Arizona
- Private-pay non-medical care
- No state license found
- Medicaid or public pay
- AHCCCS provider registration for ALTCS direct care worker agencies (program rules)
- Skilled home health
- ADHS home health agency license
United States · 14 states · Checked October 8, 2026
States where we found no non-medical home care license
Most states license agencies that give personal care at home. In these, we found no state license for private-pay non-medical home care. Here is what we found for each state, what still applies, and when nursing or Medicaid work changes the answer, with every fact quoted from its source.
Quick answer
We found no state license for an agency giving private-pay non-medical home care in 13 states: Alabama, Alaska, Arizona, Idaho, Iowa, Mississippi, Montana, Nebraska, North Dakota, South Dakota, Vermont, West Virginia and Wyoming. Arkansas licenses private care agencies for Medicaid personal care; we found no license for private-pay-only agencies there, by our reading.
“No license” is not “no rules”. Medicaid work still needs the state’s provider enrollment, which has its own program rules. Some state laws apply without a license, such as Nebraska’s worker checks, Arkansas’s 40-hour training (with exemptions) for caregivers of clients aged 50 and over, and Arizona’s duty to report abuse of vulnerable adults. And once you add nursing or other skilled care, most of these states require a home health license.
Arizona’s entry comes first and goes furthest. Confirm your own plans with the state before you open.
The 14 states at a glance
Private pay means clients pay you directly. Public pay means Medicaid or another state program. Each state’s section below quotes the sources.
Alabama
- Private-pay non-medical care
- No state license found (home health is not licensed either)
- Medicaid or public pay
- Medicaid Elderly and Disabled Waiver contract (program rules)
- Skilled home health
- No state license; the certificate of need law covers home health agencies, and Medicare and Medicaid certification are available
Alaska
- Private-pay non-medical care
- No state license found
- Medicaid or public pay
- Medicaid personal care services (PCS) agency certification (program rules)
- Skilled home health
- Department of Health home health agency license
Idaho
- Private-pay non-medical care
- No state license found
- Medicaid or public pay
- Medicaid personal assistance agency provider agreement (program rules)
- Skilled home health
- No state license since July 1, 2025; Medicare certification
Iowa
- Private-pay non-medical care
- No state license found
- Medicaid or public pay
- Medicaid HCBS waiver enrollment, attendant care (program rules)
- Skilled home health
- No Iowa licensing law named; DIAL describes home health agencies by federal rules (our reading)
Mississippi
- Private-pay non-medical care
- No state license found
- Medicaid or public pay
- Division of Medicaid E&D Waiver enrollment, after a year of private-pay service (program rules)
- Skilled home health
- MSDH home health license; a certificate of need moratorium on new agencies, re-enacted by HB 1622 in March 2026 after a court struck down the earlier one
Montana
- Private-pay non-medical care
- No state license found
- Medicaid or public pay
- Medicaid provider rules (not checked for this page)
- Skilled home health
- DPHHS home health agency license (RN required)
Nebraska
- Private-pay non-medical care
- No license for in-home personal services (excluded by statute); see the respite and home health aide caveats; worker and check duties apply
- Medicaid or public pay
- Medicaid HCBS waiver enrollment (program rules)
- Skilled home health
- DHHS home health agency license (home health aide services count)
North Dakota
- Private-pay non-medical care
- No state license found
- Medicaid or public pay
- Qualified Service Provider (QSP) enrollment for SPED (state-funded) and the Medicaid aged and disabled waiver (program rules)
- Skilled home health
- HHS home health agency license (RN plus another therapeutic service)
South Dakota
- Private-pay non-medical care
- No state license found (2026 licensing bill vetoed)
- Medicaid or public pay
- Medicaid provider rules (not checked for this page)
- Skilled home health
- No in-home category found in the facility licensing law
Vermont
- Private-pay non-medical care
- No state license found; in 2024 the Board told one planned agency it needed no certificate of need review
- Medicaid or public pay
- Medicaid program standards (not checked for this page)
- Skilled home health
- Designation by the Commissioner; new agencies need a certificate of need
West Virginia
- Private-pay non-medical care
- No state license found
- Medicaid or public pay
- Certificate of need for Medicaid personal care (our reading)
- Skilled home health
- Certificate of need; OHFLAC oversees home health agencies (state license not confirmed in our sources)
Wyoming
- Private-pay non-medical care
- No state license found (see the home health aide caveat)
- Medicaid or public pay
- Medicaid waiver provider rules (not checked for this page)
- Skilled home health
- Wyoming Department of Health home health agency license
Arkansas
- Private-pay non-medical care
- No license found for private-pay only (our reading); caregiver training rule applies
- Medicaid or public pay
- ADH Private Care Agency license, for Medicaid personal care
- Skilled home health
- ADH home health license, after a Permit of Approval
What “no license” means on this page
- We found no state license. For each state we read the licensing law or the regulator’s list of what it licenses, and quote it below. That is a finding about the sources we saved, not a promise that nothing else applies. Where a finding rests on our interpretation, it says “our reading”.
- Business law still applies. Registering your business with the state, local business licenses, payroll, tax, workers’ compensation and insurance are outside health licensing and not covered here.
- Medicaid is separate. To be paid by Medicaid you enroll under the state’s program rules. Those bind enrolled providers only, and we label them Medicaid program rule, not a license.
- Some state laws apply without a license. Worker checks, caregiver training and abuse reporting laws can apply without a license. We list the ones in our sources as Applies under state law.
- Skilled care changes the answer. Nursing, therapy or, in some states, home health aide services can make you a home health agency.
AZ · No state license found for private pay
Do you need a license for non-medical home care in Arizona?
We found no Arizona state license for a non-medical home care agency that serves private-pay clients. The Arizona Department of Health Services (ADHS) licenses health care institutions by class, and the in-home classes on its list are home health agency and hospice service agency. To be paid by Arizona Medicaid (AHCCCS) for long-term care (ALTCS) members, an agency registers with AHCCCS and follows AHCCCS’s program rules instead.
What we found
Arizona law says no one may run a health care institution without an ADHS license for its class or subclass. The ADHS rule that lists the classes names hospice service agency and home health agency as its in-home classes. Reading the full list of 27 classes, we found none for non-medical, personal care or companion agencies, apart from a catch-all “unclassified” class (see the open question below). AHCCCS’s own policy for the agencies that employ its direct care workers says they are not required to be certified by a state regulatory board or agency.
"A person shall not establish, conduct or maintain in this state a health care institution or any class or subclass of health care institution unless that person holds a current and valid license issued by the department specifying the class or subclass""A person may apply for a license as one of the following classes or subclasses of health care institution: ... 9. Hospice service agency, ... 19. Home health agency,""The DCW Agencies are not required to be certified by a state regulatory board or agency; however, agencies shall register with AHCCCS, sign, and attest to meeting the terms of the AHCCCS Provider Participation Agreement (PPA)."What still applies
Medicaid program rule, not a license
AHCCCS registration, for ALTCS work only
An agency that wants to serve ALTCS members registers as an AHCCCS provider and attests to the Provider Participation Agreement. These are AHCCCS program rules in its Medical Policy Manual (AMPM Policy 1240-A). They bind agencies that serve ALTCS members, not every home care business, and they are not a license.
- "All DCW Agencies, including those agencies that provide services through the AWC option, are responsible to conduct the following: 1. Register as an AHCCCS provider."AMPM 1240-A, III.C.1Medicaid program rule
Medicaid program rule, not a license
Background and registry checks, with a written policy
AHCCCS asks its agencies to write policies and procedures for background checks and to run them: a nationwide criminal check at hire and every three years, and a search of the Adult Protective Services (APS) and child services (DCS) registries at hire and every year. Agencies also contact three references who are not family members.
- "Develop policies and procedures for, and begin conducting background checks of, DCWs that comply with the following standards"AMPM 1240-A, III.C.3Medicaid program rule
- "At the time of hire/initial contract, and every three years thereafter conduct a nationwide criminal background check that accounts for criminal convictions in Arizona"AMPM 1240-A, III.C.3.aMedicaid program rule
- "At the time of hire/initial contract and every year thereafter, conduct a search of the Arizona Adult Protective Services (APS) and Department of Child Services (DCS) Registries"AMPM 1240-A, III.C.3.bMedicaid program rule
- "Pre-screen all prospective DCW employees/contractors including contacting three references, who are not family members"AMPM 1240-A, III.C.2Medicaid program rule
Medicaid program rule, not a license
Training, testing and CPR
Workers serving ALTCS members hold current CPR and first aid certification before they start. The agency has 90 calendar days from hire to train and test them, starting with Level I (Introduction to and Fundamentals of Caregiving), and workers complete six hours of continuing education a year.
- "Verify that all DCWs hold current certification in CPR and first aid prior to providing care to an ALTCS member and continuously maintain certification thereafter."AMPM 1240-A, III.C.8Medicaid program rule
- "A DCW Agency has 90 calendar days from date of hire/initial contract to train and test DCWs."AMPM 1240-A, III.E.2.bMedicaid program rule
- "Level I – Introduction to and Fundamentals of Caregiving: i. Shall be completed by all DCWs, including family caregivers, to provide Direct Care Services to ALTCS members"AMPM 1240-A, III.E.4.aMedicaid program rule
- "Six hours of continuing education are required annually."AMPM 1240-A, III.E.5.aMedicaid program rule
Medicaid program rule, not a license
Supervisory visits, EVV and an hours cap
The first supervisory or monitoring visit is due by the 5th day after a new worker starts with a member, with more at 30, 60 (if needed) and 90 days, then at least every 90 days. Visits are verified through Electronic Visit Verification (EVV), and a worker gives no more than 16 hours of paid care in 24 hours.
- "The initial supervisory/monitoring visit is required by the 5th day from the initial service provision by the new DCW"AMPM 1240-A, III.D.1.aMedicaid program rule
- "The remaining supervisory/monitoring visits are required on the 30th day, 60th day (required if issues are identified by the member, DCW agency or Contractor) and 90th day from the initial service provision date."AMPM 1240-A, III.D.1.bMedicaid program rule
- "After the initial 90th day visit, all other visits occur at least every 90 days from the previous visit."AMPM 1240-A, III.D.2Medicaid program rule
- "Verify the delivery of DCW services in accordance Electronic Visit Verification (EVV)"AMPM 1240-A, III.C.10Medicaid program rule
- "Provide no more than 16 hours of paid care within a 24-hour period."AMPM 1240-A, III.B.6Medicaid program rule
Applies under state law
Reporting abuse, neglect and exploitation
Arizona’s reporting law is not limited to licensed providers. It names an “other person who has responsibility for the care of a vulnerable adult”, which can include home care staff, and requires an immediate report, by phone or online, to a peace officer or Adult Protective Services central intake when there is a reasonable basis to believe abuse, neglect or exploitation has occurred.
- "or other person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the vulnerable adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit"A.R.S. 46-454(A)State law
- "The reports required by this subsection shall be made immediately by telephone or online."A.R.S. 46-454(A)State law
Our reading
The open question
Arizona defines a “health care institution” broadly: any agency that “provides facilities with” services including personal care services. Its definition of personal care services, “assistance with activities of daily living that can be performed by persons without professional skills”, matches much non-medical care. The definition does name the in-home agencies it includes, home health agencies and hospice service agencies, and that is what our reading rests on. ADHS’s rule also has an “unclassified health care institution” class for institutions not classified in statute or rule. We found nothing showing ADHS uses either to license in-home non-medical agencies, and AHCCCS’s policy assumes no state certification, but this is our reading. Ask ADHS before you open.
- "every place, institution, building or agency, whether organized for profit or not, that provides facilities with medical services, nursing services, behavioral health services, health screening services, other health-related services, supervisory care services, personal care services or directed care services"A.R.S. 36-401(A)(24)State law
- ""Personal care services" means assistance with activities of daily living that can be performed by persons without professional skills or professional training"A.R.S. 36-401(A)(42)State law
- "and includes home health agencies as defined in section 36-151, outdoor behavioral health care programs and hospice service agencies"A.R.S. 36-401(A)(24)State law
- "25. Unclassified health care institution, ... The Department determines that the health care institution is an unclassified health care institution."A.A.C. R9-10-102(A)(25), (D)(2)State rule
- ""Unclassified health care institution" means a health care institution not classified or subclassified in statute or in rule."A.A.C. R9-10-101State rule
If you add skilled care
Skilled home health care is licensed. Arizona defines home health services as care for a person under a physician’s care, including nursing by or under a registered nurse plus therapy or home health aide services, and a home health agency as one primarily engaged in skilled nursing and other therapeutic services. Homemaker services are listed as “supportive services”, outside home health services. A licensed home health agency’s staff also need fingerprint clearance cards, with exceptions.
A.R.S. 36-151(3)A.R.S. 36-151(5)(a)A.R.S. 36-151(6)A.R.S. 36-411(A)
Who to ask: ADHS licensing, if your services might fit a license class; AHCCCS provider registration, for ALTCS work.
AL · No state license found for private pay
Alabama
We found no Alabama license for non-medical home care, and Alabama does not license home health agencies either. The Alabama Department of Public Health (ADPH) says home health agencies are not required to be licensed. Medicaid waiver work runs through a contract with the waiver’s operating agency.
What we found
ADPH says home health agencies are not required to be licensed by the State Board of Health, and Alabama’s State Health Plan says there is no licensure requirement for home health agencies. ADPH’s directory separately lists providers that are not subject to state licensure but take part in Medicare and Medicaid. With skilled home health unlicensed, we found nothing that licenses non-medical home care.
"HHAs are not required to be licensed by the Alabama State Board of Health but may apply for certification in Medicare and Medicaid programs.""There is no licensure requirement for home health agencies in Alabama.""as well as a list of providers and suppliers that are not subject to state licensure, but participate in the Medicare and Medicaid programs"What still applies
Medicaid program rule, not a license
Medicaid Elderly and Disabled Waiver contracts
For waiver homemaker services, a Home Care Agency needs a business license and no certificate; for personal care, a business license with the state. Before approval, the operating agency or its Area Agency on Aging visits on site, and a provider that is not a certified home health agency needs the Medicaid Commissioner’s exemption to provide unskilled services. These are from the 2022 waiver document.
- "Home Care Agency Provider Qualifications License (specify): Business Certificate (specify): None"E&D Waiver, Appendix C, HomemakerMedicaid program rule
- "Business License with the state of Alabama ... Certificate of Need (CON) if the provider type is a Home Health Agency"E&D Waiver, Appendix C, Personal CareMedicaid program rule
- "The Operating Agency or designee (AAA) will conduct an initial on-site visit to verify that the provider is in compliance with Medicaid Waiver standards and regulations before approval as a direct service provider is made."E&D Waiver, Appendix C, open enrollmentMedicaid program rule
- "If the provider is not a certified home health agency, a letter is prepared requesting the Commissioner of the Alabama Medicaid Agency to exempt the provider from the certification requirement allowing provider to provide unskilled services."E&D Waiver, Appendix C, open enrollmentMedicaid program rule
Medicaid program rule, not a license
Nurse supervision for waiver personal care
Under the Medicaid rule, waiver personal care workers are employed by a certified home health agency or another agency approved by Alabama Medicaid, and supervised by a licensed nurse.
- "A person providing Personal Care Services must be employed by a certified Home Health Agency or other agency approved by the Alabama Medicaid Agency and supervised by a licensed nurse"Ala. Admin. Code 560-X-36-.04(3)(b)Medicaid program rule
Our reading
Abuse registry checks, if your agency is a designated service provider
Shirley’s Law requires a “service provider” to query the Alabama Elder and Adult in Need of Protective Services Abuse Registry for employees and prospective employees. Service providers include home health agencies and community-based services serving adults in need of protective services “as designated by rules” of three departments. We did not check whether those rules name non-medical home care agencies.
- "A service provider shall query the Alabama Elder and Adult in Need of Protective Services Abuse Registry with regard to an individual who is an employee or prospective employee of the provider"Code of Ala. 38-9G-5State law
- "c. Home health agencies. ... i. Group homes, other residential facilities, and community-based services serving adults in need of protective services, as designated by rules adopted by the Department of Human Resources, the Department of Mental Health, and the Alabama Department of Public Health."Code of Ala. 38-9G-1(11)State law
If you add skilled care
Skilled home health is unlicensed in Alabama, but a home health agency is a health care facility under the certificate of need law, and ADPH says agencies may apply for Medicare and Medicaid certification.
Code of Ala. 22-21-260(6)ADPH facility descriptions, Home Health Agencies
Who to ask: Alabama Medicaid Agency and the Alabama Department of Senior Services, for waiver contracting.
AK · No state license found for private pay
Alaska
We found no Alaska license for non-medical home care. Alaska’s central licensing law lists the entities the Department of Health licenses, and the in-home ones are home health agencies, which provide skilled nursing, and hospices. To be paid by Medicaid for personal care, an agency must be certified by the department.
What we found
AS 47.32.010 lists every entity the Department of Health licenses under the central licensing law. The in-home ones are home health agencies and hospices, and a home health agency primarily provides skilled nursing combined with therapy or home health aide services. Reading the full list, we found no category for non-medical personal care or companion agencies.
"The following entities are subject to this chapter and regulations adopted under this chapter by the Department of Health: (1) ambulatory surgical centers; (2) assisted living homes; (3) child care facilities; (4) freestanding birth centers; (5) home health agencies; (6) hospices""that primarily engages in providing skilled nursing services in combination with physical therapy, occupational therapy, speech therapy, or services provided by a home health aide"What still applies
Medicaid program rule, not a license
Medicaid personal care certification
An agency paid for Medicaid personal care services must be certified by the department. Its program administrator attends the department’s training course before the agency applies, and a new provider gets a one-year probationary certification.
- "To receive payment for personal care services, an agency must be certified by the department as a provider of personal care services."7 AAC 125.060(a)Medicaid program rule
- "the personal care services program administrator for that agency must attend the personal care services agency training course provided by the department"7 AAC 125.060(a)(1)Medicaid program rule
- "probationary certification of one year"7 AAC 125.060(b)(1)Medicaid program rule
Medicaid program rule, not a license
Written policies, an RN and a business license
Certified providers write and follow policies and procedures on 16 topics, from admissions to training of employees, and submit them to Senior and Disabilities Services when asked. An agency-based program retains a supervising registered nurse, and the application includes a State of Alaska business license.
- "The provider must prepare in written form and implement the following policies and procedures and, when requested, submit the written policies and procedures to SDS within the required timeframe: a. admissions to provider services; ... p. training of employees."PCS and CFC-PCS Conditions of Participation, I.A.3Medicaid program rule
- "The provider that operates an agency-based personal care services program must retain a supervising registered nurse"Conditions of Participation, I.B.6Medicaid program rule
- "the provider must submit to SDS within the required timeframe the following documents: a. State of Alaska business license"Conditions of Participation, I.A.4.aMedicaid program rule
If you add skilled care
A home health agency is one of the licensed entities, and Alaska’s criminal history and background check provisions apply to licensed entities.
AS 47.32.900(8)AS 47.32.010(d)
Who to ask: Alaska Department of Health, Senior and Disabilities Services, for Medicaid personal care certification.
ID · No state license found for private pay
Idaho
We found no Idaho license for non-medical home care, and since July 1, 2025 Idaho no longer licenses home health agencies. Medicaid personal assistance services run through provider agreements with the Department of Health and Welfare (DHW).
What we found
Idaho’s 2025 facility licensing law applies its licensing standards to certified hospitals, nursing facilities and intermediate care facilities, and says home health agencies are not required to be licensed or certified under it. DHW confirms that Medicare-certified home health agencies no longer need a state license. We found no license for non-medical home care.
"All medicare-certified or medicaid-certified hospitals, nursing facilities, or intermediate care facilities shall meet the standards for licensing pursuant to this chapter.""Neither medicare-certified hospice agencies nor home health agencies are required to be licensed or certified pursuant to this chapter.""effective July 1, 2025, Medicare Certified Home Health Agencies are no longer required to be licensed in the State of Idaho. No new licenses will be issued after July 1, 2025."What still applies
State law for Medicaid providers, not a license
Medicaid personal assistance agencies
This is a state law that applies to Medicaid personal assistance agencies. DHW enters into agreements with providers of personal assistance services for people it finds eligible for Idaho Medicaid. A personal assistance agency keeps liability insurance and provides an appropriately qualified nurse when required, among other duties.
- "The department shall enter into agreements with providers for the provision of personal assistance services."Idaho Code 39-5603(5)State law
- "means an individual determined eligible by the department for Idaho medicaid services"Idaho Code 39-5602(3)State law
- "(c) Maintaining liability insurance coverage; (d) Provision of an appropriately qualified nurse when required;"Idaho Code 39-5603(6)(c)-(d)State law
If you add skilled care
Idaho defines a home health agency as one that primarily provides skilled nursing by licensed nurses plus another health care service, but no longer licenses it. A new home health agency seeks Medicare certification through an application packet from DHW, and faces the national CMS moratorium described below.
Idaho Code 39-1301(4)DHW Home Health Agencies pageDHW Home Health Agencies page
Who to ask: Idaho Department of Health and Welfare.
IA · No state license found for private pay
Iowa
We found no Iowa license for non-medical home care. Iowa’s Department of Inspections, Appeals, and Licensing (DIAL) lists the health facilities it oversees, and describes home health agencies there by federal rules, with no personal care agency type. Medicaid waiver attendant care is open to community businesses that hold all necessary licenses and permits.
What we found
DIAL’s health facilities page lists the facility types under its oversight. Home health agencies there provide skilled nursing plus another therapeutic service and are “defined in Title 42 of the Code of Federal Regulations”; we found no personal care, companion or homemaker agency type. Iowa’s health care employment agency registration covers agencies that supply workers to health care entities, not agencies serving people at home, by our reading.
"The following types of health facilities fall under the oversight and regulation of DIAL.""Home health agencies (HHAs) provide skilled nursing services for patients in their homes, and at least one of the following other therapeutic services ... Home health agencies are defined in Title 42 of the Code of Federal Regulations (CFR)."""Health care employment agency" or "agency" means an agency that contracts with a health care entity in this state to provide agency workers for temporary or temporary-to-hire employee placements."What still applies
Medicaid program rule, not a license
Attendant care under Medicaid waivers
A community business can provide waiver attendant care if it has all necessary licenses and permits and shows liability and workers’ compensation cover. Iowa Medicaid wants the application at least 90 days before you plan to start. Home maintenance services are narrower: they need a Medicare home health agency or a local public health contract.
- "Community businesses that are engaged in the provision of attendant care services and that: (1) Have all necessary licenses and permits to operate in conformity with federal, state, and local laws and regulations, and (2) Submit verification of current liability and workers’ compensation coverage."Iowa Admin. Code 441-77.35(7)(g)Medicaid program rule
- "The Iowa Medicaid must receive the application for enrollment at least 90 days before the planned implementation date."HCBS Provider Manual, ch. IIIMedicaid program rule
- "Home maintenance providers shall be agencies that are: a. Certified as a home health agency under Medicare, or b. Authorized to provide similar services through a contract with the department for local public health services."Iowa Admin. Code 441-77.35(1)Medicaid program rule
Medicaid program rule, not a license
Written policies and screenings
Iowa Medicaid’s provider manual asks waiver providers for written policies and procedures on intake, admission, service coordination, discharge and referral, and on identifying and reporting child and dependent adult abuse, with staff training. Child abuse, dependent adult abuse and criminal background screenings come before direct care.
- "At a minimum, HCBS Waiver Providers must have written policies and procedures according to state and federal laws for intake, admission, service coordination, discharge, and referral."HCBS Provider Manual, ch. III.DMedicaid program rule
- "Providers must also have written policies and procedures and a staff training program for the identification and reporting of child and dependent adult abuse"HCBS Provider Manual, ch. III.DMedicaid program rule
- "Providers and their staff must complete child abuse, dependent adult abuse, and criminal background screenings pursuant to Iowa Code section 249A.29 before the provision of direct care services to members of any waiver program."HCBS Provider Manual, ch. III.DMedicaid program rule
Changing
Waivers are changing
Iowa is moving waiver members to new HOME waivers: four waivers from later in 2026, and the Brain Injury and Intellectual Disability waivers in 2027. Provider rules may change with them.
- "Phase 1: Starting later in 2026, all members on the AIDS/HIV, Health and Disability, Physical Disability, and Children’s Mental Health waivers will transition to the new HOME waivers. ... Phase 2: In 2027, all members on the Brain Injury and Intellectual Disability waivers will transition to the new HOME waivers."HHS HOME summary (2026)Medicaid program rule
If you add skilled care
DIAL describes home health agencies by the federal definition: skilled nursing plus another therapeutic service.
DIAL Health Facilities page, Home Health Agencies
Who to ask: Iowa HHS, Iowa Medicaid Provider Services.
MS · No state license found for private pay
Mississippi
We found no Mississippi license for non-medical home care. The State Department of Health (MSDH) licenses home health agencies, defined by skilled nursing, and its list of facility standards has no non-medical in-home category. Medicaid’s Elderly and Disabled (E&D) Waiver enrolls personal care agencies only after a year of serving private-pay clients.
What we found
MSDH’s list of health facility standards includes home health agencies, hospice and personal care homes (which are residential), and reading the full list we found nothing for non-medical care in a client’s home. Medicaid’s own enrollment guide asks for at least a year of services to clients who pay privately, which suggests private-pay agencies operate without a state license.
"Home Health Agencies, Minimum Standards ... Hospice Operation, Minimum Standards ... Personal Care Homes - Residential Living""primarily engaged in providing to individuals, at the written direction of a licensed physician, podiatrist, nurse practitioners, physician assistants, and clinical nurse specialists in the individual's place of resident, skilled nursing services provided by or under the supervision of a registered nurse""an agency must have been providing services for at least one (1) year to clients who pay privately, out-of-pocket, or through their private insurance"What still applies
Medicaid program rule, not a license
E&D Waiver enrollment
Medicaid says agencies may currently apply for E&D Waiver personal care, in-home respite or adult day care. Before enrolling, an agency has served private-pay clients for a year, has had a Mississippi office outside any personal residence for six months, holds a business privilege tax license and is registered with the Secretary of State.
- "Agencies may currently apply to enroll as providers of Personal Care services, In-Home Respite services or Adult Day Care services under the Elderly"DOM HCBS Waiver Providers pageMedicaid program rule
- "an agency must have been providing services for at least one (1) year to clients who pay privately, out-of-pocket, or through their private insurance"DOM step-by-step guide, Step 1Medicaid program rule
- "Must reside in an office with a physical address in the State of Mississippi that is not located in or on the grounds of a personal residence for a minimum of six (6) months prior to enrollment and maintain an active business privilege tax license."DOM step-by-step guide, Step 1Medicaid program rule
- "Must be registered with the MS Secretary of State Office."DOM step-by-step guide, Step 1Medicaid program rule
Medicaid program rule, not a license
Checks and a policy manual
Waiver providers run national fingerprint background checks before hire and every two years, and registry checks before hire and every month. They keep written criteria for service provision and policy and procedure manuals that comply with state and federal law and Medicaid’s rules.
- "Prior to employment and every two (2) years thereafter, conduct a national criminal background check with fingerprints on all employees and volunteers participating in face-to-face interactions with beneficiaries."Miss. Admin. Code 23-208, Rule 1.3.B.9Medicaid program rule
- "Conduct registry checks before employment and monthly thereafter"Miss. Admin. Code 23-208, Rule 1.3.B.10Medicaid program rule
- "Have written criteria for service provision, including procedures for dealing with emergency service requests. ... Maintain policy and procedure manuals compliant with all state and federal laws and regulations"Miss. Admin. Code 23-208, Rule 1.3.B.13-14Medicaid program rule
If you add skilled care
A home health agency provides skilled nursing by or under a registered nurse at a licensed practitioner’s written direction. New agencies face a certificate of need moratorium. A federal court struck down Mississippi’s earlier moratorium in January 2026; HB 1622 (approved March 23, 2026) put a moratorium on new home health agencies back in place, though MSDH said it did not apply retroactively to an application filed before it.
MSDH Rule 46.3.20MSDH CON staff analysis (May 4, 2026)HB 1622 (2026), Section 2(2)MSDH CON staff analysis (May 4, 2026), recommendation 2
Who to ask: Division of Medicaid, Office of Long Term Care, for waiver enrollment.
MT · No state license found for private pay
Montana
We found no Montana license for non-medical home care. The Department of Public Health and Human Services (DPHHS) licenses home health agencies, whose services must include a registered nurse, and the in-home types on its Licensure Bureau’s application list are home health, home infusion therapy and hospice.
What we found
Montana’s definition of a health care facility names the types it includes; the in-home ones are home health agencies, home infusion therapy agencies and hospices, and the Licensure Bureau’s application list shows the same three. Reading both lists in full, we found no type for non-medical personal care, companion or homemaker agencies.
"The term includes abortion clinics as defined in 50-20-901, critical access hospitals, eating disorder centers, end-stage renal dialysis facilities, experimental treatment centers, home health agencies, home infusion therapy agencies, hospices""Health Care and Community Residential Facility Applications ... Home Health Agency Home Infusion Therapy Agency Hospice"If you add skilled care
A home health agency needs a DPHHS license, and its services must include a licensed registered nurse and at least one other therapeutic service. DPHHS asks for policies and procedures at least 45 days before opening, issues a six-month provisional license, and the agency may not accept patients until it is licensed.
MCA 50-5-101 ("home health agency")DPHHS HHA letter, p. 1DPHHS HHA letter, p. 1
- We could not save Montana’s Medicaid provider rules for personal assistance, so Medicaid enrollment is not covered here.
Who to ask: DPHHS Licensure Bureau.
NE · No state license found for private pay
Nebraska
Nebraska’s licensing law excludes an in-home personal services agency from the licensed “health care services”. State law still sets duties for those agencies: qualified workers and documented criminal history checks. Two edges need care: respite care, which is a licensed service of its own, and home health aide services.
What we found
Nebraska defines in-home personal services as attendant, companion and homemaker services that do not require medical or nursing judgment, and its definition of a licensed health care service excludes an in-home personal services agency.
"Health care service does not include an in-home personal services agency as defined in section 71-6501.""In-home personal services means attendant services, companion services, and homemaker services that do not require the exercise of medical or nursing judgment"What still applies
Applies under state law
Worker qualifications
An in-home personal services worker is at least 18, of good moral character and without a disqualifying conviction, among other standards in the statute.
- "(1) Shall be at least eighteen years of age; (2) Shall have good moral character; (3) Shall not have been convicted of a crime"Neb. Rev. Stat. 71-6502State law
Applies under state law
Criminal history and driving record checks
The agency runs a criminal history check on each worker, and a driving record check when driving is part of the service, and keeps the records for inspection at its place of business.
- "The in-home personal services agency shall perform or cause to be performed a criminal history record information check on each in-home personal services worker ... and shall maintain documentation of such checks in its records for inspection at its place of business."Neb. Rev. Stat. 71-6503State law
State law for Medicaid providers, not a license
Medicaid waiver agencies follow program rules
Those statutory duties do not apply to people who provide personal assistant services, habilitation or aged and disabled services, among others listed in the statute. By our reading those are mainly Medicaid program services. Medicaid waiver agency providers follow Medicaid’s own rules, including policies on abuse and neglect procedures.
- "Sections 71-6501 to 71-6503 do not apply to the performance of health maintenance activities by designated care aides pursuant to section 38-2219 or to persons who provide personal assistant services, respite care or habilitation services, or aged and disabled services."Neb. Rev. Stat. 71-6504State law
- "Agency providers must ensure they have policies that strictly comply with this chapter to ensure that appropriate procedures regarding abuse or neglect are in place."480 NAC 4-002.08Medicaid program rule
Our reading
Where the line falls: respite care
Respite care service is a licensed health care service in Nebraska: short-term temporary care, on an intermittent basis, for persons with special needs when their primary caregiver is unavailable. The definition leaves out a person who gives respite care to fewer than eight unrelated persons in any seven-day period, in their own home or the recipient’s; an agency with staff is not clearly that “person”. DHHS’s roster says there are currently no active Respite Care Service licenses. If you plan to market respite care, ask DHHS first.
- "Health care service means an adult day service, a children's day health service, a home health agency, a hospice or hospice service, a PACE center, or a respite care service."Neb. Rev. Stat. 71-415State law
- "Respite care service means (a) a person or any legal entity that provides short-term temporary care on an intermittent basis to persons with special needs when the person's primary caregiver is unavailable to provide such care"Neb. Rev. Stat. 71-428(1)State law
- "A person who provides respite care to fewer than eight unrelated persons in any seven-day period in his or her home or in the home of the recipient of the respite care"Neb. Rev. Stat. 71-428(2)(e)State law
- "Respite Care Services (Currently there are no active Respite Care Service licenses)"DHHS Rosters of Facilities and ServicesRegulator guidance
Our reading
Where the line falls: home health aide services
A home health agency provides skilled nursing or at least one other therapeutic service, and the department counts home health aide services (personal care or help with daily activities by a trained, supervised aide) as a therapeutic service. The statute says a home health agency may also be an in-home personal services agency. Attendant services, which are not licensed, include hands-on help for nonmedically fragile persons. Where hands-on personal care stops being “attendant services” and becomes “home health aide services” is not settled in our sources; ask DHHS.
- "Home health agency means a person or any legal entity which provides skilled nursing care or a minimum of one other therapeutic service as defined by the department"Neb. Rev. Stat. 71-417(1)State law
- "THERAPEUTIC SERVICE. Any or all of the following services: skilled nursing care; physical therapy; speech pathology; occupational therapy; respiratory care; home health aide services;"175 NAC 14-002State rule
- "HOME HEALTH AIDE SERVICES. The use of a trained, supervised paraprofessional to provide one or more of the following: personal care, assistance with activities of daily living, or basic therapeutic care to consumers of a home health agency."175 NAC 14-002State rule
- "A home health agency may be an in-home personal services agency"Neb. Rev. Stat. 71-6501(6)State law
- "Attendant services means services provided to nonmedically fragile persons, including hands-on assistance with activities of daily living, transfer, grooming, bathing, medication reminders, and similar activities"Neb. Rev. Stat. 71-6501(2)State law
If you add skilled care
A home health agency needs a DHHS license. The initial state fee is $650, and the license expires on January 31 each year.
Neb. Rev. Stat. 71-417(1)175 NAC 14-003.01175 NAC 14-005
Who to ask: Nebraska DHHS, Licensure Unit.
ND · No state license found for private pay
North Dakota
We found no North Dakota license for non-medical home care. The state licenses home health agencies, whose services must include a registered nurse, and lists homemaker and companion services only as “supportive services”. Agencies paid through public funds enroll as Qualified Service Providers (QSPs).
What we found
North Dakota’s licensing chapter covers home health agencies. Home health services must include a currently licensed registered nurse and at least one other therapeutic service, with a physician’s or allowed practitioner’s approval. Homemaker and companion services appear in the same chapter only among “supportive services”. We read this as: a non-medical agency without nursing is not a home health agency and needs no license under the chapter.
"Services must include the services of a currently licensed registered professional nurse and at least one other therapeutic service and may include additional support services. These services may only be provided with the approval of a licensed physician or an allowed practitioner."""Supportive services" includes the use of medical appliances; medical supplies, other than drugs and biologicals prescribed by a physician; the collection of blood and other samples for laboratory analysis; and nutritional guidance, homemaker, or companion services.""A person may not conduct, maintain, or operate a home health agency without a license issued by the department."What still applies
Medicaid program rule, not a license
QSP enrollment for SPED and the Medicaid aged and disabled waiver
To care for people paid for through SPED (a state-funded program) or the Medicaid aged and disabled waiver, an agency applies to be a Qualified Service Provider on the department’s forms. A representative completes the department’s QSP orientation before enrollment, listed criminal offenses bar enrollment, and an enrolled agency gives evidence of competency at least every 60 months.
- "applicable under state or federal law and departmental standards necessary to provide care to eligible individuals whose care is paid by public funds"N.D. Admin. Code 75-03-23-07(1)Medicaid program rule
- ""Medicaid waiver program" means the federal Medicaid waiver for the aged and disabled ... "SPED program" means the service payments for elderly and disabled program, a state program which authorizes the department to reimburse qualified service providers"N.D. Admin. Code 75-03-23-01(16), (22)Medicaid program rule
- "An individual or agency seeking designation as a qualified service provider shall complete and submit the applicable forms supplied by the department in the form and manner prescribed."N.D. Admin. Code 75-03-23-07(1)Medicaid program rule
- "A representative of an enrolled qualified service provider agency or an individual qualified service provider shall complete a department-approved qualified service provider orientation prior to initial enrollment."N.D. Admin. Code 75-03-23-07(2)(h)Medicaid program rule
- "Must not be an individual who has been found guilty of, pled guilty to, or pled no contest to"N.D. Admin. Code 75-03-23-07(2)(b)Medicaid program rule
- "Provide evidence of competency, except as provided in paragraph 3, at least every sixty months for an agency enrolled as a qualified service provider"N.D. Admin. Code 75-03-23-07(2)(e)(2)Medicaid program rule
Medicaid program rule, not a license
A quality improvement program
A QSP agency that employs non-family staff needs a department-approved quality improvement program to identify, address and mitigate harm. HHS’s standards for that program start with written policies and procedures.
- "Agency providers who employ nonfamily members shall have a department-approved quality improvement program that includes a process to identify, address, and mitigate harm to the eligible individuals they serve."N.D. Admin. Code 75-03-23-07(13)Medicaid program rule
- "Standard 1: The QSP implements policies and procedures that identify, address, and mitigate harm"HHS QI program standards (2022), objectivesMedicaid program rule
If you add skilled care
A home health agency needs a license from the department; the law says no one may run one without it.
NDCC 23-17.3-02NDCC 23-17.3-01(6)
Who to ask: North Dakota Health and Human Services (Aging Services for QSP enrollment).
SD · No state license found for private pay
South Dakota
We found no South Dakota license for in-home care agencies, medical or non-medical. A 2026 bill to license non-medical home care agencies, HB 1138, passed the Legislature but was vetoed, and the veto was sustained.
What we found
South Dakota’s definition of a licensed health care facility lists institutions, hospitals, nursing facilities, assisted living centers, adult foster care homes and inpatient and residential hospices, among others. Reading the full definition, we found no home care or home health agency category. In 2026 the Legislature passed HB 1138, a bill to require the licensure of non-medical home care agencies; the Governor vetoed it, the House override vote was 36 to 27, and a news report says that fell short of the 47 votes required, so the veto stood.
""Health care facility," any institution, birth center, ambulatory surgery center, chemical dependency treatment facility, hospital, nursing facility, assisted living center, rural primary care hospital, adult foster care home, inpatient hospice, residential hospice""require the licensure of non-medical home care agencies, and to provide a penalty therefor.""Vetoed by the Governor ... Delivered veto sustained to the Secretary of State"""StatusText":"Veto override" ... "Vote":{"VoteId":84853,"Yeas":36,"Nays":27""The House then voted 36-27 on whether to override Rhoden’s veto of House Bill 1138. That also fell short of the 47 votes required, so the veto stood."If you add skilled care
The same facility definition has no home health category, so we found no state home health license either. New Medicare home health agencies anywhere face the national CMS moratorium described below.
- A licensing bill could return in a later session. We will update this entry if one passes.
- We did not check South Dakota’s Medicaid provider rules for personal care, so Medicaid enrollment is not covered here.
Who to ask: South Dakota Department of Health.
VT · No state license found for private pay
Vermont
We found no Vermont license for non-medical home care. Vermont regulates skilled home health agencies through designation and certificates of need, and in 2024 the Green Mountain Care Board told a planned nonmedical home care agency that its project was not subject to certificate of need review.
What we found
Vermont’s home care chapter defines a home health agency by part-time or intermittent skilled nursing plus at least one other therapeutic service. In February 2024, the Green Mountain Care Board wrote to a planned agency offering nonmedical home care, including companionship, help with activities of daily living and medication reminders, that the project was not subject to certificate of need review “at this time”, and asked to be told of any change in its type or scope. That letter is about certificate of need, not licensing, and it answered one applicant’s description. For licensing, DAIL’s Division of Licensing and Protection, which licenses and certifies health care facilities and providers, lists its facility and provider types: the in-home one is Home Health & Hospice, and we found no personal care or companion agency type (our reading of that list).
"means a for-profit or nonprofit health care facility providing part-time or intermittent skilled nursing services and at least one of the following other therapeutic services made available on a visiting basis""Your letter represents that you plan to provide nonmedical home care services including companionship, assistance with activities of daily living, and medication reminders""Based on the representations contained in your letter, the project is not subject to certificate of need (CON) review at this time.""if there are any changes in type, scope, or arrangements of the project, please contact the Board immediately""S&C licenses and certifies a range of health care facilities and providers.""Below is a listing of the Facilities by the type of service they provided. ... Assisted Living Residences End State Renal Dialysis Home Health & Hospice Hospital Nursing Home Other Provider Types Residential Care Home Rural Health Clinic Therapeutic Care Residence ... Ambulatory Surgery Centers Directory Portable X-Ray Providers Directory Home for the Terminally Ill Directory"If you add skilled care
Home health in Vermont works by designated service areas. No home health agency may serve patients in a designated area without the Commissioner’s designation, and designations for new agencies come through certificates of need approved by the Green Mountain Care Board.
33 V.S.A. 6304(a)33 V.S.A. 6304(c)
- We did not check Vermont’s Medicaid provider rules for personal care, so Medicaid enrollment is not covered here.
Who to ask: The Green Mountain Care Board, describing your exact services.
WV · No state license found for private pay
West Virginia
We found no West Virginia license for private-pay non-medical home care. The state’s Office of Health Facility Licensure and Certification (OHFLAC) lists home health agency and hospice among its facility types. “Providing personal care services” needs a certificate of need, but the law ties that to Medicaid-approved services, by our reading.
What we found
OHFLAC’s list of facility types includes Home Health Agency, Hospice and Hospital. Reading the full list, we found no personal care, companion or homemaker agency type.
"Facility Types: ... Home Health Agency Hospice Hospital"What still applies
Our reading
Certificate of need for personal care
West Virginia’s certificate of need law lists “providing personal care services” among services that need a certificate whatever they cost. The same law defines a personal care agency as one providing personal care services approved by the Bureau of Medical Services, and personal care services as those a personal care agency provides. We read this as Medicaid personal care, not private pay. Confirm with the West Virginia Health Care Authority before relying on it.
- "The following health services are required to obtain a certificate of need regardless of the minimum expenditure: ... (21) Establishing a home health agency; (22) Providing personal care services;"W. Va. Code 16-2D-8(b)State law
- ""Personal care agency" means an entity that provides personal care services approved by the Bureau of Medical Services. ... "Personal care services" means personal hygiene; dressing; feeding; nutrition; environmental support and health-related tasks provided by a personal care agency."W. Va. Code 16-2D-2(32), (33)State law
Our reading
WV CARES background checks may apply
The state’s registry and employment screening program covers “a provider of personal care services” as well as home health agencies. Whether a private-pay non-medical agency counts is not settled in our sources; ask the Office of Inspector General.
- ""Covered provider" means the following facilities or providers: ... (iii) A home health agency; ... (vi) A provider of personal care services;"W. Va. Code 16B-15-1State law
Voluntary
A voluntary worker registry
The Bureau of Senior Services keeps a voluntary registry of in-home care workers who have had a criminal background check.
- "There is continued within the Bureau of Senior Services an in-home care worker registry which is to be maintained by the bureau. The purpose of the registry is to provide the public a list of in-home care workers, along with their qualifications, who voluntarily agree to be included and who have obtained a criminal background check."W. Va. Code 16-5P-15(a)State law
If you add skilled care
A home health agency provides professional nursing plus at least one other service, such as home health aide services. Establishing one needs a certificate of need. OHFLAC lists home health agencies among the facility types it licenses or certifies; its list mixes the two, and we did not confirm a state home health license in our sources.
W. Va. Code 16-2D-2(19)OHFLAC page, Facility TypesW. Va. Code 16-2D-8(b)
- We did not check West Virginia’s Medicaid provider rules for personal care, so Medicaid enrollment is not covered here.
Who to ask: OHFLAC, and the West Virginia Health Care Authority on the certificate of need.
WY · No state license found for private pay
Wyoming
We found no Wyoming license for companion or homemaker home care, with one caveat. Wyoming licenses home health agencies, and the Department of Health’s rule defines them as providing two or more listed health care services at home, with home health aide services on that list.
What we found
Wyoming’s Health Facilities Act says no one may establish a health care facility without a license. Its list of health care facilities has one in-home type, the home health agency, defined in the statute as an agency primarily engaged in providing nursing or other health care services at home. We found no category for companion, homemaker or personal care agencies.
"No person shall establish any health care facility in this state without a valid license issued pursuant to this act."""Health care facility" means any ambulatory surgical center, assisted living facility, adult day care facility, adult foster care home, alternative eldercare home, birthing center, boarding home, freestanding diagnostic testing center, home health agency, hospice, hospital"""Home health agency" means an agency primarily engaged in arranging and directly providing nursing or other health care services to persons at their residence"What still applies
Our reading
Where the line falls: the home health aide caveat
The Department’s Chapter 10 rule defines a home health agency as one providing two or more health care services at home, and its list of health care services includes home health aide services, adding that all staff shall be licensed. By our reading, a companion or homemaker agency is outside it, but an agency offering hands-on aide care plus another listed service could fall inside. Ask the Department before you start.
- "primarily engaged in arranging for and directly providing two or more health care services to persons at their residence"WDH Rules Ch. 10, definitions (f)State rule
- ""Health Care Services" includes, but is not limited to, nursing, physical therapy, speech therapy, occupational therapy, respiratory therapy, medical social work, home health aide, and dietary services. All staff shall be licensed in accordance with Wyoming State Statutes."WDH Rules Ch. 10, definitions (e)State rule
If you add skilled care
Nursing or other health care services at home make an agency a home health agency, which needs a license before it is established.
W.S. 35-2-901(a)(xi)W.S. 35-2-902
- The rule’s list of health care services is open (“includes, but is not limited to”) and also names dietary services, and the rule dates from 2001.
- We did not check Wyoming’s Medicaid provider rules for personal care, so Medicaid enrollment is not covered here.
Who to ask: Wyoming Department of Health, Healthcare Licensing and Surveys.
A license, but for Medicaid personal care only
AR · Medicaid-only license
Arkansas
Arkansas does license private care agencies, but the license is for Medicaid personal care. By our reading, an agency that serves only private-pay clients needs no ADH license; we have not asked ADH to confirm this. Its caregivers who help clients aged 50 or older need 40 hours of approved training, unless an exemption applies.
What we found
The Arkansas Department of Health (ADH) wrote its Private Care Agency rules for “the licensure of private care agencies providing Medicaid Personal Care”, each license is “for Medicaid Personal Care”, and the statute, as amended in 2025, describes a private care agency as one seeking reimbursement through Arkansas Medicaid. ADH’s caregiver training rules then describe an “in-home services agency” that provides caregiver services for pay without a home health, private care or hospice license. We read these together as: a private-pay-only agency needs no ADH license. We have not asked ADH to confirm this.
"licensure of private care agencies providing Medicaid Personal Care in Arkansas""Each agency shall receive a license for Medicaid Personal Care.""Furnishes in-home staffing services for personal and ... attendant care services for which the provider seeks reimbursement through ... the Arkansas Medicaid Program"""In-home services agency" means any partnership, association, corporation, or other organization, whether public or private, proprietary, or non-profit, that provides caregiver services for pay in a client's residence and is not otherwise licensed by the Department of Health as a home health agency, private care agency, or hospice agency."What still applies
Applies under state law
Caregiver training for clients aged 50 and over
Under ADH’s caregiver training rules, a person applying to an in-home services agency to help someone aged 50 or older with daily activities shows completed training of not less than 40 hours, unless an exemption in the rules applies.
- ""Caregiver services" are services provided to an individual in the State of Arkansas to assist the recipient of the services in the activities of daily living, and the recipient of services is fifty (50) years of age or older at the time the services are provided"Home Caregiver Training rules, Section 2(a)(1)State rule
- "A person who applies for employment to provide caregiver services in this state for compensation shall provide documentation to an in-home services agency of successful completion of training ... Except as provided under Section 5 of these Rules, has successfully completed a caregiver training course ... not less than forty (40) hours of training"Home Caregiver Training rules, Section 3State rule
License for Medicaid personal care
The Private Care Agency license, for Medicaid personal care
An agency that wants Medicaid personal care work gets its license from ADH (DHS’s page tells personal care applicants to skip its provisional-letter step and contact the Health Department), then enrolls as a Medicaid provider. ADH reviews or inspects before issuing the license, and the agency keeps at least $1,000,000 of liability insurance.
- "if you are applying for personal care services, skip step two and follow step three by contacting the Arkansas Health Department"DPSQA ARChoices agency certification pageRegulator guidance
- "Verify you are licensed or received licensure by AHD before applying for your Medicaid provider identification number"DPSQA ARChoices agency certification pageRegulator guidance
- "A review and/or inspection shall be conducted before the license is issued."Rules for Private Care Agencies, Section 7State rule
- "Retains liability insurance of not less than one million ... dollars ($1,000,000) to cover its employees and independent contractors while"Ark. Code 20-10-2302(2), as amendedState law
Changing
A rule amendment
ADH took comments on amendments to the Private Care Agency rules from July 5 to August 4, 2026, and its filing gives a proposed effective date of October 1, 2026. The proposed text keeps the license for Medicaid personal care. We have not confirmed whether it took effect.
- "Private Care Agencies, 20 CAR Pt. 49 from July 5, 2026 to August 4, 2026"ADH notice of public comment periodState rule
- "15. 10/1/2026 What is the proposed effective date for this rule?"ALC questionnaire, item 15State rule
- "Each agency shall receive a license for Medicaid personal care."Proposed 20 CAR Pt. 49, licensure (b)State rule
If you add skilled care
Home health in Arkansas is licensed by ADH, and an agency obtains a Permit of Approval before it can apply.
Rules for Home Health Agencies, Section 7(C)
Who to ask: ADH Health Facility Services.
Every state · Medicare
New Medicare home health agencies are on hold
If your plan is a Medicare-certified home health agency, in any state, CMS has paused new enrollments. From May 13, 2026, CMS halted Medicare enrollment of new home health agencies and hospices nationwide, for six months, and it can be extended for further six-month periods. CMS regulations do not permit exceptions to the moratorium for individual providers.
"Effective May 13, 2026, CMS will halt the enrollment of new Hospice and HHA providers or HHA branch or practice locations. ... The moratorium will be in place for six months and can be extended for additional six-month periods""CMS regulations do not permit exceptions to a moratorium for individual providers or suppliers."States we cover that license or register non-medical home care
Each state below licenses agencies that give personal care at home, and some license companion-only care too. Florida registers homemaker and companion agencies; hands-on personal care there comes under other licenses, explained in the Florida guide. Each guide covers the license, the fees and the written policies the state requires. See them side by side in home care licensing requirements by state.
- Texas
HCSSA license, Personal Assistance Services
Texas policy manual → - North Carolina
Home care agency license
North Carolina policy manual → - Georgia
Private home care provider license
Georgia policy manual → - Virginia
Home care organization license
Virginia policy manual → - Indiana
Personal services agency license
Indiana policy manual → - Ohio
Nonmedical home health services license
- New York
Licensed home care services agency (LHCSA)
- Delaware
Personal assistance services agency (PASA) license
- Maine
Personal care agency (PCA) license
- California
Home care organization (HCO) license
- Florida
Homemaker and companion services registration
- Pennsylvania
Home care agency or home care registry license
- New Jersey
Health care service firm registration
- Illinois
Home services agency license
Illinois policy manual → - Washington
In-home services agency license (home care)
Washington policy manual → - Colorado
Home care agency license, Class B
Colorado policy manual → - Tennessee
Personal support services agency license
Tennessee policy manual → - Maryland
Residential service agency license
Maryland policy manual → - Kansas
Home health agency license, supportive care
Kansas policy manual → - South Carolina
In-home care provider license
South Carolina policy manual → - Nevada
Personal care agency license
Nevada policy manual →
Frequently asked questions
Which states do not license non-medical home care?
In our research, we found no state license for an agency giving private-pay non-medical home care in Alabama, Alaska, Arizona, Idaho, Iowa, Mississippi, Montana, Nebraska, North Dakota, South Dakota, Vermont, West Virginia and Wyoming. Arkansas licenses private care agencies, but for Medicaid personal care; we found no license for private-pay-only agencies there, by our reading. These findings rest on the laws and regulator pages we saved, checked on October 8, 2026. Some states have edge cases where hands-on care can count as home health aide work, so check the state’s entry and confirm with the state before you open.
Is it legal to run a home care agency without a license in these states?
We cannot tell you that, and “no license” does not mean “no rules”. We found no state license for private-pay non-medical home care in these states, but business registration, employment, tax and insurance law still apply, and so may state laws on worker checks, caregiver training and abuse reporting (Nebraska, Arkansas and Arizona are examples on this page). Medicaid work needs enrollment, and nursing or other skilled care brings a home health license in most of these states. Ask the state about your exact services before you start.
Do you need a license for non-medical home care in Arizona?
We found none for an agency serving private-pay clients. ADHS licenses health care institutions by class, and its in-home classes are home health agency and hospice service agency; we found no class for non-medical, personal care or companion agencies, apart from a catch-all “unclassified” class. To serve Arizona Medicaid (ALTCS) members, an agency registers with AHCCCS and follows AMPM Policy 1240-A, which covers background and registry checks, worker training and testing, supervisory visits and EVV. Arizona law defines a “health care institution” broadly enough to name personal care services, and ADHS has an “unclassified” class. We found nothing showing ADHS licenses in-home non-medical agencies, but this is our reading: ask ADHS before you open.
What changes if my agency adds nursing or other skilled care?
In most of these states, skilled care at home brings a home health agency license, usually built around a registered nurse and at least one other therapeutic service. Alabama and Idaho do not license home health agencies (Alabama’s certificate of need law covers them, and Idaho points new agencies to Medicare certification), and we found no state home health license in South Dakota or, by our reading, Iowa. Vermont uses designation and a certificate of need, and Mississippi has a moratorium on new home health agencies. New Medicare home health agencies everywhere face the CMS enrollment moratorium that began on May 13, 2026.
Can I bill Medicaid without a state license?
Usually not without enrolling. In these states Medicaid personal care runs through the state’s own provider process: AHCCCS registration in Arizona, QSP enrollment in North Dakota, PCS certification in Alaska, waiver contracts in Alabama, provider agreements in Idaho, waiver enrollment in Iowa, Mississippi and Nebraska, and a Private Care Agency license in Arkansas. Each has its own program rules, and some are narrow: Mississippi asks for a year of private-pay service first.
Why does CareRulebook not sell a policy manual for these states?
Our manuals are checked against the written-policy rules that come with a state license, and we print the rule excerpt in each policy. Without a license there is no rule set to check a full manual against. Where a Medicaid program asks for written policies, as in Alaska, Arizona, Iowa, Mississippi, Nebraska and North Dakota, those are program rules for enrolled providers only. Arkansas’s license covers Medicaid personal care only, so it does not fit a private-pay agency.
How current is this page?
We last checked the facts on October 8, 2026. Each source shows the date we saved it. Licensing laws do change: South Dakota’s Legislature passed a licensing bill in 2026 that was vetoed. We log corrections on our corrections page.
Spotted something out of date? We log every fix on our corrections page.
Keep reading
Compare
Home care licensing requirements by state
The states that do license, side by side: the license, fees, policies, surveys and nurse rules.
Compare
Background check requirements by state
Caregiver checks, registries and re-checks in the licensed states.
Dataset
The CareRulebook licensing dataset
Every comparison table, with CSV files and how the data is checked.
Method
How we verify rules
Every quote is checked word for word against the saved official text.
Sources
Every quote on this page is checked word for word against our saved copy of the source. Some official sites block automated access, so a few sources are Internet Archive or Cornell LII copies; the title says so.
Arizona
- A.R.S. 36-407, Prohibited acts; required acts · Arizona Legislature · retrieved October 1, 2026
- A.A.C. R9-10-102, Health care institution classes and subclasses · Arizona Department of Health Services (Cornell LII copy of the Arizona Administrative Code) · retrieved October 1, 2026
- A.A.C. R9-10-101, Definitions · Arizona Department of Health Services (Cornell LII copy of the Arizona Administrative Code) · retrieved October 1, 2026
- A.R.S. 36-151, Definitions (home health services, home health agency, supportive services) · Arizona Legislature · retrieved October 1, 2026
- A.R.S. 36-401, Definitions (health care institution, personal care services) · Arizona Legislature · retrieved October 1, 2026
- A.R.S. 36-411, Residential care institutions; nursing care institutions; home health agencies; fingerprinting requirements · Arizona Legislature · retrieved October 1, 2026
- A.R.S. 46-454, Duty to report abuse, neglect and exploitation of vulnerable adults · Arizona Legislature · retrieved October 8, 2026
- AHCCCS Medical Policy Manual, Policy 1240-A, Direct Care Services (effective dates through 10/01/25; Internet Archive copy of September 14, 2026) · Arizona Health Care Cost Containment System (AHCCCS) · retrieved October 1, 2026
Alabama
- Facility descriptions (Bureau of Health Provider Standards) · Alabama Department of Public Health · retrieved October 2, 2026
- Health Care Facilities Directory (page updated June 23, 2026) · Alabama Department of Public Health · retrieved October 2, 2026
- Ala. Admin. Code 410-2-4, State Health Plan 2024-2027, Facilities (410-2-4-.07 Home Health) · State Health Planning and Development Agency (Alabama Administrative Code) · retrieved October 2, 2026
- Code of Alabama 22-21-260, Certificate of need definitions · Alabama Legislature · retrieved October 2, 2026
- Ala. Admin. Code 560-X-36, Home and Community-Based Services for the Elderly and Disabled · Alabama Medicaid Agency (Alabama Administrative Code) · retrieved October 2, 2026
- Elderly and Disabled Waiver, 1915(c) application AL.0068.R08.00, effective October 1, 2022 (Appendix C) · Alabama Medicaid Agency · retrieved October 2, 2026
- Code of Alabama 38-9G-1 to 38-9G-5 (Shirley’s Law, Act 2022-161), Elder and Adult in Need of Protective Services Abuse Registry · Alabama Legislature · retrieved October 2, 2026
Alaska
- AS 47.32.010, Purpose and applicability (centralized licensing) · Alaska Legislature · retrieved October 2, 2026
- AS 47.32.900, Definitions (home health agency) · Alaska Legislature · retrieved October 2, 2026
- 7 AAC 125.060, Personal care services agency certification and enrollment · Alaska Department of Health (Alaska Administrative Code) · retrieved October 2, 2026
- Personal Care Services and Community First Choice Personal Care Services Provider Conditions of Participation (Rev. 9/1/22) · Alaska Department of Health, Senior and Disabilities Services · retrieved October 2, 2026
Idaho
- Idaho Code 39-1301, Definitions (added 2025) · Idaho Legislature · retrieved October 8, 2026
- Idaho Code 39-1303, Licensure (added 2025) · Idaho Legislature · retrieved October 8, 2026
- Home Health Agencies (provider page) · Idaho Department of Health and Welfare · retrieved October 2, 2026
- Idaho Code 39-5602, Personal Assistance Services Act definitions · Idaho Legislature · retrieved October 2, 2026
- Idaho Code 39-5603, Personal assistance services: provider agreements and agency duties · Idaho Legislature · retrieved October 2, 2026
Iowa
- Health Facilities (types under DIAL oversight) · Iowa Department of Inspections, Appeals, and Licensing (DIAL) · retrieved October 2, 2026
- Iowa Code chapter 135Q, Health care employment agencies · Iowa Legislature · retrieved October 2, 2026
- Iowa Admin. Code 441 chapter 77, Conditions of participation for providers of medical and remedial care (as rewritten effective July 1, 2026) · Iowa Department of Health and Human Services (Iowa Administrative Code) · retrieved October 2, 2026
- HCBS Waiver Provider Manual, Chapter III (revised June 24, 2022) · Iowa Department of Health and Human Services, Iowa Medicaid · retrieved October 2, 2026
- HOME waiver redesign summary (2026) · Iowa Department of Health and Human Services · retrieved October 2, 2026
Mississippi
- Health Facilities Regulations (list of minimum standards) · Mississippi State Department of Health · retrieved October 2, 2026
- Minimum Standards of Operation for Home Health Agencies (Title 15, Part 16, Subpart 1, Chapter 46; effective January 2023) · Mississippi State Department of Health · retrieved October 2, 2026
- House Bill 1622, 2026 Regular Session, as signed (approved March 23, 2026) · Mississippi Legislature · retrieved October 2, 2026
- CON staff analysis, Memorial Hospital at Gulfport home health agency (May 4, 2026) · Mississippi State Department of Health · retrieved October 2, 2026
- Elderly & Disabled Waiver: Step-by-Step Enrollment Process Guide (revised July 2025) · Mississippi Division of Medicaid · retrieved October 2, 2026
- HCBS Waiver Providers · Mississippi Division of Medicaid · retrieved October 2, 2026
- Miss. Admin. Code Title 23, Part 208, Chapter 1, Elderly and Disabled Waiver (Rule 1.3 revised effective August 1, 2026) · Mississippi Division of Medicaid · retrieved October 2, 2026
Montana
- MCA 50-5-101, Definitions (health care facility, home health agency) · Montana Legislature · retrieved October 2, 2026
- Health Care and Community Residential Facility Applications (Licensure Bureau) · Montana Department of Public Health and Human Services, Office of Inspector General · retrieved October 8, 2026
- Letter to prospective home health agency providers (updated 2025) · Montana Department of Public Health and Human Services, Licensure Bureau · retrieved October 2, 2026
Nebraska
- Neb. Rev. Stat. 71-415, Health care service, defined · Nebraska Legislature · retrieved October 2, 2026
- Neb. Rev. Stat. 71-417, Home health agency, defined · Nebraska Legislature · retrieved October 2, 2026
- Neb. Rev. Stat. 71-428, Respite care service, defined · Nebraska Legislature · retrieved October 2, 2026
- Rosters of Facilities and Services · Nebraska Department of Health and Human Services, Licensure Unit · retrieved October 2, 2026
- Neb. Rev. Stat. 71-6501, In-home personal services: terms, defined · Nebraska Legislature · retrieved October 2, 2026
- Neb. Rev. Stat. 71-6502, In-home personal services worker; qualifications · Nebraska Legislature · retrieved October 2, 2026
- Neb. Rev. Stat. 71-6503, In-home personal services agency; duties · Nebraska Legislature · retrieved October 2, 2026
- Neb. Rev. Stat. 71-6504, Sections; applicability · Nebraska Legislature · retrieved October 2, 2026
- 175 NAC 14, Home Health Agencies (002 definitions, 003 fees, 005 license term; Cornell LII copy) · Nebraska Department of Health and Human Services (Cornell LII copy of the Nebraska Administrative Code) · retrieved October 2, 2026
- 480 NAC 4-002, HCBS waiver provider participation standards (Cornell LII copy) · Nebraska Department of Health and Human Services (Cornell LII copy of the Nebraska Administrative Code) · retrieved October 2, 2026
North Dakota
- NDCC chapter 23-17.3, Home Health Agency Licensure · North Dakota Legislative Branch · retrieved October 2, 2026
- N.D. Admin. Code chapter 75-03-23, Qualified service providers (history to January 1, 2025) · North Dakota Health and Human Services · retrieved October 2, 2026
- Quality Improvement Program Standards for QSP Agencies (2022 presentation) · North Dakota Health and Human Services, Aging Services · retrieved October 2, 2026
South Dakota
- SDCL 34-12-1.1, Definitions (health care facility) · South Dakota Legislature · retrieved October 2, 2026
- 2026 House Bill 1138, require the licensure of non-medical home care agencies: bill actions · South Dakota Legislature · retrieved October 8, 2026
- South Dakota House sustains governor’s vetoes (news report, March 30, 2026) · KOTA Territory News · retrieved October 2, 2026
Vermont
- 33 V.S.A. chapter 63, Home Care Programs (ss. 6301 to 6311) · Vermont General Assembly · retrieved October 2, 2026
- Docket GMCB-003-24con, letter on a planned nonmedical home care agency (February 7, 2024) · Green Mountain Care Board · retrieved October 2, 2026
- Find a Facility Type, and Directory of All Other Provider Types (Survey and Certification) · Vermont Department of Disabilities, Aging and Independent Living, Division of Licensing and Protection · retrieved October 8, 2026
- Division of Licensing and Protection home page · Vermont Department of Disabilities, Aging and Independent Living · retrieved October 8, 2026
West Virginia
- Office of Health Facility Licensure and Certification: facility types · West Virginia Office of Inspector General · retrieved October 8, 2026
- W. Va. Code 16-2D-2, Certificate of need definitions · West Virginia Legislature · retrieved October 2, 2026
- W. Va. Code 16-2D-8, Proposed health services that require a certificate of need · West Virginia Legislature · retrieved October 2, 2026
- W. Va. Code 16B-15-1, West Virginia Clearance for Access: Registry and Employment Screening Act definitions · West Virginia Legislature · retrieved October 2, 2026
- W. Va. Code 16-5P-15, Establishment of In-home Care Registry · West Virginia Legislature · retrieved October 2, 2026
Wyoming
- W.S. 35-2-901 and 35-2-902, Health Facilities Act definitions; license required · Wyoming Legislature · retrieved October 2, 2026
- Rules, Chapter 10, Licensure of Home Health Agency (Internet Archive copy of September 2, 2025) · Wyoming Department of Health, Healthcare Licensing and Surveys · retrieved October 2, 2026
Arkansas
- Rules for Private Care Agencies in Arkansas (effective June 17, 2024; now 20 CAR Pt. 49) · Arkansas Department of Health · retrieved October 2, 2026
- Act 853 of 2025 (HB 1439), amending Ark. Code 20-10-2301 et seq. · Arkansas General Assembly · retrieved October 2, 2026
- Rules for Home Caregiver Training in Arkansas (Cornell LII copy) · Arkansas Department of Health (Cornell LII copy of the Arkansas Code of Rules) · retrieved October 2, 2026
- Rules for Home Health Agencies in Arkansas (revision effective June 17, 2024) · Arkansas Department of Health · retrieved October 2, 2026
- Agency provider certification for ARChoices in Homecare (new applicant steps) · Arkansas Department of Human Services, Division of Provider Services and Quality Assurance · retrieved October 2, 2026
- Notice of public comment period, Rules for Private Care Agencies, 20 CAR Pt. 49 (2026) · Arkansas Department of Health · retrieved October 2, 2026
- Questionnaire for filing proposed rules with the Arkansas Legislative Council, Private Care Agencies (2026) · Arkansas Department of Health · retrieved October 2, 2026
- Rules for Private Care Agencies, 20 CAR Pt. 49, proposed amendments (markup) · Arkansas Department of Health · retrieved October 2, 2026
Medicare (national)
- QSO-26-11-HHA & Hospice: Six-Month National Moratoria on Hospice and Home Health Agency Enrollment (May 20, 2026) · Centers for Medicare & Medicaid Services · retrieved October 1, 2026