How to start a home care agency in Louisiana and reach your first client faster
Louisiana does license nonmedical home care, and the license comes with a gate most owners never see coming. Before you can apply for the personal care module, the Facility Need Review committee must agree that people in your LDH region would lose access to care without you. Approval then starts a six month clock: line of credit, insurance, administrator, policies, trained caregivers and a first client before the survey. We put all of it in the right order for you.
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Louisiana rulesLAC 48:I Chapter 50 HCBS licensing standards and OAAS LT-PCS policy
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Louisiana requires.
Personal care for LT-PCS and waiver participants
- State license
- LDH HCBS provider license, Personal Care Attendant module (LAC 48:I Chapter 50), after Facility Need Review
- Who you deal with
- LDH Health Standards Section, Office of Aging and Adult Services (OAAS), Louisiana Medicaid and its fiscal intermediary, Gainwell Technologies
- Must haves
- HCBS license with the PCA module, Louisiana Medicaid enrollment for each provider type, listing on the Freedom of Choice list, monthly registry and exclusion checks, $9 an hour wage floor, EVV through LaSRS or an approved system
- Realistic time to first client
- Several months or more: license first, then Medicaid enrollment
Orientation for Louisiana only. We confirm your exact path on the free call.
Three places new Louisiana agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
The Facility Need Review gate
Before LDH will accept an HCBS license application for personal care, respite, supervised independent living or monitored in home caregiving, the Facility Need Review committee must approve you. It approves only when your data and evidence show a probability of serious, adverse consequences to people's access to care in your LDH region if you are not licensed. The burden is on you, and an application without supporting documentation is not processed.
What it costs: Months of waiting, and a $200 nonrefundable fee lost if the case is thin.
The six month clock after approval
LAC 48:I.12523 gives FNR approved applicants six months to become licensed, with at most one 90 day extension for delays outside their control. Zoning problems do not count. In that window you need a $50,000 line of credit in the agency's name, $300,000 of general and professional liability, workers' compensation, a qualified Louisiana resident administrator, LDH's three online training certificates, and one admitted client before the survey.
What it costs: An expired approval means a new review, a new fee and starting the wait again.
Home health and hospice doors that are mostly closed
State law (R.S. 40:2116.32(F)) restricts new home health licenses until LDH certifies it can fund initial surveys, and LDH's own home health page points owners to that moratorium language. Hospices need Facility Need Review. On top of that, CMS paused new Medicare enrollment of home health agencies and hospices from May 13, 2026, and LDH has said it intends to pause new home health Medicaid enrollment.
What it costs: Capital spent on a clinical startup that cannot be licensed or enrolled yet.
What does a delay cost your agency?
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Home care vs home health vs hospice in Louisiana
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 | Hands on personal care with activities of daily living, plus housekeeping and meal help as part of the plan | Skilled nursing plus therapy, medical social services or home health aide services, under a physician's order | Palliative and supportive care for terminally ill patients and their families, by an interdisciplinary team |
| State license | LDH HCBS provider license, Personal Care Attendant module (LAC 48:I Chapter 50); sitter only businesses are exempt | LDH home health agency license (R.S. 40:2116.31 et seq.; LAC 48:I Chapter 91) | LDH hospice license (R.S. 40:2181 to 2192; LAC 48:I Chapter 82) |
| Certificate of Need | No Certificate of Need, but Facility Need Review for the PCA module | No Certificate of Need, but a state licensing moratorium (R.S. 40:2116.32(F)) | No Certificate of Need, but Facility Need Review (LAC 48:I.12533) |
| Main payers | Private pay, LT-PCS, Community Choices Waiver and OCDD waivers | Medicare, Louisiana Medicaid and Healthy Louisiana plans, commercial insurance | Medicare hospice benefit, Louisiana Medicaid |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment; paused by the CMS moratorium from May 13, 2026 | Accreditation or state survey, then Medicare enrollment; paused by the CMS moratorium from May 13, 2026 |
| Key staff | Full time administrator who lives in Louisiana, direct care staff supervisor, trained direct service workers | Administrator, full time RN clinical manager with home health experience, clinical staff | Administrator, director of nursing, medical director, interdisciplinary team |
| Startup capital | Moderate: $50,000 line of credit required | Higher: $75,000 line of credit and clinical payroll, or the price of an existing agency | Highest: $75,000 line of credit and an interdisciplinary team before revenue |
| Time to first client | Several months: Facility Need Review, then licensing | Uncertain: licensing moratorium and federal enrollment pause | Longest: Facility Need Review, licensure, survey, enrollment |
In Louisiana the personal care license is the realistic first step for most new owners. Home health licenses are restricted by state law, so owners who want skilled care usually look at buying an existing licensed agency, and that has its own Medicare rules: a change in majority ownership within 36 months of the agency's last enrollment or ownership change counts as a new enrollment, which the CMS moratorium blocks. We check all of this on your first call before you commit money.
Louisiana requirements at a glance
| Nonmedical home care license | HCBS provider license with the Personal Care Attendant (PCA) module, issued by the LDH Health Standards Section under La. R.S. 40:2120.2 to 2120.7 and LAC 48:I Chapter 50 |
|---|---|
| Before you apply | Facility Need Review approval for the PCA, respite, supervised independent living and monitored in home caregiving modules (LAC 48:I.12523), $200 nonrefundable fee |
| Exempt businesses | Businesses that solely provide sitter services, housekeeping, meal preparation and delivery, home modifications or emergency response systems. Sitters may not give hands on help with activities of daily living. |
| Home health and hospice | Licensed by LDH: home health under LAC 48:I Chapter 91 (new licenses restricted by R.S. 40:2116.32(F)), hospice under LAC 48:I Chapter 82 with Facility Need Review |
| Medicaid programs | Long-Term Personal Care Services (LT-PCS), Community Choices Waiver and Adult Day Health Care Waiver (OAAS); New Opportunities, Children's Choice, Supports and Residential Options waivers (OCDD) |
| Caregiver training | At least 16 hours before providing care, a competency evaluation, first aid within 45 days of hire and 8 hours of training every year (LAC 48:I.5055) |
| Background screening | Criminal history and security check through Louisiana State Police or an authorized agency (R.S. 40:1203.1 et seq., changed by Act 802 of 2026); DSW Registry and OIG exclusion checks before hire and monthly |
| Electronic visit verification | Required for Medicaid personal care and home health; LDH's system is LaSRS, run by Statistical Resources, Inc., and other systems need an LDH attestation |
| Medicare (home health, hospice) | Accreditation or state survey, then Medicare enrollment. A CMS moratorium on new enrollment took effect May 13, 2026. |
| Entity filing | Louisiana Secretary of State through geauxBIZ, which also handles Department of Revenue tax and unemployment insurance registration |
Summary of Louisiana requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Louisiana
The order matters. Facility Need Review comes before everything else, and once it is approved you have six months to be licensed, so policies, insurance, the line of credit and caregiver screening must be ready to move the day approval arrives.
Form the business and register for taxes
File your LLC or corporation with the Louisiana Secretary of State through geauxBIZ, which also registers you with the Department of Revenue and for unemployment insurance. Get an EIN and check your parish and city license rules.
You do this; we give you the checklistChoose your modules and region
Decide between hands on personal care (the PCA module) and a sitter only business that needs no license, and pick the LDH region where your office will be. Both the license and the FNR approval are tied to that region.
Decided on your free consultationBuild and file the Facility Need Review case
Assemble data and evidence on access to care in your region, then file the HCBS FNR application with the $200 fee online or by mail. Attach all supporting documentation, and do not send your license application with it.
We prepare the applicationLine up money, insurance and leadership
Get a $50,000 line of credit in the agency's name from a federally insured lender (not a loan, credit card or bank balance), $300,000 of general and professional liability and workers' compensation with HSS as certificate holder, and a full time administrator who lives in Louisiana and meets the education or experience rules.
You do this; we specify what is requiredWrite policies to LAC 48:I Chapter 50
Adopt policies for admissions, service plans, back up staffing, client rights, grievances, abuse and incident reporting, supervision, records, infection control and emergency preparedness, written to the HCBS licensing standards.
We write this for youSubmit the HCBS license packet
Send the application with the FNR approval letter, fees, office floor sketch with a 24 hour phone number, administrator documents, owner and administrator background checks, ownership disclosure and certificates from LDH's three online provider training videos.
We prepare the applicationBuild the caregiver pipeline
Run criminal history and security checks at the offer of employment, check the DSW Registry and the OIG exclusion list before hire and monthly, deliver 16 hours of training and a competency evaluation before the first visit, and track first aid within 45 days.
We set up the system and trackerAdmit one client and pass the initial survey
After HSS confirms your packet and training, you must admit one client and contact the HSS field office within 30 days to schedule the announced initial survey, fully operational and serving only that client.
We get you ready for the surveyEnroll in Louisiana Medicaid
Enroll through the Louisiana Medicaid provider enrollment portal for each provider type, get on the Freedom of Choice list participants use to pick agencies, and set up EVV through LaSRS or an attested third party system.
We prepare and manage it
Direct service worker training and background checks
Louisiana calls unlicensed caregivers direct service workers (DSWs). LAC 48:I Chapter 50 sets the training an HCBS agency must give them, and LAC 48:I Chapter 92 sets the registry and background check duties for every licensed provider that employs them. There is no state certificate for personal care workers; the agency trains and tests them.
- Before the first visit: At least 16 hours of training covering agency policies, emergencies, client rights, abuse and neglect reporting using LDH's approved curriculum, critical incidents, universal precautions, documentation, service plans, confidentiality and scald prevention.
- Competency evaluation: A written or oral exam that reflects the training, with a substitute exam for workers with limited literacy.
- First aid: A basic first aid course within 45 days of hire.
- Every year: At least 8 hours of training. Orientation and normal supervision do not count.
- Supervision: An unannounced in person supervisory visit for each worker within 60 days of hire and at least once a year, more often if the service plan or performance calls for it.
- Basic eligibility: Workers must be at least 18 and able to read, write and understand English well enough to follow the service plan.
- Criminal history checks: A criminal history and security check through Louisiana State Police or an authorized agency on offer of employment, under R.S. 40:1203.1 et seq. Act 802 of 2026, effective October 1, 2026, changed these rules and more checks now route through the State Police LAPS system.
- Registry and exclusion checks: The DSW Registry and the federal OIG exclusion list before hire and every month after (LAC 48:I.9202 and 9231). Keep proof of every search, even when nothing is found.
- Medication and noncomplex tasks: Workers may give medication or perform noncomplex medical tasks only with extra training and RN delegation under LAC 48:I Chapter 92, Subchapter D.
Six mistakes that slow Louisiana agencies down
We look for every one of these in the first week of an engagement.
Treating Facility Need Review as a formality
- What it costs
- A denial, a lost $200 fee and months back at the start.
- How we prevent it
- We build your FNR case around access to care evidence in your LDH region.
Letting the six month clock run out
- What it costs
- The FNR approval expires automatically, and zoning delays do not earn an extension.
- How we prevent it
- Policies, insurance, line of credit and administrator are lined up before approval arrives.
A sitter business that starts giving hands on care
- What it costs
- The first bath or transfer means operating an unlicensed PCA provider.
- How we prevent it
- Clear service definitions so sitters never help with activities of daily living until the PCA module is licensed.
A line of credit that is really a loan
- What it costs
- Chapter 50 rejects loans, credit cards and bank balances, so the packet stalls.
- How we prevent it
- We specify the exact letter your bank must issue, in the agency's name and at its licensed address.
Skipping monthly registry and exclusion checks
- What it costs
- Medicaid can recoup payments, sanction you or end your enrollment.
- How we prevent it
- A tracker that logs DSW Registry and OIG searches for every worker every month.
Buying or starting a clinical agency without checking federal rules
- What it costs
- A home health or hospice purchase that triggers a new Medicare enrollment while the CMS moratorium is in force.
- How we prevent it
- We check the state moratorium, Facility Need Review and CMS moratorium status before you commit capital.
In a free 30 minute call we confirm your Louisiana path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Louisiana 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.
- Louisiana path and a dated launch plan
- Policy and procedure manual written to LAC 48:I Chapter 50 HCBS licensing standards and OAAS LT-PCS policy
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
LT-PCS ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to LT-PCS requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for Louisiana Medicaid through the provider enrollment portal, with a listing on the Freedom of Choice list
- Survey and audit readiness
- Louisiana city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to LDH HSS 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 Louisiana 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 LAC 48:I Chapter 50 HCBS licensing standards and OAAS LT-PCS policy |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for Louisiana Medicaid through the provider enrollment portal, with a listing on the Freedom of Choice list 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 Louisiana home care startup checklist
Every Louisiana 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 PCA licensing or a sitter only business, and your LDH region
- Form your LLC or corporation through geauxBIZ with the Secretary of State
- Get an EIN and register with the Department of Revenue and for unemployment insurance
- Check parish and city license rules
- Gather access to care data and evidence for your LDH region
- 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 Louisiana
- 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 Louisiana cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, LT-PCS, 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 Louisiana
| Item | Notes |
|---|---|
| Facility Need Review | $200 nonrefundable fee per HCBS FNR application (also charged on a change of ownership) |
| HCBS license | LDH lists a $600 initial fee and $600 renewal, with extra fees for adult day care or center based respite and $200 to add a module such as PCA later. Check current fees with HSS. |
| Home health and hospice licenses | LDH's fee schedule lists $600 for an initial home health or hospice license and $600 for renewal, plus branch fees |
| Line of credit | At least $50,000 for an HCBS provider; at least $75,000 for a home health agency or hospice |
| Insurance | General and professional liability of at least $300,000, plus workers' compensation |
| Entity formation | Secretary of State filing fees, which changed on October 1, 2026 under Act 921 of 2026, plus any parish or city license |
| Background checks | State Police or authorized agency fees for owners, the administrator and every worker |
| Caregiver training | Paid time for 16 hours of training before the first visit and 8 hours a year, plus first aid courses |
| EVV | LDH's LaSRS system is offered at no cost for home health and EPSDT personal care; a third party system is the agency's expense |
| Operating reserve | Covers rent, payroll and insurance through Facility Need Review, licensing and Medicaid enrollment |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Louisiana
Several months: Facility Need Review first, then up to six months to be licensed after approval. No official processing time is published for FNR decisions.
Longer: everything above, then Louisiana Medicaid enrollment and the Freedom of Choice listing before participants can choose you.
Longest and least certain: the state home health licensing moratorium, Facility Need Review for hospice, and the CMS Medicare enrollment pause that began May 13, 2026.
Because Facility Need Review decides who may open by LDH region, where you put your office matters as much as how you run it. Regions around New Orleans and Baton Rouge already have many licensed providers, so an FNR case there has to show a real access gap; rural parishes can be harder to staff but may make access problems easier to document. Many Louisiana families search by parish and city, and many adult children search from out of state, so a complete Google Business Profile and clear pages for your parishes and towns help families and LT-PCS participants find you on the Freedom of Choice list and in search.
Frequently asked questions
Do you need a license to start a home care agency in Louisiana?
Yes, for hands on personal care. You need an HCBS provider license with the Personal Care Attendant module from the LDH Health Standards Section, and Facility Need Review approval comes first. Businesses that solely provide sitter, housekeeping or meal services are exempt, as long as they never help with activities of daily living.
What is Facility Need Review in Louisiana?
A review under LAC 48:I Chapter 125 that must approve you before LDH will license the PCA, respite, supervised independent living or monitored in home caregiving modules. The committee approves only if your evidence shows a probability of serious, adverse consequences to access to care in your LDH region if you are not licensed. LDH states it has no Certificate of Need program.
How much does it cost to get licensed in Louisiana?
State fees are modest: $200 for Facility Need Review and a $600 initial HCBS license fee on LDH's fee schedule. The larger requirements are a $50,000 line of credit, $300,000 of general and professional liability, workers' compensation, a qualified administrator and trained staff. Check current fees with HSS before you pay.
Can I open a new home health agency in Louisiana?
It is difficult. R.S. 40:2116.32(F) bars new home health licenses, apart from surveys eligible for priority federal funding, until LDH certifies it can fund initial surveys, and LDH's home health page points to that moratorium. Buying an existing licensed agency is the other route, subject to Medicare ownership rules and the CMS moratorium.
Does Louisiana require a Certificate of Need for hospice?
Not a Certificate of Need, but hospices must win Facility Need Review approval under LAC 48:I.12533 before licensure. The review looks at need within a 50 mile radius of your proposed location, and outpatient hospices must be licensed within six months of approval.
Do Louisiana caregivers need certification?
No state certificate is required for personal care workers. Each must complete at least 16 hours of agency training and a competency evaluation before providing care, first aid within 45 days and 8 hours of training a year, and pass criminal history, DSW Registry and OIG exclusion checks. Home health aides need nursing assistant certification or a home health aide training program.
How do Louisiana agencies get LT-PCS clients?
After licensure, enroll with Louisiana Medicaid for each provider type and get listed on the Freedom of Choice list that LT-PCS participants use to choose an agency. LT-PCS providers must pay workers at least $9 an hour, pass 70 percent of the 2022 rate increase to workers, check registries monthly and use EVV.
Is Medicare enrollment open for new home health agencies and hospices?
Not at the moment of writing. CMS put a nationwide six month moratorium on new Medicare enrollment of home health agencies and hospices starting May 13, 2026, and it can be extended in six month steps. LDH requires Medicare enrollment before hospice Medicaid enrollment, and has said it intends to pause new home health Medicaid enrollment. Check current status before you plan.
How much does Louisiana home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: Facility Need Review and licensing, LT-PCS enrollment, or a clinical agency. You receive the price in writing after a free 30 minute consultation. There are no hourly charges.
Do you only work in Louisiana?
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 (39)
- LDH Health Standards Section, Home and Community Based Service Providers (HCBS)
- LAC 48:I Chapters 50 and 51, HCBS minimum licensing standards (LDH compilation, February 2022)
- LDH HCBS Initial Application Checklist
- LDH HCBS Add or Delete a Service Module (module fees)
- LDH HCBS Provider Training Resources (three mandatory videos)
- LDH HCBS Rulemaking (MIHC Notice of Intent, March 2026)
- LDH Facility Need Review page (no Certificate of Need; provider types; $200 fee)
- LAC 48:I Chapter 125, Facility Need Review (LDH compilation, March 2025)
- LDH HCBS Facility Need Review Application (rev. 08/16/2023)
- LDH HSS Licensing Fees, Waiver Programs
- LDH HSS Fee Schedule, non waiver programs (home health, hospice)
- LDH Home Health Agency page (moratorium language at R.S. 40:2116.32(F)(1))
- LAC 48:I Chapter 91, home health agency licensing standards (LDH compilation, October 2022)
- LDH Hospice page (Facility Need Review, initial license documents)
- LAC 48:I Chapter 82, hospice licensing standards (LDH compilation, November 2023)
- LDH Direct Service Workers (DSW) Registry
- LAC 48:I Chapter 92, Direct Service Worker Registry (LDH compilation, October 2025)
- LDH DSW Rulemaking Activity (final rule effective October 22, 2025)
- LDH Criminal Background Check Information (Act 802 of 2026, effective October 1, 2026)
- LDH OAAS Long-Term Personal Care Services (LT-PCS)
- LDH OAAS Community Choices Waiver
- LDH OAAS home page (ADHC Waiver, CCW, LT-PCS, PACE)
- Louisiana Medicaid Services Manual 30.6, LT-PCS provider requirements (proposed revision posted 04/29/25)
- Louisiana State Plan Amendment 25-0001, CMS approval (LT-PCS wage floor and pass-through)
- LDH Medicaid For Providers (enrollment portal, Gainwell, Healthy Louisiana plans)
- LDH Electronic Visit Verification (LaSRS, waiver manuals)
- LDH Informational Bulletin 25-29, EVV for home health and EPSDT personal care
- LDH news, June 16, 2026: Medicaid provider oversight and program integrity
- LDH Medicaid two year program integrity strategy (intended HHA and DME moratoria)
- Louisiana geauxBIZ (Secretary of State, Department of Revenue, unemployment insurance)
- Louisiana Secretary of State, Start a Business
- 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 moratorium
- 42 CFR Part 484, home health Conditions of Participation (eCFR)
- 42 CFR Part 418, hospice care (eCFR)
- R.S. 40:2116.32 text via FindLaw (current as of January 1, 2023; legis.la.gov unreachable)
- Vitable, Louisiana licensure summary (secondary, pointer only)
- Newsline report on Act 802 and LAPS, October 13, 2026 (secondary, pointer only)
This guide is general information and reflects Louisiana requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Louisiana Department of Health, Louisiana Medicaid 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.