Nurse entrepreneurship Independent and private-duty nursing
Nurse entrepreneurship guide
Independent and private-duty nursing
An independent nurse caring for one client is usually one of three things: the family’s household employee, a genuinely independent business, or a nurse working through a licensed agency or registry. Payment sources push toward one of them.
Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Last reviewed October 17, 2026. 14 findings: 9 verified, 5 provisional. 2 time-sensitive, flagged with a recheck date. How findings are sourced and labelled.
1The family as employer
IRS Publication 926 (2026) lists private nurses as household workers. A family owes Social Security and Medicare taxes at $3,000 or more in cash wages in 2026 and federal unemployment tax at $1,000 or more in any quarter; a worker supplied and controlled by an agency is not the family’s employee, and a worker who alone controls how the work is done is self-employed.
Time-sensitive. Thresholds change each year.
Source: IRS Publication 926 (2026), Household Employer’s Tax Guide
2Contractor classification
Federal enforcement since May 2025
ProvisionalSince May 1, 2025, the Department of Labor has used its 2008 Fact Sheet #13 approach in investigations instead of its 2024 independent-contractor rule, which remains for private litigation. DOL proposed rescinding the 2024 rule on February 27, 2026 (91 FR 9932); comments closed April 28, 2026, and no final rule was found as of October 17, 2026.
Not yet confirmed — check with the U.S. Department of Labor, Wage and Hour Division.
Time-sensitive. A final rule on the February 2026 proposal may issue; recheck the Federal Register.
Corrected 2026-10-18: Added DOL’s February 27, 2026 proposed rescission (not final).
Source: Duane Morris: DOL guidance on the 2024 independent contractor rule (May 2025)U.S. Department of Labor: news release on the proposed rescission of the 2024 independent contractor rule (Feb 26, 2026; published in the Federal Register Feb 27, 2026)
California’s ABC test
ProvisionalCalifornia’s AB 5 does not exempt RNs, NPs or LVNs, so a family-controlled independent nurse arrangement is hard to sustain as contracting in California.
Not yet confirmed — check with the California Labor Commissioner or the Employment Development Department.
Source: Hooper Lundy: California AB 5 and health care workers
3Licensing exemptions for directly hired nurses
State by state: compare the states or open the map layers for elective IV hydration, the home-care license and sole-practitioner exemption, RN PICC insertion and NP practice environment.
Texas exempts “an individual hired and paid directly by the client or the client’s family or legal guardian to provide home health or personal assistance services” (HSC §142.003(a)(13)).
Recheck on the official site. Read on a verbatim mirror of the statute; confirm the wording on the official site.
Source: HSC §142.003 (public.law mirror)Texas Health and Safety Code ch. 142 (official)
Virginia exempts a natural person “retained by the individual or by another individual acting on the individual’s behalf” (Va. Code §32.1-162.8).
Source: Va. Code §32.1-162.8
Florida exempts an individual who acts alone, in an individual capacity, and is not employed by or affiliated with a home health agency or registered with a nurse registry (§400.464(6)(e)). Florida licenses nurse registries separately.
Source: Fla. Stat. §400.464
A licensed Illinois home health agency must also hold a nurse agency license when referring nurses to facilities, except for private duty assignments for a particular individual (68 Ill. Adm. Code 690).
California: private duty nursing agencies
ProvisionalCalifornia licenses private duty nursing agencies through the health department; health facilities licensed under H&SC §1250 et seq. are exempt (H&SC §1743.15).
Not yet confirmed — check with the California Department of Public Health.
Recheck on the official site. Read on a verbatim mirror of the statute; confirm the wording on the official site.
Corrected 2026-10-18: Status changed from Verified to Provisional: the statute was read only on an unofficial mirror.
Source: Cal. Health & Safety Code §1743.15 (public.law mirror)
4Medicaid private duty nursing enrollment varies
Montana: enrolled agencies
VerifiedMontana requires home care agencies to be enrolled to provide and bill EPSDT private duty nursing.
Source: Montana Medicaid: private duty nursing provider training (Aug 2025)
In Missouri, Medicare-certified, state-licensed home health agencies qualify as private duty nursing providers.
New York enrolls both licensed home care services agencies and private-practice RNs and LPNs for private duty nursing, enrolled before service starts, with an enhanced rate for medically fragile children.
Recheck on the official site. An archived 2016 policy was read; confirm the current eMedNY manual.
Source: eMedNY: private duty nursing policy (2016, archived)
California: individual providers
ProvisionalCalifornia is reported to allow individually enrolled Medi-Cal RN and LVN providers.
Not yet confirmed — check with the California Department of Health Care Services.
Source: Cal. Health & Safety Code §1743.15 (public.law mirror)
5Long-term care insurance
Many policies pay only licensed agencies
ProvisionalMany long-term care insurance policies pay only for care from licensed or certified home care agencies; some reimburse independent caregivers.
Not yet confirmed — check with the policy’s insurer and the state insurance department.
Source: Griswold Home Care: does long-term care insurance pay for home care (Nov 2025)
Florida: nurse registries count
VerifiedA Florida statute barred long-term care policies from requiring care only from a licensed home health agency when a nurse registry would qualify.
Recheck on the official site. The 1999 version was read; confirm the current statute.
Source: Fla. Stat. §627.94071 (1999)
Official sources
- IRS Publication 926 (2026), Household Employer’s Tax Guide
- Duane Morris: DOL guidance on the 2024 independent contractor rule (May 2025)
- U.S. Department of Labor: news release on the proposed rescission of the 2024 independent contractor rule (Feb 26, 2026; published in the Federal Register Feb 27, 2026)
- Hooper Lundy: California AB 5 and health care workers
- HSC §142.003 (public.law mirror)
- Texas Health and Safety Code ch. 142 (official)
- Va. Code §32.1-162.8
- Fla. Stat. §400.464
- 68 Ill. Adm. Code 690 (nurse agency licensing)
- Cal. Health & Safety Code §1743.15 (public.law mirror)
- Montana Medicaid: private duty nursing provider training (Aug 2025)
- Missouri DSS: home health provider notice
- eMedNY: private duty nursing policy (2016, archived)
- Griswold Home Care: does long-term care insurance pay for home care (Nov 2025)
- Fla. Stat. §627.94071 (1999)
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
Independent and private-duty nursing: common questions
If a family hires me directly, do I need an agency license?
Several states exempt a nurse hired and paid directly by the client or family (Texas, Virginia) or acting alone (Florida). The family may then be a household employer with payroll duties.
Can I bill Medicaid private duty nursing as an individual nurse?
It depends on the state: New York enrolls private-practice nurses, Montana and Missouri pay enrolled agencies.