How to start a home care agency in North Carolina

North Carolina requires a Home Care Agency license (service categories include in-home aide services and in-home companion, sitter and respite services) from NC DHHS Division of Health Service Regulation (DHSR), Acute and Home Care Licensure and Certification Section to operate a home care agency. Fee: $510. Processing time: DHSR does not set a time frame; it depends on completeness and surveyor workload. Applicants must finish all requirements within 12 months of the application and fee.

License required

Yes

License

Home Care Agency license (service categories include in-home aide services and in-home companion, sitter and respite services)

Issuing agency

NC DHHS Division of Health Service Regulation (DHSR), Acute and Home Care Licensure and Certification Section

Fee

$510

Fee details

$510 initial license fee; $510 for a change of ownership; all fees non-refundable (DHSR FAQ revised 5/30/25).

Renewal

Every year · $510 annual renewal; all licenses expire at midnight December 31 and must be renewed before then.

Processing time

DHSR does not set a time frame; it depends on completeness and surveyor workload. Applicants must finish all requirements within 12 months of the application and fee.

Survey and inspection

Initial survey (desk review of policies, procedures and personnel files); unannounced inspections about every 3 years plus complaint investigations.

Certificate of need

Not required

Medicare certification

A Certificate of Need is needed only to become a Medicare-certified home health agency; state-licensed-only home care agencies cannot bill Medicare.

Regulation

N.C. Gen. Stat. 131E-135 to 131E-142; 10A NCAC 13J

1. Review the 10A NCAC 13J rules and the Initial Home Care Survey Checklist
2. Complete DHSR-approved home care provider training, unless you can prove prior ownership/operation of a home care agency
3. Mail the licensure application with the fee and training (or prior-operation) proof
4. DHSR confirms receipt and requests policies, procedures and personnel records
5. DHSR conducts the initial survey by reviewing those documents
6. Receive the approval letter and print the license from the Enterprise system
7. Notify DHSR 30 days before adding a service category or expanding counties; renew annually by December 31

Staffing

• Agency Director meeting rule qualifications (health care practitioner, 2 years home care/licensed-provider management, or bachelor's plus 1 year); lower bar for companion/sitter/respite-only agencies (high school/GED plus experience)
• RN must be continuously available for supervision and consultation whenever in-home aide services are provided; RN assesses clients, writes the plan of care and supervises aides (LPNs may not)
• In-home aide services limited to contiguous counties or within 90 minutes' drive of the agency site
• No hiring of anyone with a substantiated Health Care Personnel Registry finding; criminal history check requested within 5 business days of a conditional job offer (G.S. 131E-265)

Training

• Owner/applicant: DHSR-approved home care provider training unless prior agency operation is shown
• In-home caregiver competency must be verified by demonstration
• In-service education hours set by agency policy, with attendance records

Program

NC Medicaid (NCDHHS Division of Health Benefits), including NC Medicaid Managed Care

Enrollment portal

NCTracks Provider Portal

Fiscal agent

GDIT (NCTracks; the enrollment page still lists the call center under the firm name CSRA)

Application fee

North Carolina charges a $100 NC Medicaid Provider Application Fee on enrollment and on revalidation/reverification applications. It was waived from late 2021 to June 30, 2023 and reinstated July 1, 2023. Institutional provider types also pay the federal fee, which NCTracks lists as $750 for 2026. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.

Fingerprinting

Fingerprint-based criminal background checks are required for all high-risk providers and for anyone owning 5% or more of one. Fingerprints already on file with Medicare (confirmed in PECOS) can be accepted unless the provider was moved up to high risk. A provider is moved to high risk after a fraud-based payment suspension, an overpayment, an exclusion, or a similar trigger. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. The NCTracks pages we reviewed do not give a state list of provider types that get site visits.

Revalidation

NC calls revalidation 'recredentialing' or 'reverification'. It is due every five years, and NC law requires the $100 fee each time. Providers get notices in the NCTracks message inbox, with reminders 50, 20 and 5 days before the due date if they have not applied. A provider who misses the due date is suspended from Medicaid. Recredentialing includes a criminal background check on all owners and managing relationships. Time-limited enrollees, such as out-of-state providers, are exempt.

Full North Carolina Medicaid enrollment guide →

For this business

Not required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

NC Department of Health and Human Services, Division of Health Service Regulation, Healthcare Planning and Certificate of Need Section

Services covered

• new health service facilities (hospitals, nursing homes, adult care homes, kidney disease treatment centers, long-term care hospitals, psychiatric and chemical dependency facilities as defined)
• changes in bed capacity
• capital expenditures over $4,000,000 to develop or expand a health service
• dialysis and home health services new to a facility
• home health agency and hospice offices; hospice, hospice inpatient and hospice residential facilities
• major medical equipment over $2,000,000 and specified services (e.g., MRI only in counties of 125,000 or fewer)
• operating rooms and GI endoscopy rooms; specialty-to-multispecialty ASC conversions
• relocation between service areas; mobile medical equipment

North Carolina certificate of need details →

Model

hybrid

State vendor

Sandata (NC Medicaid Direct, free solution and aggregator); HHAeXchange or CareBridge offered free by health plans

Services in scope

• personal care
• CAP/C
• CAP/DA
• Innovations and TBI waiver services
• home health

Alternate EVV allowed

Yes

Program

https://medicaid.ncdhhs.gov/EVV

North Carolina EVV requirements →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

Rate pass-through

SL 2023-134, s. 9E.15 raised Innovations waiver rates to fund direct care worker wage increases. To get the increase, each provider files an attestation with its LME/MCO, reports at the end of the state fiscal year on how the funds were used, and keeps its own documentation showing it met the legislative requirements.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Personal care / in-home supportive care organizations — active organization NPIs (NPPES)

3,618 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

2,811,382 (as of Jun 1, 2026)

All North Carolina Home care Medicaid rates, ranked →

• NC Community Alternatives Program for Children Waiver (1915(c))
• NC Community Alternatives Program for Disabled Adults (CAP/DA) Waiver (1915(c))
• NC Innovations Waiver (1915(c))
• NC Traumatic Brain Injury (TBI) Waiver (1915(c))

North Carolina waivers and waiting lists →