How to start a home care agency in Florida and reach your first client faster
Florida draws a hard line at hands on care. Companions and homemakers need only an AHCA registration, but bathing, dressing or transfers require a home health agency license, with a business plan, CPA compiled projections, proof of contingency funds and $250,000 insurance. Then come Level 2 screening for every worker, Florida Medicaid enrollment, separate contracts with SMMC Long-Term Care plans and electronic visit verification. We put all of it in the right order for you.
- Guides reviewed by Christine Ochimas, RN, LMFT, MBA
- One fixed price, agreed in writing
- You own 100%. No franchise fees or royalties
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Florida rulesChapter 400, Part III, F.S., Rule Chapter 59A-8, F.A.C. and SMMC plan provider manuals
- Local search marketingGoogle Business Profile and local search
- All 50 states and DCExpand beyond Florida with us
Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Florida requires.
Personal care and companion services for SMMC Long-Term Care members
- State license
- AHCA home health agency license for personal care (s. 400.471, F.S.); homemaker and companion registration (s. 400.509) for companion and homemaker services only
- Who you deal with
- AHCA (licensing and Florida Medicaid) and each SMMC Long-Term Care plan in your region
- Must haves
- AHCA license or registration, Florida Medicaid enrollment, LTC plan contracts and credentialing, Level 2 screening, aide training, electronic visit verification through each plan's system
- Realistic time to first client
- Several months
Orientation for Florida only. We confirm your exact path on the free call.
Three places new Florida agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Starting with the wrong credential
Owners register as a companion and homemaker provider because it is quick, then learn their clients need help bathing, dressing and moving. Florida law says companions and homemakers may not provide hands on personal care. That work needs a home health agency license, which is a new application, not an add on.
What it costs: Months of rework, and clients you have to turn away or refer out while the license is pending.
The home health financial package
AHCA wants a signed business plan, two years of financial statements compiled and signed by a CPA, proof of at least three months of projected expenses in startup funds and contingency, $250,000 per claim insurance and proof of your right to occupy the office. Projections may not show a 15% operating margin in any month of year one. Missing items must be filed within 21 days of AHCA's request or the application is withdrawn and the fee is lost.
What it costs: A withdrawn application, a forfeited fee and starting the clock over.
The SMMC plan wall
Florida Medicaid home care runs through Statewide Medicaid Managed Care Long-Term Care plans. Each plan may limit its network based on credentials, quality and price, and contracts with you separately after Florida Medicaid enrollment. Members also come off a statewide waitlist only as funding allows, so new agencies compete for a limited number of referrals.
What it costs: Months of payroll and rent carried by your reserve while plan contracts are pending.
What does a delay cost your agency?
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Home care vs home health vs hospice in Florida
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 | Companionship, outings, meal preparation, housekeeping, shopping; hands on personal care needs a home health agency license | Personal care by home health aides and CNAs, plus nursing and therapy for skilled agencies | Palliative and supportive care for people who are terminally ill, and their families |
| State license | AHCA homemaker and companion services registration (s. 400.509; Rule 59A-8.025) | AHCA home health agency license (s. 400.471; Rule Chapter 59A-8) | AHCA hospice license (Part IV, Ch. 400; Rule Chapter 59A-38) |
| Certificate of Need | No | No Certificate of Need step | Yes: Certificate of Need required (s. 408.036), based on need AHCA publishes twice a year for each hospice service area |
| Main payers | Private pay, SMMC Long-Term Care plans where they contract for homemaker and companion services | Medicare, SMMC plans, commercial insurance, private pay | Medicare hospice benefit, Florida Medicaid through SMMC plans |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment (paused for new agencies since May 13, 2026) | Accreditation or state survey, then Medicare enrollment (paused for new hospices since May 13, 2026) |
| Key staff | Owner or manager; companions and homemakers with Level 2 screening and verified work history | Administrator, alternate administrator, RN director of nursing, home health aides or CNAs under RN supervision | Administrator, physician, RN, social worker, counselor, volunteers |
| Startup capital | Lowest | Higher: at least three months of projected expenses must be shown to AHCA | Highest: Certificate of Need process and interdisciplinary team before revenue |
| Time to first client | Weeks (registration) to months (SMMC plans) | Months: AHCA review, survey, accreditation for skilled care | Longest: Certificate of Need, licensure, survey, enrollment |
Many Florida owners start with a companion and homemaker registration, then find that most paying clients need hands on help. Licensed home health agencies are exempt from the separate registration and may provide companion and homemaker services too, so if personal care is in your plan, applying for the home health agency license first can save a second application. A home health agency that provides only nonskilled care does not need accreditation; adding skilled care does. We plan this with you on day one.
Florida requirements at a glance
| Companion and homemaker services | AHCA registration under s. 400.509, F.S. and Rule 59A-8.025, renewed every two years. No hands on personal care allowed. |
|---|---|
| Personal care and skilled care | AHCA home health agency license under s. 400.471, F.S. and Rule Chapter 59A-8, F.A.C. Accreditation is required only if you provide skilled care. |
| Hospice | Certificate of Need under s. 408.036, F.S. and Rule 59C-1.0355, then an AHCA hospice license under Part IV of Chapter 400 and Rule Chapter 59A-38 |
| Medicaid agency | Agency for Health Care Administration (AHCA), which runs Florida Medicaid |
| Long term care program | Statewide Medicaid Managed Care (SMMC) Long-Term Care program, delivered by contracted plans in nine regions (A to I) |
| Caregiver training | Home health aides: 40 hours of training, the AHCA competency test or a current CNA certificate, plus CPR, a one time HIV/AIDS course and yearly inservice. Dementia training for all direct care staff. |
| Background screening | Level 2 fingerprint screening through the Care Provider Background Screening Clearinghouse before any client contact, and every five years |
| Electronic visit verification | Required by federal law for Medicaid personal care and home health visits; SMMC plans use HHAeXchange |
| Medicare (home health, hospice) | Accreditation or state survey, then Medicare enrollment. A CMS moratorium on new enrollment took effect May 13, 2026. |
| Business and tax | Division of Corporations filing, EIN, Department of Revenue reemployment tax, county and city local business tax |
Summary of Florida requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Florida
The order matters. Decide registration or license in step 2 before you spend on anything else, and start screening and policies early, because AHCA, Florida Medicaid and every SMMC plan check them.
Form the business and register for taxes
File your LLC or corporation with the Florida Division of Corporations, get an EIN, register with the Florida Department of Revenue for reemployment tax (new employers start at 2.7% on the first $7,000 of each worker's wages), and get your county and city local business tax receipts.
You do this; we give you the checklistChoose registration or license
If caregivers will only provide companionship, errands, meals and housekeeping, a homemaker and companion registration is enough. If they will help with bathing, dressing, toileting or transfers, you need a home health agency license. Decide your payer mix too: private pay, SMMC Long-Term Care or both.
Decided on your free consultationSet up insurance and office basics
Arrange workers' compensation, general liability and auto coverage. Home health agencies need malpractice and liability coverage of at least $250,000 per claim and proof of a legal right to occupy the office, such as a lease.
You do this; we specify what is requiredWrite policies to Rule 59A-8
Adopt policies for service agreements, client records, client rights and complaint notices, screening, supervision, incident and abuse reporting, emergency management and infection control, written to Rule Chapter 59A-8 and each SMMC plan's provider manual.
We write this for youBuild the caregiver pipeline
Register with the Clearinghouse, run Level 2 fingerprint screening before any client contact, check each worker's employment history, deliver dementia training, and for a licensed agency confirm aide training or testing, CPR and the HIV/AIDS course.
We set up the system and trackerApply to AHCA
Registration uses AHCA Form 3110-1003 and names your service area counties. A home health license uses Form 3110-1011 with the licensing addendum, a business plan, CPA compiled two year statements and proof of contingency funds. Answer any AHCA request within 21 days.
We prepare the applicationEnroll in Florida Medicaid and contract with LTC plans
Enroll as a Florida Medicaid provider, since federal rules require managed care network providers to be enrolled with the state. Then apply to each SMMC Long-Term Care plan serving your region and complete its credentialing.
We prepare every plan's packetSet up electronic visit verification
SMMC plans require visits to be verified through HHAeXchange. Plans offer free HHAeXchange tools, or you can connect your own scheduling system to it. Set this up before your first Medicaid visit.
We walk you through setup
Level 2 screening and caregiver training
Every Florida home care worker who has client contact needs Level 2 background screening under s. 400.512 and Chapter 435, F.S. Training depends on the credential: home health aides must meet Rule 59A-8.0095, while companions and homemakers have no state training hour minimum beyond dementia training.
- Level 2 screening: Fingerprint based state and national checks for direct care workers, the administrator, the financial officer and controlling interests (s. 408.809). Workers may complete training and orientation, but may not have contact with clients until screening clears (s. 435.06).
- Clearinghouse and rescreening: Screening runs through AHCA's Care Provider Background Screening Clearinghouse, where employers register and report changes within five business days. Rescreening is required every five years.
- Employment history: Companion and homemaker providers must obtain and check each worker's employment or contract history. Rule 59A-8.025 accepts two documented attempts when a former employer cannot be reached.
- Home health aide training: At least 40 hours of training in the listed subjects, or a passing score on the AHCA Home Health Aide Competency Test, or a current CNA certificate. Assisting with medications needs at least two more hours of training.
- CPR, HIV/AIDS and inservice: Aides and CNAs keep CPR current and receive inservice training each calendar year. Most home health agency employees complete a one time HIV/AIDS course within 30 days of hire.
- Dementia training: Since July 2023, s. 430.5025 covers home health agencies, nurse registries and companion and homemaker services: basic information at hire, a one hour course within 30 days for staff with regular client contact, and two more hours within seven months for staff who provide personal care.
- RN supervision: Home health aides and CNAs work under RN supervision, with supervisory visits to the client's home.
Six mistakes that slow Florida agencies down
We look for every one of these in the first week of an engagement.
Letting companions give hands on care
- What it costs
- Personal care under a registration is unlicensed home health activity, with fines, injunctions and lost payer trust.
- How we prevent it
- We decide registration or license with you on the first call and write service definitions that hold the line.
Advertising without your AHCA number
- What it costs
- Florida law requires the license or registration number in every ad, with fines of at least $100 for a first offense and $500 after that.
- How we prevent it
- We review your website, Google Business Profile and printed materials before launch.
Projections that break AHCA's rules
- What it costs
- Statements not compiled by a CPA, or showing a 15% operating margin in a first year month, send the application back.
- How we prevent it
- We coordinate the business plan and projections with your CPA to the s. 400.471 standard.
Missing the 21 day deadline
- What it costs
- If AHCA's request for missing information goes unanswered for 21 days, the application is withdrawn and the fee is forfeited.
- How we prevent it
- We manage AHCA correspondence and answer each request well inside the deadline.
Scheduling a caregiver before screening clears
- What it costs
- A violation of Chapter 435 and a finding on your next survey or plan audit.
- How we prevent it
- A tracker that blocks scheduling until the Clearinghouse shows an eligible result.
Planning hospice or Medicare without checking the gates
- What it costs
- Hospice cannot be licensed without a Certificate of Need, and CMS stopped enrolling new home health agencies and hospices on May 13, 2026.
- How we prevent it
- We check Certificate of Need need and the CMS moratorium status before you commit capital.
In a free 30 minute call we confirm your Florida path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Florida 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.
- Florida path and a dated launch plan
- Policy and procedure manual written to Chapter 400, Part III, F.S., Rule Chapter 59A-8, F.A.C. and SMMC plan provider manuals
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
SMMC Long-Term Care ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to SMMC Long-Term Care requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for each SMMC Long-Term Care plan in your region
- Survey and audit readiness
- Florida city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to AHCA 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 Florida 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 Chapter 400, Part III, F.S., Rule Chapter 59A-8, F.A.C. and SMMC plan provider manuals |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for each SMMC Long-Term Care plan in your region 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 Florida home care startup checklist
Every Florida 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.
- Decide registration (no hands on care) or home health agency license, and your payer mix
- Form your LLC or corporation with the Florida Division of Corporations
- Get an EIN and register for reemployment tax with the Department of Revenue
- Get county and city local business tax receipts
- Buy workers' compensation, liability and auto coverage ($250,000 per claim malpractice and liability for home health)
- and 14 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 Florida
- 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 Florida cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, SMMC Long-Term Care, 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 Florida
| Item | Notes |
|---|---|
| AHCA registration or license | Statute sets the companion and homemaker registration fee at $50 per two years. Home health agency fees are set by rule and capped by statute at $2,000 per two years. Check current fees with AHCA. |
| Entity formation and local business tax | Division of Corporations filing fee plus county and city local business tax receipts |
| CPA compiled financial statements | Required for a home health agency license: two years of projections compiled and signed by a CPA |
| Startup and contingency funds | Home health applicants must show at least three months of average projected expenses, with at least one month as contingency funds (s. 408.8065) |
| Insurance | At least $250,000 per claim malpractice and liability for home health agencies, plus workers' compensation and auto coverage |
| Level 2 screening | Fingerprinting and screening fees per worker, with retention and rescreening every five years |
| Training | Aide training or competency testing, CPR, HIV/AIDS and dementia courses. The one hour state dementia course is free online. |
| EVV and scheduling software | Plans offer free HHAeXchange tools; your own scheduling system and integration costs are extra |
| Accreditation (skilled home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while AHCA review, plan contracts or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Florida
Weeks for a registration, since AHCA waives the initial inspection for companion and homemaker providers and must act within 60 days of a complete application. Months for a home health agency license.
Several months: AHCA licensing or registration, Florida Medicaid enrollment, then contracting and credentialing with each plan in your region.
Longest: AHCA review and survey, accreditation for skilled care, a Certificate of Need for hospice, and Medicare enrollment, which CMS has paused for new agencies since May 13, 2026.
Florida's SMMC program divides the state into nine regions, from the Panhandle and Big Bend (Region A) to Miami-Dade and Monroe (Region I). Agencies in the large metro areas, such as Broward, Palm Beach, Orange and Hillsborough, compete for plan contracts and private pay referrals, while in rural North and Central Florida, reliable staffing over long distances is the selling point. Many families search for care for a parent from another state, and seasonal residents search before they arrive, so a strong Google Business Profile and clear pages for each city and community you serve matter.
Frequently asked questions
Do you need a license to start a home care agency in Florida?
It depends on the services. Companion and homemaker services with no hands on care need an AHCA registration under s. 400.509, F.S. Personal care such as bathing, dressing and transfers requires a home health agency license under s. 400.471. A licensed home health agency does not need the separate registration.
Who licenses home health agencies and hospices in Florida?
The Agency for Health Care Administration. Home health agencies are licensed under Chapter 400, Part III, F.S. and Rule Chapter 59A-8, F.A.C. Hospices are licensed under Chapter 400, Part IV and Rule Chapter 59A-38, after receiving a Certificate of Need.
Does a nonskilled home health agency in Florida need accreditation?
No. Section 400.471 requires accreditation for agencies that provide skilled care, and a home health agency that does not provide skilled care is exempt. Adding skilled care later brings the accreditation requirement with it.
Does Florida require a Certificate of Need for home health or hospice?
Not for home health agencies. Hospices do need one: s. 408.036 makes establishing a hospice subject to Certificate of Need review, and AHCA may not issue a hospice license without it. Need is calculated for each of 27 hospice service areas under Rule 59C-1.0355.
What training do Florida caregivers need?
Home health aides need 40 hours of training, a passing score on the AHCA competency test or a current CNA certificate, plus CPR, a one time HIV/AIDS course and yearly inservice. Companions and homemakers have no state training hour minimum, but all direct care staff need dementia training under s. 430.5025.
What background check do Florida home care workers need?
Level 2 screening, which is fingerprint based, through AHCA's Care Provider Background Screening Clearinghouse. It applies to caregivers, administrators, financial officers and owners with a controlling interest. Workers cannot have client contact until screening clears, and rescreening is due every five years.
How do Florida home care agencies get Medicaid clients?
By enrolling as a Florida Medicaid provider and contracting with the Statewide Medicaid Managed Care Long-Term Care plans in their region. Plans may limit their networks, and members are released from a statewide waitlist as funding allows, so plan contracts decide your referrals.
Can a new Florida home health agency or hospice enroll in Medicare right now?
CMS imposed a nationwide moratorium on new Medicare enrollment of home health agencies and hospices effective May 13, 2026, for six months, and it can be extended in six month steps. Applications received before that date continue to be processed. Check its current status with CMS before you plan on Medicare revenue.
How much does Florida home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: companion registration, home health agency license, SMMC Long-Term Care or Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges.
Do you only work in Florida?
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 (44)
- Fla. Stat. 400.462, home health definitions (companion, homemaker, personal care, administrator, director of nursing)
- Fla. Stat. 400.464, home health agency licensure and advertising
- Fla. Stat. 400.471, home health agency license application, insurance, accreditation, fees
- Fla. Stat. 400.476, home health staffing
- Fla. Stat. 400.4765, home health aides for medically fragile children
- Fla. Stat. 400.4785, dementia training for home health agencies
- Fla. Stat. 400.506, nurse registries
- Fla. Stat. 400.509, homemaker and companion services registration
- Fla. Stat. 400.512, screening of home health and companion personnel
- Fla. Stat. 400.602, hospice licensure
- Fla. Stat. 400.606, hospice license application and Certificate of Need
- Fla. Stat. 408.036, projects subject to Certificate of Need review
- Fla. Stat. 408.805, license fees
- Fla. Stat. 408.806, license application process (60 day decision, 21 day omissions)
- Fla. Stat. 408.8065, contingency funding for home health agencies
- Fla. Stat. 408.809, background screening
- Fla. Stat. 408.810, minimum licensure requirements
- Fla. Stat. 435.06, employer screening and contact with vulnerable persons
- Fla. Stat. 435.12, Care Provider Background Screening Clearinghouse
- Fla. Stat. 430.5025, Alzheimer's disease and related dementia training
- Fla. Stat. 409.966, SMMC regions A to I
- Fla. Stat. 409.979, long term care eligibility and preenrollment list
- Fla. Stat. 409.98, long term care plan benefits
- Fla. Stat. 409.982, long term care plan networks
- Fla. Stat. 409.907, Medicaid provider agreements and screening
- Fla. Stat. 393.0662, APD iBudget system
- Fla. Stat. 205.032, county local business tax
- Rule 59A-8.003, F.A.C., home health licensure requirements (Cornell LII)
- Rule 59A-8.0095, F.A.C., home health personnel (Cornell LII)
- Rule 59A-8.025, F.A.C., homemaker and companion registration (Cornell LII)
- Rule 59A-38.004, F.A.C., hospice administration (Cornell LII)
- Rule 59C-1.0355, F.A.C., hospice Certificate of Need (Cornell LII)
- Florida Department of Revenue, reemployment tax
- CMS Provider Enrollment Moratoria (last modified 08/27/2026)
- CMS Home Health and Hospice Nationwide Moratorium Q&As (revised 7/09/26)
- Federal Register 2026-09717, nationwide HHA enrollment moratoria (govinfo)
- Federal Register 2026-09718, nationwide hospice enrollment moratorium (govinfo)
- Medicaid.gov, Electronic Visit Verification
- 42 CFR 438.602, state screening and enrollment of managed care network providers (Cornell LII)
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- CMS-855A Medicare enrollment application, institutional providers
- Sunshine Health (SMMC plan), EVV through HHAeXchange under the AHCA SMMC contract
- Home Care Roadmap, moratorium decision point (secondary, pointer only)
This guide is general information and reflects Florida requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Florida Agency for Health Care Administration 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.