing
North Carolina requires a state Home Care Agency license for all non-medical and skilled home care — and a Certificate of Need before a single Medicare-certified home health or hospice patient can be served.
RegulatorNC DHSR AHCLCS
Typical timelineHome Care Agency (non-medical or skilled, no CON): typically 60–90 days from completed application submission to license issuance, provided the policy manual and personnel are ready before the survey is scheduled. Certified Home Health Agency or Hospice with CON: add 6–18 months for the CON review cycle alone — DHSR's CON section has 90 to 150 days to issue a decision, then SHCC committee review follows, and any contested case appeal adds up to 270 additional days before a final order.
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Licensing in North Carolina
North Carolina licenses every home care agency — including companion, sitter, and non-medical respite providers — through the Division of Health Service Regulation (DHSR), making state licensure a mandatory first step for any home care business. Medicare-certified Home Health Agencies and Hospice programs face an additional layer: a Certificate of Need (CON) issued through the annual State Medical Facilities Plan (SMFP) process, meaning applicants can only move forward when identified need exists in a specific county. For 2026, no new home health agencies are identified as needed statewide, while the proposed 2026 SMFP initially identified nine counties with hospice home care need — making the CON landscape the defining strategic question before any application begins.
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)
Any agency providing companion, sitter, respite, or homemaker services in a client's home; does not require a CON; governed by G.S. 131E-135 through 142 and 10A NCAC 13J.
Home Care Agency License (In-Home Aide / Skilled Services)
Agencies providing in-home aide services, nursing, therapy, or other skilled services in a client's home alongside or instead of non-medical services; same state license but with higher administrator qualification requirements.
Certified Home Health Agency (CON Required)
Agencies seeking Medicare and Medicaid certification to deliver part-time, intermittent skilled nursing, therapy, and home health aide services; must first obtain a Certificate of Need through the SMFP process before DHSR will issue a state license.
Hospice Agency License (CON Required)
Agencies providing palliative and end-of-life care in the home; must obtain a CON where county need is identified in the annual SMFP; governed by G.S. 131E-200 through 207 and 10A NCAC 13K.
How we get you licensed
- 1Confirm CON status before anything else
For Home Care Agency (non-medical or skilled non-Medicare), skip this step and go straight to state licensure. For Certified Home Health or Hospice, consult the current year's State Medical Facilities Plan to confirm identified need exists in your target county. If no need is identified, a CON application cannot be filed for that service area — no exceptions.
- 2Register the business entity and obtain an EIN
Form an LLC or corporation with the North Carolina Secretary of State, obtain a federal Employer Identification Number, open a business bank account, and register for NC state taxes. DHSR requires proof of a legal business entity before issuing a license.
- 3Develop policies, procedures, and hire qualified personnel
Draft a comprehensive policy and procedure manual following the Home Care and Hospice Licensure Survey Checklist published by DHSR. Hire an Agency Director (administrator) who meets at least one of the qualification pathways under 10A NCAC 13J .1001: a licensed health care practitioner as defined in G.S. 90-640(a); or an individual with at least two years of supervisory or management experience in home care or any other provider licensed under G.S. 131E or G.S. 122C; or an individual holding a bachelor's degree in health, business, or public administration and at least one year of supervisory or management experience in home care or another licensed health care program. Obtain criminal background checks (SBI) for the administrator, all owners, and all direct care staff. If the applicant cannot demonstrate prior ownership or operation of a home care agency, DHSR requires completion of a DHSR-approved home care training course before a license will be issued.
- 4Submit the license application and nonrefundable fee
Mail or deliver the completed application and the $560 nonrefundable license fee to DHSR AHCLCS. All supporting documentation — including proof of premises, insurance certificates, personnel records, and the policy manual — must be assembled but is reviewed at the survey, not at submission.
- 5Pass the initial in-office licensure survey
DHSR will schedule an in-office survey with a state surveyor after confirming receipt of your application. The surveyor reviews the policy manual, organizational chart, personnel files, and physical office setup against the 10A NCAC 13J checklist. The applicant has 12 months from the application receipt date to complete all requirements and receive the license — if that window lapses, the application is closed and fees are forfeited.
- 6Obtain Medicare / Medicaid certification (Home Health only)
After DHSR issues the state license and the CON holder has been operating, the agency applies to the Centers for Medicare and Medicaid Services (CMS) through the NC Medicaid intermediary for Medicare and Medicaid certification. This includes a separate federal survey and enrollment process.
Key North Carolina requirements
- State Home Care Agency license issued by DHSR AHCLCS is mandatory for all home care providers in North Carolina — there is no exemption for non-medical or companion-only agencies (only voluntary, unpaid services fall outside the licensure requirement).
- Certificate of Need approval through the annual State Medical Facilities Plan process is required before a Certified Home Health Agency or Hospice can be licensed or operated; for 2026, no new home health agencies are identified as needed statewide.
- Agency Director (administrator) must meet at least one of three qualification pathways under 10A NCAC 13J .1001: be a licensed health care practitioner (G.S. 90-640(a)); have at least two years of supervisory or management experience in home care or any G.S. 131E or 122C licensed provider; or hold a bachelor's degree in health, business, or public administration plus at least one year of supervisory or management experience in home care or another licensed health care program.
- First-time applicants who cannot demonstrate prior ownership or operation of a home care agency must complete a DHSR-approved home care training course before DHSR will issue the license (10A NCAC 13J .0903).
- Criminal background investigations through the NC State Bureau of Investigation (SBI) are required for the administrator, all owners, and all direct care staff prior to licensure.
- All licenses expire at midnight on December 31 and must be renewed annually; the 12-month application window is hard — failure to complete all requirements within one year from the application receipt date voids the application.
Traps that catch new owners
- Submitting the application before the policy manual and administrator hire are finalized: DHSR's 12-month clock starts on the date fees are received, not when you feel ready. If policies, personnel records, or the DHSR-approved training certificate are incomplete when the surveyor arrives, deficiencies must be corrected and a re-survey scheduled — all within the same 12-month window. Applicants who underestimate manual preparation time routinely let the window expire and must reapply with a new fee.
- Pursuing a Certified Home Health license without first confirming CON availability: the 2026 SMFP identifies zero new home health agencies as needed anywhere in North Carolina, meaning there is no open CON review opportunity for home health this cycle regardless of service quality or capital readiness. Filing a CON application when no need is published wastes the $5,000 minimum filing fee (plus 0.3% of any capital expenditure exceeding $1 million, up to a $50,000 cap) and months of preparation.
- Conflating the NC Home Care Agency license with Medicare certification: the state license and federal Medicare certification are two separate processes with separate surveyors and separate standards. Operating under a state license and billing Medicare without completing the CMS enrollment and federal certification survey is a federal compliance violation. New owners sometimes assume the state license alone enables Medicare billing — it does not.
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 to run a companion or non-medical home care agency in North Carolina?
Yes. North Carolina mandates licensure for all home care agencies, including those providing only companion, sitter, respite, or homemaker services. This is a broader licensing requirement than most states — the only entities exempt are those providing services on a purely voluntary, unpaid basis. Any agency that receives reimbursement from a client or on a client's behalf must obtain a Home Care Agency license from DHSR before serving any clients.
Can I open a Medicare-certified home health agency in North Carolina right now?
Only if a Certificate of Need is available. The 2026 State Medical Facilities Plan identified no new home health agency need in any North Carolina county, which means there is no open CON review cycle for home health agencies in 2026. The market effectively remains closed to new entrants for this service type until a future SMFP identifies need. Hospice is different — the 2026 SMFP included hospice home care need determinations for several counties (the proposed plan named nine; the final approved list should be confirmed against the signed 2026 SMFP), making hospice the active CON opportunity this cycle.
How long does the NC Home Care Agency license process actually take, and what is the biggest delay?
Plan for 60 to 90 days from the day you mail your application and $560 fee to the day you hold a license, assuming your policy manual and staff are ready before the in-office survey is scheduled. The most common delay is an incomplete or non-compliant policy and procedure manual — DHSR's survey checklist is detailed, and deficiencies require a corrected manual and a re-survey. Because the 12-month application window is a hard deadline, every week spent reworking deficiencies shortens the runway.
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