Where are you starting?
North Carolina · G.S. 131E-136 · State Medical Facilities Plan
North Carolina has three licenses for care at home. Which one you need depends on whether your staff touch clients, and whether you want to bill Medicare. Only one of them needs a Certificate of Need, and in 2026 none are being granted.
Quick answer
In North Carolina, a home care agency is licensed by DHSR to give care at home, including hands-on in-home aide care. A home health agency is a licensed home care agency that is also Medicare-certified: "Home Health means a licensed home care agency which is certified to receive Medicare and Medicaid reimbursement for providing nursing care, therapy, medical social services, and home health aide services".
The difference that matters for a new owner: "To become a medicare certified home health agency, a Certificate of Need (CON) must be obtained." And the 2026 State Medical Facilities Plan says of new Medicare-certified home health agencies: "It is determined that there is no need anywhere in the state and no reviews are scheduled."
So a new agency starts as a licensed home care agency ($510 a year, no Certificate of Need). If you will only offer companion, sitter or respite care, you need a home assistance services provider license instead.
Start from what your staff will actually do in the client’s home. ""Hands-on care" means any home care service that involves touching the patient in order to implement the patient's plan of care." 13J .0901(10)
Home assistance
Company, supervision and respite with no hands-on care. Needs a DHSR license, liability insurance and criminal background checks, and clients must be told you give no hands-on care.
G.S. 131E-136(1b), -138(h)Home care agency
Help with bathing, dressing, toileting, eating and moving, plus nursing or therapies if you add them. A DHSR license under 10A NCAC 13J, $510 a year. Where most new agencies start.
G.S. 131E-136(3)dHome health
A licensed home care agency certified to bill Medicare and Medicaid for skilled care. Needs a Certificate of Need first, and none are available in 2026.
DHSR FAQ 3-6Not sure? Take the short license check on our North Carolina guide.
| Home assistance provider | Home care agency | Medicare-certified home health | |
|---|---|---|---|
| What it covers | Companion, sitter or respite care on its own, or with homemaker services. No hands-on care. G.S. 131E-136(1b) | Home care services: in-home aide (hands-on) care, nursing, therapies, medical social services and more, as licensed. DHSR FAQ 2 | A licensed home care agency that is also certified to bill Medicare and Medicaid for nursing, therapy, medical social services and home health aide services. DHSR FAQ 3 |
| License | A DHSR license as a home assistance services provider. G.S. 131E-138(a) | A DHSR home care agency license, one per site, $510 a year. G.S. 131E-138(c) | A DHSR home care license, after the Certificate of Need. DHSR |
| Certificate of Need | No. DHSR ties the CON to Medicare certification. DHSR FAQ 3-6 | No, unless it seeks Medicare certification. DHSR FAQ 3-6 | Required first, one per site. DHSR |
| Medicare | No. DHSR FAQ 5 | Cannot bill Medicare without certification. DHSR FAQ 5 | Certified to bill Medicare and Medicaid. DHSR FAQ 3 |
| New ones in 2026 | Yes, apply to DHSR. G.S. 131E-138(a) | Yes, apply to DHSR. DHSR | No need found anywhere in the state; no CON reviews scheduled. SMFP 2026 Table 12E |
The $510 is DHSR’s state license fee, not a CareRulebook price.
"No one may develop a new certified home health agency without first obtaining a certificate of need." A certificate cannot be issued unless the State Medical Facilities Plan shows a need for the agency in the county where it is proposed. DHSR
The plan, published each year, shows how many new Medicare-certified home health agencies are needed and in which counties. Each county is its own service area, and need is only found where the projected unmet need is 325 patients or more.
SMFP 2026, ch. 12Only where the plan shows need, by the deadline it sets. There is a comment period and a public hearing, and the CON Section decides within 150 days of the start of the review.
DHSRWith the CON issued, apply to DHSR’s Acute and Home Care Licensure and Certification Section for the license, one per site.
DHSRSteps to certify for Medicare and Medicaid come after the agency is licensed and operating, with an unannounced on-site survey.
DHSR2026 and 2027 · No need anywhere
Table 12E of the 2026 plan, for new Medicare-certified home health agencies or offices: "It is determined that there is no need anywhere in the state and no reviews are scheduled." The proposed 2027 plan, for reviews starting in 2027, says the same. SMFP 2026 Proposed SMFP 2027
Medicare enrollment is closed to new agencies too, nationwide: "Effective May 13, 2026, CMS will halt the enrollment of new Hospice and HHA providers or HHA branch or practice locations." The moratorium lasts six months, can be extended, and allows no individual exceptions. CMS, QSO-26-11
The plan’s inventory lists 208 licensed Medicare-certified agencies or offices already operating (our count). Questions about home health Certificates of Need go to DHSR’s Certificate of Need Section on 919-855-3873.
DHSR’s page describing the home health route was last updated in 2008. The Certificate of Need requirement is confirmed in DHSR’s FAQ (revised May 30, 2025) and in the 2026 plan.
This is where a new North Carolina agency giving personal care starts. The statute lists among home care services: "In-home aide services that involve hands-on care to an individual." G.S. 131E-136(3)d
DHSR asks for your policies, procedures and personnel documents after you apply and reviews them before licensing you. How the application works →
CareRulebook
CareRulebook writes the North Carolina policies DHSR’s initial survey checklist asks for, for a home care agency giving in-home aide care, with optional companion, sitter and respite services. Your agency’s details are filled in and the 13J rule is quoted under every policy.
$199CareRulebook founding price for the first 50 North Carolina agencies, then $249. Not a DHSR fee.
Since 2023 the statute treats companion-only care as its own service: "In-home companion, sitter, or respite care services provided to an individual." G.S. 131E-136(1b)
It still needs a license: "No person or governmental unit shall operate a home care agency or a home assistance services provider without a license obtained from the Department." G.S. 131E-138(a) A home assistance provider must carry liability insurance, run criminal background checks, and "inform all new clients that they do not provide health care or hands-on care." G.S. 131E-138(h)
A home care agency can offer companion, sitter and respite services alongside in-home aide care under its home care license; DHSR’s application lists them as a service to tick.
No. Not as a new agency. It needs a Certificate of Need, which can only be issued where the State Medical Facilities Plan shows need. The 2026 plan, and the proposed 2027 plan, find no need anywhere in the state.
"It is determined that there is no need anywhere in the state and no reviews are scheduled."
No. Since 2023 the statute calls companion, sitter and respite services "home assistance services", and a home assistance services provider needs a license too.
"No person or governmental unit shall operate a home care agency or a home assistance services provider without a license obtained from the Department."
No. In-home aides may assist clients with self-administration of medication ordered by a prescriber, but may not administer it.
"No, In-home aides may not administer medications."
No. DHSR says the Medicaid personal care services plan is not a plan of care and cannot replace one.
"The Service Plan is not a Plan of Care and may not be substituted as a Plan of Care."
In North Carolina a home health agency is a licensed home care agency that is also certified to receive Medicare and Medicaid reimbursement for nursing, therapy, medical social services and home health aide services. A home care agency that is licensed but not certified cannot receive Medicare reimbursement. Both are licensed by DHSR under the same home care rules, 10A NCAC 13J.
DHSR’s FAQ ties the Certificate of Need to Medicare certification: "To become a medicare certified home health agency, a Certificate of Need (CON) must be obtained." A home care agency offering in-home aide services applies to DHSR for a license with the $510 fee.
Not as a new agency at the moment. A Certificate of Need can only be issued where the State Medical Facilities Plan shows need, and the 2026 plan states: "It is determined that there is no need anywhere in the state and no reviews are scheduled." The proposed 2027 plan says the same, and CMS has separately paused Medicare enrollment of new home health agencies nationwide from May 13, 2026, for six months.
Nursing is one of the home care services DHSR licenses, given by or under the supervision of an RN. Without Medicare certification the agency cannot bill Medicare for it.
Yes. Since 2023 companion, sitter and respite care on its own is a "home assistance service", and a home assistance services provider needs a license from DHSR. It must carry liability insurance, tell new clients it does not provide health care or hands-on care, and run criminal background checks.
Under 10A NCAC 13J, hands-on care means any home care service that involves touching the client in order to carry out the plan of care. Hands-on in-home aide services are home care services and need a home care agency license.
The 2026 State Medical Facilities Plan’s inventory lists 208 licensed Medicare-certified home health agencies or offices (our count of license numbers in its Table 12A). DHSR’s full home care list has 3,336 licensed sites.
The State Health Coordinating Council publishes a new State Medical Facilities Plan every year. Leave your email and we will tell you if it finds need for home health agencies, or when North Carolina home care rules change.
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