Guides Home health licensing
Service-line guide
State home health licensing
How states license home health agencies and their offices, where entry is need-gated, how far an office may reach, and why a license stops at the state line. State licensing is separate from Medicare certification, which Medicare home health covers; each state’s own rules are on its page in the 50-State Regulatory Atlas.
Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Last reviewed October 17, 2026. 65 findings: 54 verified, 9 provisional, 2 disputed. 4 time-sensitive, flagged with a recheck date. How findings are sourced and labelled.
1What it is
A state home health license is the state’s permission to give skilled care at home. It is granted by the state where the patient lives, attaches to an office or service area inside that state, and exists whether or not the agency ever bills Medicare.
Two meanings of “home health”
Verified“Home health” names two different legal things. One is a state-licensed agency giving skilled nursing or therapy at home, whatever its payers. The other is a Medicare-certified home health agency that meets the Conditions of Participation in 42 CFR Part 484. Texas writes the split into its license: “licensed home health services” (no Medicare) and “licensed and certified home health services” (Medicare) are separate categories, alongside hospice and personal assistance services (26 TAC §558.13). This guide covers the state license.
Source: 26 TAC §558.1342 CFR Part 484
Personal or non-medical home care is usually licensed apart from skilled home health. California licenses home health agencies through the Department of Public Health and non-medical Home Care Organizations through the Department of Social Services; Georgia licenses private home care providers separately, Oregon licenses in-home care agencies separately, and Hawaii licenses non-medical home care agencies under a different chapter.
Source: Cal. HSC §1726Ga. Comp. R. & Regs. 111-8-31OAR 333-027HAR ch. 11-97
No state reviewed for this guide has a separate “home infusion nursing agency” license; infusion nursing falls inside the skilled home care license. Texas defines home health service to include “intravenous therapy” (HSC §142.001). Florida provides that “a home infusion therapy provider must be licensed as a home health agency or nurse registry” (Fla. Stat. §400.464). North Carolina lists infusion nursing services within its home care agency license (G.S. 131E-136).
In practice: State-by-state treatment: infusion licensing map.
Source: Tex. HSC §142.001Fla. Stat. §400.464N.C. G.S. 131E-136
Texas exempts a pharmacy or medical supply company “that does not furnish services, other than supplies,” at the patient’s home (HSC §142.003). A business whose nurses give care in the home is not within that exemption.
Source: Tex. HSC §142.003
Some definitions may leave a single-service business outside the home health license. Delaware defines a skilled home health agency as one providing “two (2) or more home care services, one of which must be either licensed nursing services or home health aide services” (3350 §1.1). Missouri requires two skilled services, one of them nursing (19 CSR 30-26.010). Arizona defines an agency “primarily engaged in providing skilled nursing services and other therapeutic services”.
In practice: Where a business offers one service only, which license applies is a question for the state agency, best answered in writing.
Source: 16 Del. Admin. Code 3350 (27 DE Reg 44)19 CSR 30-26.010A.A.C. R9-10-1202
2Who regulates it
The state health or facilities agency licenses; a separate planning body issues any certificate of need; CMS runs the Medicare track on its own records.
The licensing agency
VerifiedThe license comes from a state health or health facilities agency whose name varies: Health and Human Services in Texas, the Division of Health Care Quality in Delaware, the Agency for Health Care Administration in Florida, the Department of Public Health in California and Illinois, and the Health Facilities Commission in Tennessee.
Source: 26 TAC §558.1116 Del. Admin. Code 3350 (27 DE Reg 44)Fla. Stat. §400.464Cal. HSC §172677 Ill. Adm. Code 245.20TN HFC home health branch application
Where a certificate of need applies, a planning body issues it, and usually first. In Maryland an applicant obtains a certificate of need or exemption from the Maryland Health Care Commission, then a license from the Office of Health Care Quality. In Vermont the Green Mountain Care Board issues the certificate and the Department of Disabilities, Aging and Independent Living designates agencies by geographic area.
Source: Maryland OHCQ home health agency license application (2026)MHCC: Home health18 V.S.A. §9434Vermont designation rules
CMS keeps a separate record
VerifiedMedicare certification is a separate track with its own location records. For a Medicare-certified agency, the CMS location, not the state survey agency, approves a branch (SOM ch. 2 §2182). A Medicare branch in a second state still needs that state’s license where it licenses home health (§2184).
In practice: Certification and enrollment: Medicare home health.
Source: CMS State Operations Manual ch. 2, Rev. 125 (§§2182–2184)
License terms differ
VerifiedTerms run from one year to indefinite. Texas licenses for three years (HSC §142.006); Alaska for two years, renewing before April 1 of even-numbered years; Arizona for up to two years; Delaware for 12 months after a 90-day initial license; North Dakota to December 31 each year; Wyoming from July 1 to June 30. Wisconsin’s regular license is valid indefinitely, with an annual report and fee.
Source: Tex. HSC §142.006Alaska DOH: Home health agenciesA.A.C. R9-10-120216 Del. Admin. Code 3350 (27 DE Reg 44)NDAC 33-03-10.1Wyoming DOH Rules Ch. 10Wis. Admin. Code DHS 133.03
3Federal rules
Federal rules govern Medicare-certified agencies only. They shape how branches are defined and when a Medicare agency may cross a state line, but they never replace the state license.
What a Medicare branch is
VerifiedA branch is “an approved location or site from which a home health agency provides services within a portion of the total geographic area served by the parent agency,” under the parent’s supervision and administrative control (42 CFR 484.2). Since January 13, 2018 there are only parents and branches: each former subunit had to become a freestanding agency or a branch of its parent.
Source: 42 CFR 484.2CMS S&C 18-03-HHA
Branch identifiers
VerifiedA branch has no provider agreement of its own. It receives an identifier derived from the parent’s CMS Certification Number with a “Q” inserted (for example 01Q7001001), reported on OASIS item M0016 and never reused (SOM ch. 2 §2182.5).
Source: CMS State Operations Manual ch. 2, Rev. 125 (§§2182–2184)
A branch’s area
VerifiedA Medicare branch’s service area must sit inside the parent’s, and any extension must be contiguous (SOM ch. 2 §2182.4B).
Source: CMS State Operations Manual ch. 2, Rev. 125 (§§2182–2184)
A Medicare agency may serve across a state line under one CCN only where the two state survey agencies have a written reciprocal agreement; each state verifies that its own licensure and personnel requirements are met, and without an agreement the agency “must establish a separate parent agency” in the second state (SOM ch. 2 §2184). CMS publishes a model agreement (Exhibit 289); this review found no published list of which state pairs have signed one.
In practice: Minnesota’s published process shows the steps: written notice, the other state’s licensure and personnel rules, a reciprocal agreement and a CMS determination.
Source: CMS State Operations Manual ch. 2, Rev. 125 (§§2182–2184)SOM Exhibit 289: model reciprocal agreementMinnesota DOH: serving across state lines
Under the nationwide moratorium on new Medicare home health enrollment effective May 13, 2026, no new home health branches are accepted or approved while it lasts. It restricts Medicare enrollment only; it does not stop a state license or state-approved office.
Time-sensitive. The first six-month term runs to about November 13, 2026, when CMS reassesses it; recheck the Federal Register after that date.
Source: CMS FY 2027 Mission and Priority DocumentFederal Register 2026-09718: HHA and hospice enrollment moratoria
4Payment
A state license allows an agency to operate. Who pays, and under what conditions, is decided elsewhere, and in some states the payer an agency chooses also decides whether a certificate of need applies.
Medicare home health covers services furnished by, or under arrangements with, a participating home health agency (42 CFR 409.42(e)). A state license is a precondition in licensing states, but billing Medicare home health also needs certification and enrollment.
In practice: The certification path: Medicare home health.
Source: 42 CFR 409.42
In three states the certificate of need turns on federal certification. Washington applies it only to Medicare and Medicaid agencies, per county, so serving a new county counts as a new agency. North Carolina applies it only to Medicare-certified agencies, and each certified site needs its own certificate and license. Hawaii requires it for an agency seeking federal certification; otherwise the state planning agency issues a letter saying none is needed.
Source: WA DOH certificate of need order CN20-02NC DHSR: Certified home health agenciesHawaii OHCA: Opening a home health agency
Medicare’s home infusion therapy benefit is a Part B supplier benefit under 42 CFR Part 486 Subpart I, not home health. It covers parenteral drugs given through a durable medical equipment pump and requires accreditation by a CMS-designated body; ACHC, The Joint Commission and URAC were confirmed.
In practice: The benefit in detail: Medicare home infusion therapy.
Source: 42 CFR 486.50585 FR, April 24, 2020 (ACHC home infusion therapy approval)
Whether a branch needs its own NPI
ProvisionalNo primary source reviewed says whether a Medicare home health branch must obtain its own National Provider Identifier or bills under the parent’s. The branch identifier under the parent CCN is confirmed; the NPI question is not.
Not yet confirmed — check with your Medicare Administrative Contractor.
Source: CMS State Operations Manual ch. 2, Rev. 125 (§§2182–2184)
5How states differ: four branch-office models
The first question for any agency with more than one office is how the state treats the second office. Branch-office models map · State home health license map.
The four models, counted
ProvisionalCounting rule: each of 51 jurisdictions (the 50 states and the District of Columbia) is placed in exactly one model by what its rules say about an office beyond the first, using this guide’s state data as of October 17, 2026. Separate license per office: 7. One license with branches listed or approved: 23. A state license whose branch rule was not confirmed: 15. No state agency license: 6, of which 2 rest on secondary or conflicting sources. Placements in the last two groups are the least settled.
Not yet confirmed — check with each state’s licensing agency.
In practice: The model for each state is on its state page and the branch-office models map.
Source: 26 TAC §558.27NDAC 33-03-10.1Michigan LARA: Home health agenciesCMS State Operations Manual ch. 2, Rev. 125 (§§2182–2184)
Separate license per office (7)
VerifiedTexas issues a branch license that “expires on the same date as the license” of the parent (HSC §142.008). Delaware: “A separate license shall be required for each office.” North Carolina: “Each agency premises shall obtain a license.” Nevada licenses a specific location and gives each branch a copy, with separate branch fees. New Mexico issues a branch license only after the parent has operated a year with a compliant survey. Utah “shall issue a separate license identifying the agency as a branch.” California: “A state license is required to operate a branch office,” added to the parent’s license.
Source: Tex. HSC §142.00826 TAC §558.2716 Del. Admin. Code 3350 (27 DE Reg 44)10A NCAC 13J .0902NAC 449.7588.370.22 NMACUtah Admin. Code R432-1-7CDPH: HHA branch office application
Most states keep one parent license. North Dakota: branches under the same management “will be licensed under the parent agency’s license.” Virginia includes each branch address on the license; Rhode Island lists the central office and each branch on one license; Washington’s license shows branch locations, with notice within 30 days of opening or closing an office. Others approve before opening: Illinois by branch questionnaire, Nebraska on 30 working days’ notice, Louisiana by written approval once the parent has held full licensure a year, Tennessee by Health Facilities Commission approval.
Source: NDAC 33-03-10.112VAC5-381216-RICR-40-10-17.4WAC 246-335-33577 Ill. Adm. Code 245.20175 NAC 14-005LAC 48:I.9118TN HFC home health branch application
District of Columbia, Hawaii, Indiana, Kansas, Kentucky, Maine, Massachusetts, Minnesota, Mississippi, Missouri, Montana, New Jersey, Pennsylvania, South Carolina and West Virginia license or are reported to license home health, but their branch rule was not confirmed. In Massachusetts (a statute without implementing rules found) and West Virginia (secondary sources only), whether licensing operates at all is itself unconfirmed.
Not yet confirmed — check with each state’s licensing agency.
Source: HAR ch. 11-97410 IAC 17-9-5K.A.R. 28-51-100M.G.L. c. 111 §51KW. Va. Code §16-2D-819 CSR 30-26.010
Idaho ended home health licensing on July 1, 2025 (Idaho Code §39-1303). Michigan: “State licensing is not required for home health agencies.” South Dakota “does not require state licensure for certified HHAs.” Vermont has no conventional agency license; it requires a certificate of need for “the offering of any home health service” and designates agencies by area. Where no state license exists, branch rules follow Medicare for certified agencies.
Source: Idaho Code §39-1303Michigan LARA: Home health agenciesSD DOH: Home health agencies18 V.S.A. §9434Vermont designation rules
Alabama and Iowa are placed with the no-license states on weaker evidence. Alabama is reported to control entry through a certificate of need from its State Health Planning and Development Agency rather than a license; that comes from secondary sources. For Iowa, sources conflict and no statute or rule was found either way.
Not yet confirmed — check with the Alabama State Health Planning and Development Agency or Iowa’s licensing agency.
Source: Ala. Admin. Code 410-1-4-.02CHAP: Alabama (secondary)Iowa Capital Dispatch (2025, secondary)
Branch expiry tied to the parent
ProvisionalTexas’s co-terminous branch expiry holds clearly only where the branch instrument derives from the parent license, as in Texas and Nevada. Whether Delaware, Utah and New Mexico office or branch licenses keep their own expiry dates was not confirmed.
Not yet confirmed — check with each state’s licensing agency.
Source: Tex. HSC §142.008NAC 449.75816 Del. Admin. Code 3350 (27 DE Reg 44)Utah Admin. Code R432-1-78.370.22 NMAC
6Certificate of need and public need
In some states the first gate is not the license but a finding that the area needs another agency. Certificate of need for home health map.
Counting rule: a jurisdiction counts where this guide’s state data records a certificate of need or public-need review for home health. Fourteen apply one generally (Alabama, Arkansas, District of Columbia, Georgia, Kentucky, Maryland, Mississippi, New Jersey, New York, Rhode Island, South Carolina, Tennessee, Vermont, West Virginia); three only for Medicare or Medicaid certified agencies (Hawaii, North Carolina, Washington); 27 have none; seven are unconfirmed (Connecticut, Delaware, Louisiana, Maine, Nevada, New Hampshire, Pennsylvania). A trade association’s 2026 list names 16, including Connecticut and omitting Maryland and Vermont; a 2021 report gave 15, and another 18 plus DC.
Not yet confirmed — check with each state’s health planning agency.
Source: Alliance for Care at Home: CON programs for home health and hospice (2026)Home Health Care News (2021)Maryland OHCQ home health agency license application (2026)18 V.S.A. §9434
Where a certificate applies it usually precedes the license. South Carolina: “A home health agency shall obtain a certificate of need before licensure.” New Jersey licenses a home health agency only after a certificate of need (N.J.A.C. 8:42-2.1). Rhode Island requires one for both of its licenses before establishment. Maryland and the District of Columbia make it a step in initial licensure, and Maryland places branch offices inside the certificate process too.
Source: S.C. Code ch. 44-69N.J.A.C. 8:42-2.1216-RICR-40-10-17.4Maryland OHCQ home health agency license application (2026)DC Health: Certificate of need
Georgia requires a certificate before a new agency opens and before an existing agency expands its area, reviews applications in county batching cycles, and bars applying for counties outside the planning areas of the current service area. Washington treats serving a new county as a new agency. West Virginia requires a certificate for any expansion of a home health agency’s service area (W. Va. Code §16-2D-8). Arkansas issues a Permit of Approval for the geographic area before licensing.
Source: Ga. Comp. R. & Regs. 111-8-31Ga. Comp. R. & Regs. 111-2-2-.32WA DOH certificate of need order CN20-02W. Va. Code §16-2D-8Arkansas Rules for Home Health Agencies
New York public-need review
VerifiedNew York applies public-need and financial-feasibility review to initial Licensed Home Care Services Agency applications from April 1, 2020, not only to Medicare-type Certified Home Health Agencies; licenses are county-based and sites and counties are added by amendment.
New York’s five-agency presumption
ProvisionalUnder a 2022 methodology, there is reported to be a rebuttable presumption of no need for a new licensed home care services agency in a county already served by five or more.
Not yet confirmed — check with the New York State Department of Health.
Source: Manatt: NY DOH LHCSA application requirements (secondary)
California’s moratorium
VerifiedCalifornia has no certificate of need, but a statutory moratorium bars new home health licenses and new branch offices unless the department finds an unmet need (HSC §§1728.9, 1728.95); changing a branch’s area is also subject to it.
Mississippi’s 2026 ruling
ProvisionalA federal court struck down Mississippi’s 1983 moratorium on new home health agencies in January 2026 and upheld its certificate of need requirement. The source is a news report.
Not yet confirmed — check with the Mississippi State Department of Health.
Time-sensitive. Whether the ruling was appealed, and the outcome, is not confirmed; recheck the court record before relying on it.
7Geographic limits on an office
Where an office may send nurses is set in at least six different ways. A rule of one form cannot be read as a rule of another.
Nesting inside the parent’s area
VerifiedTexas: “The service area of a branch office must be located within the parent agency’s service area,” with no mileage cap and 30 days’ written notice to expand a branch’s area (26 TAC §558.321). Colorado, Louisiana, South Carolina and Virginia likewise describe a branch as serving a portion of the parent’s area.
Source: 26 TAC §558.32126 TAC §558.276 CCR 1011-1 Chapter 26LAC 48:I.9118S.C. Code ch. 44-6912VAC5-381
County lists
VerifiedFlorida’s license lists counties, and the agency may not serve a patient who lives in a county not on it. Illinois approves a service area of contiguous counties, and approval is needed before caring for clients in a new county. Maryland lists every county served on the application; New York licenses by county; Georgia and Washington approve counties through the certificate of need.
Source: Fla. Admin. Code 59A-8.00777 Ill. Adm. Code 245.20IDPH Home Health FAQMaryland OHCQ home health agency license application (2026)NY DOH: LHCSA public need methodologyGa. Comp. R. & Regs. 111-2-2-.32WA DOH certificate of need order CN20-02
County adjacency
VerifiedDelaware limits service to the county where the office sits plus immediately adjacent Delaware counties: “the agency shall only provide services in the service area,” except during a patient’s time-limited travel (3350 §§1.1, 2.1.7).
In practice: New Castle and Sussex counties do not border each other, so an office in New Castle reaches New Castle and Kent, and Sussex needs an office in Kent or Sussex.
Mileage from the parent
VerifiedOregon uses a 60-mile radius, with case-by-case exceptions and underserved-area waivers. New Mexico places branches within 100 miles of the parent and patients within 100 miles of the licensed location. Arkansas allows service up to 100 miles from the parent or branch. Kansas keeps the service area and branches within 200 miles of the parent office.
Source: OAR 333-0278.370.22 NMACArkansas Rules for Home Health AgenciesK.A.R. 28-51-100
Drive time
VerifiedIndiana requires a branch to be within 120 minutes’ driving time of the parent agency (410 IAC 17-9-5).
Source: 410 IAC 17-9-5
Close enough to supervise
VerifiedSome states give no number. North Dakota requires branches close enough to share administration, supervision and services; Wyoming requires a branch “sufficiently close” and asks for its mileage at renewal; Wisconsin applies a volume and distance test and may require a separate license; Colorado requires a branch close enough to share administration and supervision.
Source: NDAC 33-03-10.1Wyoming DOH Rules Ch. 10Wis. Admin. Code DHS 133.036 CCR 1011-1 Chapter 26
8Out-of-state agencies
The state where the patient is decides. Each state’s license is a separate licensed entity, not a branch spread across states.
No license reaches across a state line
ProvisionalThis review found no jurisdiction where a home-state home health license covers patients in another state. Each licensing state ties its license to an in-state office or in-state service area, and the cross-border rules that look like exceptions all produce a license from the destination state. Texas, for example, is silent on a Texas agency serving patients across the border; the other state’s law decides.
Not yet confirmed — check with the licensing agency in the patient’s state.
Source: 26 TAC §558.11CMS State Operations Manual ch. 2, Rev. 125 (§§2182–2184)Wyoming DOH Rules Ch. 10Maryland OHCQ home health agency license application (2026)
Counting rule: a state counts where its rules require an in-state office or an in-state licensed parent to serve its residents; this guide’s data records 11. Texas: a place of business “must be in Texas with a Texas address,” and an out-of-state agency must obtain a Texas parent license. Colorado requires a physical business office in Colorado; Illinois an Illinois license and office; Washington at least one in-state office where records are kept; Nevada a home office in Nevada; Delaware an office in Delaware; California a parent office licensed in California; Ohio an Ohio administrative office holding Ohio records; Connecticut offices in Connecticut; Arkansas a primary Arkansas license; Indiana an Indiana branch for an out-of-state parent.
Source: 26 TAC §558.116 CCR 1011-1 Chapter 26IDPH Home Health FAQWAC 246-335-335NAC 449.75816 Del. Admin. Code 3350 (27 DE Reg 44)CDPH: HHA branch office applicationOAC 3701-60-03Regs. Conn. State Agencies §§19-13-D66 to D79Arkansas Rules for Home Health Agencies410 IAC 17-10-1
Maryland will license an agency whose parent is out of state if at least one branch is in Maryland, or if the parent is in a bordering state and a reciprocal agreement exists or the agency accepts state inspection. Missouri admits only a Medicare-certified agency of a bordering state with a reciprocal agreement and a Missouri business location. Wyoming: “Branch offices located out of state will be individually licensed in the State of Wyoming.” Oklahoma licenses branches of out-of-state parents as full home care agencies. Each still ends in a license from the destination state.
Source: Maryland OHCQ home health agency license application (2026)19 CSR 30-26.010Wyoming DOH Rules Ch. 10OAC 310:662
Foreign entity qualification
VerifiedSome states test the entity as well as the office. Wisconsin requires a foreign corporation to show authority to do business in Wisconsin; Indiana requires an out-of-state parent to be authorized by the Indiana Secretary of State; Connecticut requires control by a corporation chartered or qualified in Connecticut or by Connecticut residents.
Source: Wis. Admin. Code DHS 133.03410 IAC 17-10-1Regs. Conn. State Agencies §§19-13-D66 to D79
9Nurse licensure is not agency licensure
Two separate checks apply to every visit: the agency’s license in the patient’s state, and the nurse’s license in the patient’s state. Nurse Licensure Compact map.
Compact membership
VerifiedForty-three jurisdictions have enacted the Nurse Licensure Compact and 40 have fully implemented it. Pennsylvania (July 7, 2025) and Connecticut (October 1, 2025) are the newest; Massachusetts, Guam and the U.S. Virgin Islands are not fully implemented.
Time-sensitive. Membership changes as states implement; recheck the NCSBN map before relying on a state’s status, especially Massachusetts.
Alaska, California, the District of Columbia, Hawaii, Illinois, Michigan, Minnesota, Nevada, New York and Oregon are not compact members, and Massachusetts is not yet implemented. A nurse needs that state’s own license to practice there.
The compact lets a nurse with a multistate license practice where the patient is located in another compact state; it gives the agency no authority there. The agency still needs the license of the patient’s state. CMS requires a Medicare agency’s personnel to be “qualified in all States in which they provide services” (SOM ch. 2 §2184).
Source: NCSBN Nurse Licensure Compact mapCMS State Operations Manual ch. 2, Rev. 125 (§§2182–2184)
Texas accepts a compact license for the supervising nurse: “an RN licensed in Texas or under Texas Board of Nursing rules for the Nurse Licensure Compact,” with at least one year of RN experience in the last 36 months (26 TAC §558.244).
Source: 26 TAC §558.244
10Accreditation in place of a state survey
Several states accept Medicare certification or accreditation instead of their own routine licensure survey, while keeping complaint authority. Accreditation in place of state survey map.
Texas
VerifiedAn agency accredited for the relevant services and license category by an HHSC-approved organization is exempt from additional HHSC surveys “except complaint investigations” (26 TAC §558.503).
Source: 26 TAC §558.503
Washington
VerifiedA Medicare-certified or listed-accredited agency “is not subject to a state licensure survey” where the department finds the standards “substantially equivalent,” an on-site survey was done within the previous 24 months and the reports are provided; validation surveys may cover “no greater than ten percent” of each survey type (RCW 70.127.085).
Source: RCW 70.127.085
Oklahoma exempts a certified or accredited agency from routine licensure inspections but not from inspection at any time, and does not treat branches of out-of-state parents as accredited. Virginia exempts an organization from licensure after initial licensure if it is Medicare or Medicaid certified or accredited by a CMS-recognized body, but only if it is located in Virginia.
Arizona may relicense without a state survey an agency that is Medicare-certified and has been licensed for at least a year. In Ohio, ACHC, CHAP or Joint Commission accreditation, or Medicare certification, satisfies the skilled license application. Massachusetts’s statute deems a Medicare- or Medicaid-certified agency to meet the initial application, though implementing rules were not found.
Oregon
ProvisionalOregon inspects before licensure and every three years after, and may accept certification or accreditation from an approved body; the rule text was read on a secondary host.
Not yet confirmed — check with the Oregon Health Authority.
State survey cadence varies
VerifiedWhere the state surveys itself, the interval is set by state law. Florida surveys before initial licensure and “at least every 36.9 months” after; South Carolina inspects annually; Illinois issues a 240-day provisional license and surveys on site before it expires.
Source: Fla. Admin. Code 59A-8.003S.C. Code ch. 44-69IDPH Home Health FAQ
11How to start
Order matters because each step depends on the one before. The order below follows from the cited requirements; no single official checklist sets it.
Order of steps
ProvisionalThe cited rules put the work in this order: form the legal entity (and qualify it in the state where a foreign entity needs authority); obtain the certificate of need where the state requires one; apply for the license in the right category; establish the in-state office the state requires; hire the required leadership and staff; and write policies to the state rule, which in some states is the Medicare standard. Medicare certification, if wanted, comes after the state license.
Not yet confirmed — check with the state licensing agency.
Source: Wis. Admin. Code DHS 133.03Maryland OHCQ home health agency license application (2026)26 TAC §558.136 CCR 1011-1 Chapter 2616 Del. Admin. Code 3350 (27 DE Reg 44)
Choose the license category from the state’s definition, not the business’s name: Texas’s categories (26 TAC §558.13), Delaware’s two-service definition and Missouri’s nursing-plus-one rule each decide which license, if any, a business needs.
Source: 26 TAC §558.1316 Del. Admin. Code 3350 (27 DE Reg 44)19 CSR 30-26.010
A license generally belongs to its holder. Delaware voids the license on a change of ownership and requires the new owner to apply as a new agency (3350 §§2.1.4, 2.5.2); Indiana licenses cannot be transferred (410 IAC 17-10-1).
Source: 16 Del. Admin. Code 3350 (27 DE Reg 44)410 IAC 17-10-1
Initial and provisional licenses
VerifiedSeveral states license in phases with a survey while the agency operates. Delaware issues a 90-day non-renewable initial license with an on-site survey, then an annual license. Illinois issues a 240-day provisional license surveyed before it expires. Montana starts with a six-month provisional license and an on-site survey.
Source: 16 Del. Admin. Code 3350 (27 DE Reg 44)IDPH Home Health FAQMontana DPHHS letter to prospective agencies (2021)
The office and its records
VerifiedOffice rules include where records live. Washington keeps records at the in-state office; Texas and Louisiana keep the original clinical record at the branch; Rhode Island keeps clinical records for a branch’s patients at that branch.
Source: WAC 246-335-33526 TAC §558.321LAC 48:I.9118216-RICR-40-10-17.4
Leadership and supervision
VerifiedDelaware requires a Director and an RN Clinical Director, one of whom is available during all operating hours, with aide supervision every two weeks when skilled care is also given and every 60 days for aide-only patients. Texas requires the parent’s administrator or supervising nurse to visit each branch on site at least monthly. California requires a branch nurse supervisor on site or reachable by phone; New Mexico an on-site branch administrator.
Source: 16 Del. Admin. Code 3350 (27 DE Reg 44)26 TAC §558.321CDPH: HHA branch office application8.370.22 NMAC
Montana adopts the Medicare Conditions of Participation as its state standard, and Missouri’s rule adopts them too, so a licensed agency in those states writes policies to 42 CFR Part 484 even if it never bills Medicare.
Source: Montana DPHHS letter to prospective agencies (2021)19 CSR 30-26.010
12Common pitfalls
A nurse’s multistate license lets the nurse practice in the patient’s compact state; the agency still needs that state’s license to send the nurse.
Source: NCSBN Nurse Licensure Compact mapCMS State Operations Manual ch. 2, Rev. 125 (§§2182–2184)
Florida bars serving a patient in a county not on the license; Illinois requires approval before caring for clients in a new county; Washington requires approval of an expanded area before services start.
Source: Fla. Admin. Code 59A-8.007IDPH Home Health FAQWAC 246-335-335
Opening a branch too early
VerifiedLouisiana bars a branch until the parent has held full licensure for a year; New Mexico requires a year of operation and a compliant survey; Nebraska requires written notice 30 working days before adding a branch.
An Oklahoma branch of an out-of-state parent is licensed as a full home care agency and is not treated as certified or accredited, so it is not exempt from routine inspection.
Source: OAC 310:662OAC 310:662-7-1
Rules that changed recently
VerifiedSeveral rules changed recently: Idaho ended licensing on July 1, 2025; California’s moratorium limits new licenses and branches; Colorado’s Chapter 26 took effect July 1, 2025; New Mexico’s rule took effect July 1, 2024. Each state page carries its source and date.
Source: Idaho Code §39-1303Cal. HSC §1728.96 CCR 1011-1 Chapter 268.370.22 NMAC
Proposed amendments to 26 TAC §§558.27 and 558.29, which govern Texas branch licensing, were published in the Texas Register on September 18, 2026. Their text was not reviewed, and adoption is not confirmed.
Time-sensitive. Proposed September 18, 2026; recheck the Texas Register for adoption or withdrawal before relying on the branch rules above.
Source: Texas Register, September 18, 2026 (proposed rules)26 TAC §558.27
Official sources
- 26 TAC §558.13
- 42 CFR Part 484
- Cal. HSC §1726
- Ga. Comp. R. & Regs. 111-8-31
- OAR 333-027
- HAR ch. 11-97
- Tex. HSC §142.001
- Fla. Stat. §400.464
- N.C. G.S. 131E-136
- Tex. HSC §142.003
- 16 Del. Admin. Code 3350 (27 DE Reg 44)
- 19 CSR 30-26.010
- A.A.C. R9-10-1202
- 26 TAC §558.11
- 77 Ill. Adm. Code 245.20
- TN HFC home health branch application
- Maryland OHCQ home health agency license application (2026)
- MHCC: Home health
- 18 V.S.A. §9434
- Vermont designation rules
- CMS State Operations Manual ch. 2, Rev. 125 (§§2182–2184)
- Tex. HSC §142.006
- Alaska DOH: Home health agencies
- NDAC 33-03-10.1
- Wyoming DOH Rules Ch. 10
- Wis. Admin. Code DHS 133.03
- 42 CFR 484.2
- CMS S&C 18-03-HHA
- SOM Exhibit 289: model reciprocal agreement
- Minnesota DOH: serving across state lines
- CMS FY 2027 Mission and Priority Document
- Federal Register 2026-09718: HHA and hospice enrollment moratoria
- 42 CFR 409.42
- WA DOH certificate of need order CN20-02
- NC DHSR: Certified home health agencies
- Hawaii OHCA: Opening a home health agency
- 42 CFR 486.505
- 85 FR, April 24, 2020 (ACHC home infusion therapy approval)
- 26 TAC §558.27
- Michigan LARA: Home health agencies
- Tex. HSC §142.008
- 10A NCAC 13J .0902
- NAC 449.758
- 8.370.22 NMAC
- Utah Admin. Code R432-1-7
- CDPH: HHA branch office application
- 12VAC5-381
- 216-RICR-40-10-17.4
- WAC 246-335-335
- 175 NAC 14-005
- LAC 48:I.9118
- 410 IAC 17-9-5
- K.A.R. 28-51-100
- M.G.L. c. 111 §51K
- W. Va. Code §16-2D-8
- Idaho Code §39-1303
- SD DOH: Home health agencies
- Ala. Admin. Code 410-1-4-.02
- CHAP: Alabama (secondary)
- Iowa Capital Dispatch (2025, secondary)
- Alliance for Care at Home: CON programs for home health and hospice (2026)
- Home Health Care News (2021)
- S.C. Code ch. 44-69
- N.J.A.C. 8:42-2.1
- DC Health: Certificate of need
- Ga. Comp. R. & Regs. 111-2-2-.32
- Arkansas Rules for Home Health Agencies
- NY DOH: LHCSA public need methodology
- Manatt: NY DOH LHCSA application requirements (secondary)
- Cal. HSC §1728.9
- Clarke County Tribune (January 2026, secondary)
- 26 TAC §558.321
- 6 CCR 1011-1 Chapter 26
- Fla. Admin. Code 59A-8.007
- IDPH Home Health FAQ
- OAC 3701-60-03
- Regs. Conn. State Agencies §§19-13-D66 to D79
- 410 IAC 17-10-1
- OAC 310:662
- NCSBN Nurse Licensure Compact map
- 26 TAC §558.244
- 26 TAC §558.503
- RCW 70.127.085
- OAC 310:662-7-1
- Va. Code §32.1-162.8
- A.R.S. §36-425.01
- OAR 333-027-0036 (secondary host)
- Fla. Admin. Code 59A-8.003
- Montana DPHHS letter to prospective agencies (2021)
- Texas Register, September 18, 2026 (proposed rules)
Revision history
| Date | Change |
|---|---|
| 2026-10-17 | First published |
About this guide. Published and maintained by Paloma Health Technologies; Findings are cited to official sources, dated and status-labelled; see the editorial policy. Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Questions
Home health licensing: common questions
Does a nurse’s compact license let an agency serve patients in another state?
No. The Nurse Licensure Compact covers the nurse only: a nurse with a multistate license may practice where the patient is in another compact state. The agency still needs the home health license of the patient’s state, and Medicare requires personnel to be qualified in every state where they serve.
Does Texas license each branch office separately?
Yes. Texas issues a license for each place of business, and a branch office holds its own branch license that expires on the same date as the parent’s. The branch’s service area must sit inside the parent’s, and the parent’s administrator or supervising nurse visits each branch at least monthly.
Can a Medicare-certified agency serve another state under one certification?
Only where the two state survey agencies have a written reciprocal agreement and CMS approves; otherwise the agency must establish a separate parent agency in the second state. Even with an agreement, each state’s own licensure and personnel requirements apply.
Does accreditation replace the state licensure survey?
In some states. Texas exempts an accredited agency from additional state surveys except complaint investigations, and Washington exempts a certified or accredited agency surveyed within the previous 24 months where standards are substantially equivalent. Oklahoma and Virginia limit their exemptions to agencies based in the state.
Which states confirm they issue no home health agency license?
Idaho ended licensing on July 1, 2025; Michigan states that licensing is not required; South Dakota does not require state licensure for certified agencies; and Vermont has no conventional license but requires a certificate of need and a state designation.
How far may a branch office be from its parent?
It depends on the state. Oregon uses a 60-mile radius, New Mexico and Arkansas 100 miles, Kansas 200 miles, and Indiana 120 minutes’ drive; Texas has no mileage cap but nests the branch inside the parent’s area, and Delaware limits service to the office’s county and adjacent Delaware counties.