Federal District
Washington, DC Home Care, Home Health & Hospice Licensing
Two separate DC licenses, a mandatory Certificate of Need for skilled home care agencies (not hospice), and a 2026 CMS Medicare enrollment freeze make the District one of the most layered markets for new home care entrants.
RegulatorHRLA
Typical timelineFor a Home Support Agency (non-medical), plan on roughly 3–5 months from entity formation through portal submission, HRLA review, and pre-opening survey. For a Home Care Agency (skilled services), add 3–6 months for the SHPDA CON process — which runs concurrently where possible but must reach approval before HRLA issues the license — bringing a realistic total to 6–12 months. Hospice licensure timelines are comparable to the Home Care Agency track but without the CON step. All timelines assume complete, accurate application packages; deficiency cycles add time.
License routes3
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Licensing in Washington, DC
Washington, DC licenses home-based care providers under the Health-Care and Community Residence Facility Hospice and Home Care Licensure Act of 1983 (DC Law 5-48), with day-to-day oversight by DC Health's Health Regulation and Licensing Administration (HRLA). The District requires a separate Certificate of Need (CON) from the State Health Planning and Development Agency (SHPDA) before a home health agency license application can be approved — a threshold that does not apply to the companion Home Support Agency license for non-medical personal care, nor to hospice applicants. As of May 13, 2026, CMS has imposed a nationwide six-month moratorium on new Medicare enrollment for home health agencies and hospices; the DC state license itself remains obtainable independently of Medicare enrollment.
Your regulator
DC Health, Health Regulation and Licensing Administration (HRLA)
Official licensing page →License routes we cover in Washington, DC
Home Care Agency License
Agencies providing skilled nursing and at least one other therapeutic service (physical therapy, speech therapy, etc.) in a patient's home — the DC equivalent of what most states call a home health agency license, governed by DCMR Title 22-B, Chapter 39.
Home Support Agency License
Agencies providing exclusively non-medical personal care and supportive services (activities of daily living, homemaker tasks) without skilled nursing; governed by DCMR Title 22-B, Chapter 99 and does not require a CON.
Hospice License
Agencies or organizations primarily engaged in providing palliative and supportive services — including in-home, outpatient, and inpatient care — to terminally ill individuals and their families, as defined in DC Code § 44-501 and DC Law 5-48. Hospice licensure does not require a CON under DC's current regulatory framework.
How we get you licensed
- 1Determine License Category and CON Obligation
Decide whether your agency will provide skilled services (Home Care Agency — CON required) or non-medical personal care only (Home Support Agency — no CON). Hospice applicants also do not require a CON. If skilled services are planned, the CON must be obtained before the license is issued. Contact SHPDA at (202) 442-5875 or dcshpda.com for a pre-application conference.
- 2File Certificate of Need with SHPDA (Home Care Agencies Only)
Submit a letter of intent through the SHPDA automated portal (dcshpda.com), publish a public notice in a local newspaper, observe the mandatory 60-day waiting period, then submit the full CON application with a fee equal to the greater of 3% of proposed capital expenditure or $5,000 (capped at $300,000). SHPDA has 90 days to complete its review. CONs are issued for up to three years.
- 3Form the Business Entity and Secure an Operating Office
Register with the DC Department of Licensing and Consumer Protection (DLCP) — the agency that absorbed the former DCRA's business registration functions effective October 1, 2022 — obtain an EIN, and secure a physical office within the District of Columbia staffed at minimum eight hours per day, Monday through Friday. P.O. boxes are not acceptable.
- 4Assemble Required Personnel and Documentation
Appoint a Director who is a licensed physician, licensed registered nurse, or has at least one year of supervisory or administrative experience in home health or a related program. Prepare governing body documents, personnel policies, a patient rights policy, care plan protocols, clinical record procedures, and an admissions policy.
- 5Submit the License Application Through the HRLA Online Portal
All applications are submitted electronically at dchealth.dc.gov (paper applications have not been accepted since May 3, 2023). Pay the initial application fee of $600. Attach proof of malpractice insurance ($1,000,000 per incident), general liability insurance ($1,000,000 per occurrence), and any applicable product liability coverage.
- 6Pass the Mandatory Pre-Opening Survey
HRLA conducts an on-site inspection before issuing the initial license; this inspection is required by DC Code § 44-505(a) and cannot be substituted by private accreditation at the initial licensure stage. After the initial license is granted, DC Code § 44-505(b) permits the Mayor to accept accreditation by an approved body (e.g., CHAP or ACHC) in lieu of a state inspection at renewal, provided the agency notifies DC Health of survey dates within five days of receiving notice and submits accreditation documents within five days of completion.
Key Washington, DC requirements
- Certificate of Need approval from SHPDA is a prerequisite for a Home Care Agency license; SHPDA reviews applications within 90 days but the mandatory 60-day letter-of-intent waiting period means the CON track alone spans at least five months. This CON requirement does not apply to Home Support Agencies or hospice applicants.
- Maintained physical operating office within the District of Columbia, staffed a minimum of eight hours per day, Monday through Friday — a P.O. box or virtual address does not satisfy this requirement.
- Director must be a licensed physician, licensed RN, or an individual with at least one year of supervisory or administrative experience in home health or a related health program (DCMR 22-B § 3904).
- Malpractice insurance of at least $1,000,000 per incident and general liability insurance of at least $1,000,000 per occurrence are mandatory prior to licensure (DCMR 22-B § 3901).
- Initial license application fee of $600 paid through the HRLA online portal; annual renewal fees range from $400 (1–150 patients) to $1,300 (1,251+ patients) based on patient census (DCMR 22-B § 3902).
- All applications must be submitted electronically through the HRLA digital portal; paper applications are no longer accepted as of May 3, 2023.
Traps that catch new owners
- Pursuing Medicare certification for a home health agency or hospice without checking the CMS moratorium status: as of May 13, 2026, CMS imposed a nationwide six-month moratorium on new HHA and hospice Medicare enrollment; new applicants can still obtain the DC state license but cannot complete Medicare initial certification until the moratorium lifts or an exception applies.
- Skipping or underestimating the CON process: applicants who submit a license application to HRLA before obtaining CON approval from SHPDA will be denied. The CON fee is nonrefundable, and denial in a saturated service area is a real risk — a needs assessment and market analysis before filing can prevent an expensive dead end.
- Assuming accreditation can replace the pre-opening inspection: DC Code § 44-505(b) permits CHAP or ACHC accreditation to substitute for a state survey only at license renewal, not at initial licensure. The pre-opening on-site inspection under § 44-505(a) is mandatory for all new applicants.
- Naming conflicts and reserved terms: DC Health scrutinizes agency names that include words suggesting a scope of care the license does not authorize. A Home Support Agency using clinical-sounding terminology may face naming objections or classification disputes during review.
- Using the former DCRA name for business registration: DCRA was reorganized effective October 1, 2022, with business entity registration now handled by the DC Department of Licensing and Consumer Protection (DLCP). Applications or correspondence sent to DCRA may be misdirected.
Washington, DC licensing packages
Fixed price, agreed in writing before any work begins. Each package is prepared and submitted for you, fully online.
Washington, DC licensing FAQs
Do I need a Certificate of Need to open a non-medical home care agency in DC?
No. The CON requirement under DC Code § 44-406 applies to home health agencies providing skilled nursing and therapeutic services (licensed as a Home Care Agency under DCMR Title 22-B Chapter 39). Agencies providing only personal care and supportive services — licensed as Home Support Agencies under DCMR Title 22-B Chapter 99 — are not subject to the CON requirement and may apply directly to HRLA.
Can I obtain a DC Home Care Agency license and accept Medicare patients right now?
You can apply for and receive the DC state license at any time, because state licensure and Medicare certification are separate processes. However, as of May 13, 2026, CMS imposed a six-month nationwide moratorium on new home health agency Medicare enrollment. New agencies cannot complete initial Medicare enrollment until the moratorium expires or is lifted; existing providers with applications filed before May 13, 2026 are unaffected.
Will DC Health accept a CHAP or ACHC accreditation survey instead of a state inspection?
Only at renewal, not for initial licensure. Under DC Code § 44-505(a), an on-site inspection prior to initial licensure is required and cannot be waived by private accreditation. After the initial license is issued, DC Code § 44-505(b) permits the Mayor (acting through DC Health) to accept accreditation by an approved private accrediting body in lieu of conducting a state inspection at renewal. The agency must notify DC Health of all survey and resurvey dates no later than five days after receiving notice, permit government officials to observe if requested, and submit accreditation documents to the department within five days of completion.
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