How to start a home care agency in California and reach your first client faster
California licenses nonmedical home care, and it checks every caregiver too. Your agency needs a Home Care Organization license from the Department of Social Services, with liability insurance, a dishonesty bond and workers' compensation in place before you apply. Each aide must then clear the Home Care Aide Registry, pass a TB test and finish training before meeting a client. Medi-Cal work runs through health plans and waivers, not IHSS. We put all of it in the right order for you.
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Get your free California launch plan
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to California rulesthe Home Care Services Consumer Protection Act (H&S Code § 1796.10 et seq.) and Medi-Cal plan provider manuals
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what California requires.
Nonmedical home care for Medi-Cal members
- State license
- CDSS Home Care Organization license (H&S Code § 1796.10 et seq.)
- Who you deal with
- CDSS, DHCS, Medi-Cal managed care plans, HCBA waiver agencies and MSSP sites
- Must haves
- HCO license, contracts with plans that offer Personal Care and Homemaker Services in your county, Medi-Cal provider enrollment where the program requires it, CalEVV registration, registered aides
- Realistic time to first client
- Several months or more
Orientation for California only. We confirm your exact path on the free call.
Three places new California agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Applying before the insurance is bought
California writes insurance into the licensing law itself. Section 1796.37 requires proof of liability coverage of at least $1,000,000 per occurrence and $3,000,000 in the aggregate, a $10,000 employee dishonesty bond and workers' compensation for your aides as part of the application. Owners who price these last find out the policies have to be in force before the packet can go in.
What it costs: Weeks of delay and a premium bill you did not budget for, before CDSS even looks at your application.
Aides you hired but cannot send out
An aide must be cleared on the Home Care Aide Registry before any direct contact with clients. That means an online application, a $35 fee and Live Scan fingerprints, plus a TB test and five hours of entry level training. Agencies that start this after a family calls cannot staff the first shift.
What it costs: A client who needed care this week, and a new hire who may take another job while they wait.
Building the plan around IHSS
In-Home Supportive Services (IHSS) is the best known Medi-Cal home care program, but IHSS recipients hire and direct their own individual providers. Agencies reach Medi-Cal members through managed care plans that offer Personal Care and Homemaker Services, the HCBA waiver, which has had a waiting list since 2023, and local MSSP sites.
What it costs: Months spent on a business plan whose Medi-Cal referrals never arrive.
What does a delay cost your agency?
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Home care vs home health vs hospice in California
The three sound alike and are regulated differently. The one you choose decides your regulator, staffing, startup capital and timeline.
| Topic | Nonmedical home care | Home health (skilled) | Hospice |
|---|---|---|---|
| What your staff do | Bathing, dressing, toileting, meals, housekeeping, transportation, companionship; help with medication the client takes on their own | Skilled nursing in the home, therapy and home health aide services | Palliative and supportive care for people who are terminally ill, and their families |
| State license | CDSS Home Care Organization license (H&S Code § 1796.10 et seq.) | CDPH home health agency license (H&S Code § 1725 et seq.; 22 CCR § 74600 et seq.) | CDPH hospice license (H&S Code § 1745 et seq.); new licenses on hold |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need, but a moratorium on new licenses and a county unmet need test for multi county service areas |
| Main payers | Private pay, long term care insurance, Medi-Cal plans that offer Personal Care and Homemaker Services, HCBA waiver, MSSP | Medicare, Medi-Cal, commercial insurance | Medicare hospice benefit, Medi-Cal |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment | Accreditation or state survey, then Medicare enrollment |
| Key staff | Licensee, staff who supervise and train aides, registered home care aides | Administrator and director of patient care services (one person may hold both), nurses, therapists, certified home health aides | Administrator with a health related degree, RN director of patient care services, physician medical director, interdisciplinary team |
| Startup capital | Lowest, but insurance, the bond and the $5,603 license fee come first | Higher: a licensed only agency must show funds for its first 90 days | Highest: experienced leaders and a 12 month commercial lease |
| Time to first client | Several months for the license, then each aide's registry clearance | Longest: licensure, survey, enrollment | Closed to new licenses until the moratorium ends |
Many California owners start with a Home Care Organization, build a caregiver team and private pay revenue, then add home health. The two licenses come from different departments with different rules: CDSS for nonmedical care and CDPH for skilled care. Section 1725 requires a home health agency license for anyone providing skilled nursing in the home. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
California requirements at a glance
| Nonmedical home care license | Home Care Organization (HCO) license, valid two years, from the California Department of Social Services (CDSS), Community Care Licensing Division, Home Care Services Branch |
|---|---|
| Governing law | Home Care Services Consumer Protection Act, Health and Safety Code Division 2, Chapter 13 (§ 1796.10 et seq.) |
| License fee | $5,603 for two years; $100 for a change of location; $200 for a change of corporation |
| Insurance and bond | Liability insurance of $1,000,000 per occurrence and $3,000,000 aggregate, an employee dishonesty bond with third party coverage of at least $10,000, and workers' compensation for aides (§ 1796.37) |
| Caregivers | Home Care Aide Registry clearance with Live Scan ($35 for two years), TB test, five hours of entry level training and five hours of annual training; dementia content required in annual training from January 1, 2027 |
| Home health and hospice licensing | California Department of Public Health (CDPH), Licensing and Certification Program. New hospice agency licenses are under a moratorium (H&S Code § 1751.70). |
| Medicaid agency | Department of Health Care Services (DHCS) runs Medi-Cal. IHSS is run by counties under CDSS, and recipients hire their own providers. |
| Medi-Cal routes for agencies | Managed care plan Community Supports (Personal Care and Homemaker Services, Caregiver Respite), the HCBA waiver and the Multipurpose Senior Services Program (MSSP) |
| Electronic visit verification | Required for Medi-Cal personal care services since January 1, 2022 and home health care services since January 1, 2023, through CalEVV or an approved alternate system |
| Entity and tax | Secretary of State filing, EDD payroll tax account, $800 annual tax for LLCs with the Franchise Tax Board, city business license |
Summary of California requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in California
The order matters. Insurance and the bond must be in force before you file, and aide registration should start the moment your agency can sponsor applicants, because no aide can meet a client until the registry clears them.
Form the business with the Secretary of State
File your LLC or corporation, get an EIN, open a payroll tax account with the EDD, plan for the Franchise Tax Board's $800 annual LLC tax, and check your city's business license rules.
You do this; we give you the checklistDecide your payer mix
Private pay, long term care insurance, Medi-Cal plans, the HCBA waiver, MSSP or a mix. IHSS is consumer directed, so it is rarely an agency's main Medi-Cal route. Use the path finder above.
Decided on your free consultationBuy the insurance and bond the law requires
General and professional liability of at least $1,000,000 per occurrence and $3,000,000 aggregate, an employee dishonesty bond with third party coverage of at least $10,000 (form HCS 402), and workers' compensation covering your aides. Build California paid sick leave into payroll: at least 40 hours or five days a year.
You do this; we specify what is requiredWrite the Section B documents
The application needs job descriptions for each position, personnel policies, a training plan, an HCO program description and insurance information. From January 1, 2027, the training plan must cover the special care needs of clients with dementia.
We write this for youFile the HCO license application
Complete forms HCS 200, HCS 215, HCS 308, HCS 309, HCS 402 and HCS 9165, attach your formation documents and the $5,603 fee, and mail the packet to the Home Care Services Branch in Sacramento. The receipt notice gives your HCO number and explains fingerprinting and the required online orientation.
We prepare the applicationBuild the caregiver pipeline
Each aide applies through the CDSS Guardian portal using your HCO's PIN, pays $35 and completes Live Scan fingerprints. Add a TB test within 90 days before or seven days after starting and five hours of entry level training before the first visit, then track annual training.
We set up the system and trackerContract with Medi-Cal plans and programs
Find the managed care plans in your county that offer Personal Care and Homemaker Services or Caregiver Respite, then apply to each one. Approach HCBA waiver agencies and MSSP sites too, and complete Medi-Cal provider enrollment where a program requires it.
We prepare every plan's packetSet up electronic visit verification
Medi-Cal personal care visits must be recorded in CalEVV or an approved alternate EVV system. Register in the CalEVV Provider Self-Registration Portal and train your aides before the first Medi-Cal visit.
We walk you through setup
Home Care Aide Registry, training and TB rules
California screens every caregiver an HCO sends into a home. An affiliated home care aide is an employee of a licensed HCO who is listed on the Home Care Aide Registry. Health and Safety Code §§ 1796.43 to 1796.45 set what must happen before and after that aide meets a client.
- Registry clearance: The aide applies online through the CDSS Guardian portal with your HCO's PIN, pays $35 and completes Live Scan fingerprints. The aide must be cleared on the registry before any direct contact with clients. Registration lasts two years and is renewed through Guardian.
- Entry level training: At least five hours before being with a client: two hours of orientation on the aide's role and terms of employment, and three hours of safety training covering emergency procedures and infection control. It may be completed online.
- Annual training: At least five hours every year, related to core competencies and the people you serve: client rights and safety, daily living needs, preventing and reporting abuse and neglect, personal hygiene, and safe transportation if you offer it.
- Dementia training from 2027: SB 412 (Chapter 414, Statutes of 2025) requires annual training to include the special care needs of clients with dementia starting January 1, 2027. CDSS will not prescribe a curriculum but will check your materials at application, renewal and inspection.
- TB test: Within 90 days before or seven days after starting work. A positive test needs a chest X-ray and written clearance before the aide works. Aides with a negative test repeat it at least every two years.
- When an aide leaves: Notify CDSS right away when you no longer employ an aide, so the registry shows the change.
- Home health aides: Home health agencies use CDPH certified home health aides: a 120 hour approved program, or a 40 hour program for aides who already hold an active CNA certificate, plus 24 hours of in service training every two years, at least 12 in each year.
Six mistakes that slow California agencies down
We look for every one of these in the first week of an engagement.
Placing an aide before registry clearance
- What it costs
- A violation of § 1796.43 on your record, and a caregiver in a home before the state has cleared their background.
- How we prevent it
- A tracker that shows each aide's registry status before they can be scheduled.
Buying insurance below the statute
- What it costs
- A $1,000,000 policy without the $3,000,000 aggregate, or a missing dishonesty bond, holds up the application.
- How we prevent it
- We specify the exact coverage, limits and bond wording before you call a broker.
Letting TB tests lapse
- What it costs
- The TB exam is a condition of continuing employment, so an aide past the two year retest has to come off the schedule.
- How we prevent it
- A tracker that flags TB, training and registry renewal dates for every aide.
Writing a training plan without dementia content
- What it costs
- Applications filed on or after January 1, 2027 must include dementia care in the annual training plan, and CDSS checks it at inspection.
- How we prevent it
- We write your training plan to the current § 1796.44 from the start.
Counting on IHSS for Medi-Cal clients
- What it costs
- IHSS recipients hire their own providers, so a plan built on IHSS referrals stalls.
- How we prevent it
- We map which Medi-Cal plans in your county offer Personal Care and Homemaker Services and apply to them.
Drifting into skilled care without a CDPH license
- What it costs
- Section 1725 requires a home health agency license for skilled nursing in the home, and HCO services exclude medication that needs a licensed professional.
- How we prevent it
- Clear service definitions so nonmedical caregivers never perform skilled tasks.
In a free 30 minute call we confirm your California path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
California launch packages
Three fixed price packages, matched to the path you choose. Your exact price is quoted in writing after your free call, before any work starts.
Private pay launch
For nonmedical agencies serving families who pay privately.
- California path and a dated launch plan
- Policy and procedure manual written to the Home Care Services Consumer Protection Act (H&S Code § 1796.10 et seq.) and Medi-Cal plan provider manuals
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Medi-Cal ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Medi-Cal requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for each Medi-Cal managed care plan that offers Personal Care and Homemaker Services in your county
- Survey and audit readiness
- California city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to CDPH rules and the Medicare Conditions of Participation
- License application and inspection readiness
- Accreditation survey preparation
- Medicare and Medicaid enrollment support
Every package: one fixed price agreed in writing · you own 100% of your agency · no franchise fees or royalties.
On your own vs a franchise vs Lunaria
| Topic | On your own | Home care franchise | With Lunaria |
|---|---|---|---|
| Who owns the business | You | You, under the franchisor's brand and rules | You, 100% |
| Ongoing fees | None | Royalties and brand fees, usually a share of revenue | None. One fixed project fee |
| Knowing what California requires | Pieced together from manuals and forums | A national playbook, adapted | Confirmed on your first call, then in writing |
| Policy manual | A template, often from another state | The franchisor's standard manual | Written to the Home Care Services Consumer Protection Act (H&S Code § 1796.10 et seq.) and Medi-Cal plan provider manuals |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for each Medi-Cal managed care plan that offers Personal Care and Homemaker Services in your county prepared together |
| Your brand and marketing | Up to you | The franchisor's brand, with territory limits | Your brand, plus local search set up for you |
The California home care startup checklist
Every California step in order: business setup, your payer path, policies, caregiver screening and training, Medicaid enrollment and getting found. The items to start first are starred.
- Choose your care type and payer mix (private pay, Medi-Cal plans, or both)
- Form your LLC or corporation with the California Secretary of State
- Get an EIN and open an EDD payroll tax account
- Plan for the $800 annual LLC tax and check your city business license rules
- Buy liability insurance of $1,000,000 per occurrence and $3,000,000 aggregate
- and 15 more steps
Christine Ochimas, RN, LMFT, MBA
Christine founded Lunaria Care Consulting to give nurses and caregivers a direct route from "I want my own agency" to a compliant business with clients. She reads state requirements the way a reviewer does and writes policies the way a nurse would actually use them.
- We serve owners in all 50 states and DC, with a plan written for California
- We help through enrollment and survey readiness, not just the application
- We tell you what we cannot promise: no one can guarantee a state or health plan decision
Have these ready for your consultation
- The care you want to provide and the clients you want to serve
- The California cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Medi-Cal, Medicare
- Your target opening month and rough budget
No client or patient records. We never need them for a first call.
What it costs to start a home care agency in California
| Item | Notes |
|---|---|
| HCO license | $5,603 for a two year license (CDSS fee page). A change of location costs $100 and a change of corporation $200. |
| Home Care Aide registration | $35 per aide for two years, plus the Live Scan vendor's fingerprint fees |
| Insurance and bond | Liability, employee dishonesty bond and workers' compensation at the minimums in § 1796.37; premiums depend on your carrier and payroll |
| Entity and taxes | Secretary of State filing fee, $800 annual LLC tax with the Franchise Tax Board, city business license |
| TB tests and training | Per aide at hire, TB retests at least every two years, and annual training |
| Scheduling and EVV | Scheduling software, and an alternate EVV system if you do not use CalEVV for Medi-Cal visits |
| CDPH home health license | $2,946 statewide for fiscal year 2026 to 2027, plus a $2,103 Los Angeles County supplemental fee. Check current fees with CDPH. |
| CDPH hospice license | $2,780 for a two year license, plus a $2,275 Los Angeles County supplemental fee, once new licenses are issued again |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while the license, plan contracts or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in California
Several months: insurance and bond, the HCO application, fingerprinting and orientation, then registry clearance for each aide.
Longer: the HCO license first, then contracting and credentialing with each managed care plan or program in your county.
Longest: CDPH licensure, certification survey and Medicare enrollment. New hospice licenses are on hold until the moratorium ends.
California is large and varied, so the opportunity changes by county. Los Angeles, the Bay Area, Orange County and San Diego are crowded markets where agencies compete on caregiver quality, languages spoken and specialty care such as dementia, which every HCO must train for from 2027. Inland and rural counties have long drive times, so hiring caregivers who live nearby is a selling point. Medi-Cal plans and the Community Supports they offer differ by county. Families search by city and neighborhood, often in more than one language, so a complete Google Business Profile and city pages matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in California?
Yes. An organization that arranges nonmedical home care through aides it employs needs a Home Care Organization license from the CDSS Home Care Services Branch under Health and Safety Code § 1796.10 et seq. Skilled nursing in the home needs a separate home health agency license from CDPH.
How much does a California HCO license cost?
The CDSS fee is $5,603 for a two year license. Each aide pays $35 to register on the Home Care Aide Registry for two years, plus Live Scan fees. Insurance, the dishonesty bond and workers' compensation are separate costs you need before applying.
Do California caregivers need certification?
Not certification, but registration. HCO aides must be cleared on the Home Care Aide Registry, pass a TB test, complete five hours of entry level training before working with a client and complete five hours of training every year. Home health aides are different: they need CDPH certification.
What changes for California home care agencies in 2027?
From January 1, 2027, SB 412 requires every HCO's annual aide training to include the special care needs of clients with dementia. New applicants from that date must include it in the training plan they submit, and CDSS checks it at renewal and inspection.
Can a California HCO bill Medi-Cal?
Not through IHSS, where recipients hire their own providers. HCOs can contract with Medi-Cal managed care plans that offer Personal Care and Homemaker Services or Caregiver Respite as Community Supports, and can work with HCBA waiver agencies and MSSP sites. Medi-Cal personal care visits require electronic visit verification.
Who licenses home health and hospice agencies in California?
The California Department of Public Health, through its Licensing and Certification Program and Centralized Applications Branch. Home health agencies are licensed under Health and Safety Code § 1725 et seq. and Title 22, § 74600 et seq. Hospices are licensed under § 1745 et seq., with new regulations in effect since June 22, 2026.
Can I open a new hospice in California?
Not yet. Since January 1, 2022, a moratorium has stopped CDPH from issuing new hospice agency licenses. The statute ends it on January 1, 2027 or one year after emergency regulations are adopted, and those regulations took effect June 22, 2026. Ask CDPH for the current status before you plan.
Does California require a Certificate of Need for home health?
No. The CDPH home health application has no Certificate of Need or need review. Hospice is different: on top of the moratorium, the 2026 hospice rules require evidence of unmet need for each county a hospice serves beyond its first.
How much does California home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Medi-Cal or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges.
Do you only work in California?
No. Lunaria works with owners in all 50 states and DC, so you can expand into a second state with the same team.
Sources checked for this guide (37)
- CDSS Home Care Services application fees (HCO $5,603, aide $35, change fees)
- CDSS Home Care Organization application process (forms, Section B documents, receipt notice, orientation)
- CDSS Home Care Aide application process (Guardian, $35, Live Scan, renewal)
- CDSS Home Care Services laws and policies
- CDSS PIN 26-02-HCS, 2025 chaptered legislation (SB 412 dementia training, SB 582), March 27, 2026
- CDSS PIN 26-10-CCLD, CCLD Public Portal, August 5, 2026
- CDSS In Home Supportive Services
- H&S Code § 1796.12, definitions (california.public.law copy)
- H&S Code § 1796.37, HCO application, insurance and bond (california.public.law copy)
- H&S Code § 1796.43, registry clearance before client contact (california.public.law copy)
- H&S Code § 1796.44, aide training (california.public.law copy)
- H&S Code § 1796.45, TB examination (california.public.law copy)
- Senate Floor Analysis, SB 412 (2025), Senate Rules Committee
- H&S Code § 1725, home health agency licensure (california.public.law copy)
- H&S Code § 1745, hospice licensure chapter (california.public.law copy)
- H&S Code § 1751.70, hospice moratorium (california.public.law copy)
- H&S Code § 1751.75, moratorium exception (california.public.law copy)
- Title 22 CCR Division 5, Chapter 6, Home Health Agencies (Cornell LII)
- CDPH AFL 25-04, extension of hospice licensure moratorium (Internet Archive copy, May 2026)
- CDPH AFL 26-20, compliance with hospice emergency regulations, June 26, 2026 (Internet Archive copy)
- CDPH AFL 26-23, hospice regulations stakeholder meeting, July 7, 2026 (Internet Archive copy)
- CDPH Home Health Agency Initial and CHOW Application Checklist (Internet Archive copy)
- CDPH Health Care Facility License Fees, effective July 1, 2026 to June 30, 2027 (Internet Archive copy, October 2026)
- CDPH Home Health Aide certification (Internet Archive copy, July 2026)
- CDPH 40 hour Home Health Aide training program applicants (Internet Archive copy)
- DHCS Electronic Visit Verification (Internet Archive copy, February 2026)
- DHCS Enhanced Care Management and Community Supports (Internet Archive copy, March 2026)
- DHCS CalAIM Community Supports elections by plan and county, updated December 2025 (Internet Archive copy)
- DHCS Home and Community Based Alternatives Waiver (Internet Archive copy, December 2025)
- California Department of Aging, Multipurpose Senior Services Program
- DIR Labor Commissioner, California paid sick leave
- Franchise Tax Board, limited liability company annual tax (Internet Archive copy, November 2026)
- EDD, registering as an employer
- CMS accreditation and approved accrediting organizations
- CMS-855A Medicare enrollment application, institutional providers
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
This guide is general information and reflects California requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the California Department of Social Services, the California Department of Public Health, DHCS and CMS before filing. Lunaria Care Consulting provides professional consulting services and does not provide legal advice.
Other states: see all state guides. What we do: licensing, compliance, Medicaid enrollment and local search marketing.