How to start a home care agency in New York and reach your first client faster
New York is one of the hardest states to open a home care agency. A LHCSA license is a Certificate of Need filing: the Department of Health tests whether your counties need another agency, whether you can fund it and whether your owners are fit to run it, then a state council votes. Policies, a survey, aide training, criminal history checks and MLTC plan contracts come after that, and Medicaid enrollment for new LHCSAs is paused in 2026. 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 New York rules10 NYCRR Parts 765 and 766 and the Department of Health LHCSA policy guidance
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what New York requires.
Personal care for MLTC members
- State license
- LHCSA license (Public Health Law 3605; 10 NYCRR Parts 765 and 766)
- Who you deal with
- NYSDOH, PHHPC, NY Medicaid (eMedNY Provider Services Portal) and each Managed Long Term Care (MLTC) plan
- Must haves
- LHCSA license, NY Medicaid enrollment once the 2026 enrollment moratorium for LHCSAs lifts, MLTC plan contracts, EVV, wage parity compliance downstate, home care minimum wage
- Realistic time to first client
- Longest nonmedical path: Medicaid enrollment for new LHCSAs is paused
Orientation for New York only. We confirm your exact path on the free call.
Three places new New York agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Choosing counties the state says need no new agency
Under 10 NYCRR 765-1.16 there is a presumption of no need in any county where five or more LHCSAs each actively serve at least 25 patients. The current Department of Health report lists 20 such counties, including all five New York City boroughs, Nassau, Suffolk and Westchester. You can still apply there, but each of those counties needs a rebuttal built on data, or the application may not be accepted.
What it costs: A $2,000 fee that is not refunded once the application is acknowledged, plus months of review, if the need case does not hold.
Working capital and paperwork that fail the financial review
The Department requires working capital greater than your projected expenses for the first two months, prepared with a Certified Public Accountant. A loan or grant counts only if it was awarded by the time you apply. Owners with health facilities in other states must also attach compliance reports from those states when they file.
What it costs: An application that is not accepted, or a disapproval with no refund, after months of preparation.
Licensed, but no way into Medicaid yet
Most Medicaid home care in New York runs through Managed Long Term Care plans, and every LHCSA in a plan network must be enrolled in NY Medicaid. In July 2026 the state put a moratorium of at least six months on new Medicaid enrollments for LHCSAs, and state law already caps how many LHCSAs each MLTC partial capitation plan may contract with.
What it costs: Months of payroll and rent with no Medicaid clients if your plan depends on MLTC referrals from day one.
What does a delay cost your agency?
Enter your own numbers. Nothing is stored or sent.
Home care vs home health vs hospice in New York
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 | Personal care: help with hygiene, dressing, feeding and household tasks essential to health, under an RN supervised plan of care | Skilled nursing, therapies and home health aide services; Medicare and Medicaid home health billing needs a CHHA | Palliative and supportive care for people who are terminally ill, and their families |
| State license | LHCSA license (Public Health Law 3605; 10 NYCRR Parts 765 and 766) | LHCSA for private pay and plan contracts; CHHA certificate of approval for Medicare (Public Health Law 3606 and 3608; 10 NYCRR Parts 760 and 763) | Hospice certificate of approval (Public Health Law Article 40; 10 NYCRR Parts 790 to 794) |
| Certificate of Need | Yes: LHCSA Certificate of Need with public need review (10 NYCRR 765-1.16) | Yes: CHHA public need review (10 NYCRR 760.5) and PHHPC approval | Yes: hospice public need review (10 NYCRR 790.16) and PHHPC approval |
| Main payers | Private pay, long term care insurance, MLTC and other Medicaid managed care plans | Medicare, Medicaid, MLTC plans, commercial insurance | Medicare hospice benefit, Medicaid, commercial insurance |
| Medicare | Not covered | CHHA only: accreditation or state survey, then Medicare enrollment | Accreditation or state survey, then Medicare enrollment |
| Key staff | Administrator, RN or NP to assess patients, write plans of care and supervise aides; personal care aides with 40 hours of approved training | Administrator, nursing leadership, therapists, home health aides with 75 hours of approved training | Administrator, medical director, RN leadership, interdisciplinary team |
| Startup capital | Working capital above two months of projected expenses, documented at filing | Higher: clinical payroll before Medicare or Medicaid revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Many months: need review, PHHPC, manual review, survey | Longest: need review, PHHPC, survey, enrollment | Longest: need review, PHHPC, survey, enrollment |
In New York the license, not the payer, sets the pace. Almost every hands on home care business needs a LHCSA, and the CHHA and hospice routes add their own need methodologies and PHHPC approval on top of Medicare certification. Many owners start with a LHCSA serving private pay families in counties with presumed need, build a caregiver team, then add counties or Medicaid once they qualify. Adding a county later is an administrative request, but the Department approves it only where fewer than five LHCSAs actively serve patients and normally only after 12 months of licensure, so pick your first counties carefully.
New York requirements at a glance
| Personal care license | Licensed Home Care Services Agency (LHCSA) license, approved for named counties, under Public Health Law Article 36 (section 3605) and 10 NYCRR Parts 765 and 766 |
|---|---|
| Licensing agency | New York State Department of Health (NYSDOH), Bureau of Home Care Licensure and Certification, with approval by the Public Health and Health Planning Council (PHHPC) |
| Public need | Rebuttable presumption of no need in counties where five or more LHCSAs each actively serve 25 or more patients; 20 such counties in the current report |
| Application | Certificate of Need application in NYSE-CON, $2,000 fee, up to five counties in one DOH region plus one contiguous county in another |
| Home health and hospice | Certified home health agency (CHHA) certificate of approval (Public Health Law 3606 and 3608) and hospice certificate of approval (Article 40), each with its own public need review |
| Aide training | Personal care aides at least 40 hours, home health aides at least 75 hours, through DOH approved programs; certificates issued through the Home Care Registry |
| Background checks | Fingerprint based Criminal History Record Check under 10 NYCRR Part 402 for LHCSAs, CHHAs and hospices |
| Medicaid route | NY Medicaid enrollment (Provider Services Portal, category of service 0264) and contracts with Managed Long Term Care (MLTC) plans; new LHCSA enrollment paused since July 27, 2026 |
| Electronic visit verification | Required for Medicaid personal care and home health services; New York uses a choice model and data goes to the NYS EVV Data Aggregator |
| Entity filing | New York Department of State, Division of Corporations; LLCs must publish notice in two newspapers within 120 days |
Summary of New York requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in New York
The order matters. Counties, working capital and the need case must be settled before you file, because the application is judged as submitted. Your policy manual goes in only after PHHPC approval, and caregiver screening should be ready before the survey.
Decide whether you need a LHCSA and which counties
Any hands on personal care, home health aide or nursing service needs a LHCSA. Then choose up to five counties in one DOH region, plus one contiguous county in another region, using the LHCSA County Presumption of No Need Report. Counties with presumed need are mostly upstate.
Decided on your free consultationForm the business with the Department of State
File your LLC or corporation, get an EIN, and register for withholding and unemployment insurance. An LLC must publish notice of its formation in two newspapers within 120 days and file a Certificate of Publication, or its authority to do business is suspended.
You do this; we give you the checklistDocument working capital with a CPA
Show working capital greater than your projected expenses for the first two months, with a budget the Department finds reasonable and projections that cover expenses over time. Only funding already awarded counts.
You do this; we specify what is requiredBuild the need rebuttal for any no need county
For each county with a presumption of no need, present data on the factors in 10 NYCRR 765-1.16(d): waiting lists, the capacity and quality of existing agencies, workforce, training resources, cultural competency and special populations.
We write this for youFile the LHCSA application in NYSE-CON
Submit the Certificate of Need application through the Health Commerce System with ownership, character and competence and financial schedules, plus compliance reports for any affiliated facilities in other states. Mail the $2,000 fee within 30 days. The Department reviews it, then PHHPC votes at one of its six meetings a year.
We prepare the applicationSubmit the policy and procedure manual after approval
After PHHPC contingent approval, send your manual to the Home Care regional office. It must meet 10 NYCRR Part 766 and the Department's LHCSA policy guidance; DOH reviews it with its published review tools.
We write this for youBuild the caregiver pipeline
Confirm identity, employment history and references, check the Home Care Registry, run Criminal History Record Checks, document health assessments, TB testing and immunizations, and track yearly in service hours for every aide.
We set up the system and trackerPass the survey and get licensed
Once the manual is accepted, the regional office schedules a survey before opening. After a successful survey the Bureau of Home Care Licensure and Certification issues the license. Register every year under Public Health Law 3605-b and file the annual statistical report.
We get you ready for the surveyEnroll in Medicaid and contract with MLTC plans
When the LHCSA enrollment moratorium ends, enroll in NY Medicaid through the Provider Services Portal, apply to MLTC plans in your counties, connect an EVV system to the state aggregator, and meet wage parity rules in New York City, Nassau, Suffolk and Westchester.
We prepare every plan's packet
Aide training, the Home Care Registry and criminal history checks
New York sets aide training through Department of Health approved training programs and records every certificate on the Home Care Registry under 10 NYCRR Part 403. LHCSA personnel rules are in 10 NYCRR 766.11, and criminal history checks are in 10 NYCRR Part 402.
- Personal care aides: At least 40 hours of training through an approved Personal Care Aide Training Program, with classroom, skills training and competency evaluation completed within 90 days of entering the program.
- Home health aides: At least 75 hours of training, including at least 59 hours of classroom and 16 hours of supervised practical training, completed within 60 days. A personal care aide with home care experience can upgrade with 35 more hours.
- Home Care Registry: Training programs issue certificates through the Registry, and agencies must enter required worker information in it. Check it before you retrain a new hire.
- Criminal History Record Check: Fingerprint based checks under Part 402 apply to LHCSAs, CHHAs and hospices. The agency names an authorized person, writes CHRC policies, and gives temporary employees direct observation while results are pending.
- Health and immunization records: A health assessment before patient care, TB screening and testing at hire with yearly assessments, rubella and measles immunity, and a flu vaccine or a mask during flu season.
- Yearly in service education: 12 hours for home health aides, six hours for personal care aides and 18 hours for advanced home health aides, plus a yearly performance review that includes an in home visit where applicable.
- Pay rules: Home care aides have their own minimum wage under Public Health Law 3614-f: $19.65 an hour in New York City, Nassau, Suffolk and Westchester and $18.65 elsewhere in 2026. Medicaid funded work in those downstate counties is also subject to wage parity under section 3614-c.
Six mistakes that slow New York agencies down
We look for every one of these in the first week of an engagement.
Running a companion business that drifts into personal care
- What it costs
- Once a worker helps a client bathe, dress, toilet or eat, the business is providing personal care without a license.
- How we prevent it
- Clear written service limits and caregiver training until your LHCSA license is issued.
Requesting no need counties without a data rebuttal
- What it costs
- The application may not be accepted, and once acknowledged the $2,000 fee is not refunded.
- How we prevent it
- We pick counties with you and build a rebuttal on the 765-1.16(d) factors for every county that needs one.
Counting a future loan as working capital
- What it costs
- The Department ignores prospective funding, so the financial review fails.
- How we prevent it
- Funding awarded and documented before filing, with CPA prepared schedules.
Planning to add counties right after opening
- What it costs
- The Department adds a county administratively only where fewer than five LHCSAs actively serve patients, and normally only after 12 months of licensure.
- How we prevent it
- Choose your first five counties with the long term plan in mind.
Counting on MLTC referrals in year one
- What it costs
- New LHCSA Medicaid enrollment has been paused since July 2026, and plans may contract with only a limited number of LHCSAs.
- How we prevent it
- A private pay launch plan, with MLTC packets ready for when enrollment reopens.
Missing the yearly LHCSA registration
- What it costs
- An unregistered agency may not operate or be paid, owes $500 for each month in default, and faces revocation after two missed years.
- How we prevent it
- A compliance calendar for registration, statistical reports, in service hours and wage certifications.
In a free 30 minute call we confirm your New York path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
New York 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.
- New York path and a dated launch plan
- Policy and procedure manual written to 10 NYCRR Parts 765 and 766 and the Department of Health LHCSA policy guidance
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
MLTC ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to MLTC requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for each MLTC plan serving your counties
- Survey and audit readiness
- New York city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to NYSDOH 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 New York 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 10 NYCRR Parts 765 and 766 and the Department of Health LHCSA policy guidance |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for each MLTC plan serving your counties 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 New York home care startup checklist
Every New York 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.
- Confirm you need a LHCSA and choose up to five counties in one DOH region
- Check each county against the LHCSA County Presumption of No Need Report
- Form your LLC or corporation with the Department of State
- Publish LLC notice in two newspapers within 120 days and file the Certificate of Publication
- Get an EIN and register for withholding and unemployment insurance
- 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 New York
- 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 New York cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, MLTC, 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 New York
| Item | Notes |
|---|---|
| LHCSA application fee | $2,000 under Public Health Law 3605(13), not refunded once the application is acknowledged. CHHA and hospice establishment applications also carry a $2,000 fee. |
| Working capital | More than your projected expenses for the first two months of operation, documented when you file |
| CPA and legal work | Financial schedules, organizational documents and need rebuttal support |
| Entity formation and LLC publication | Department of State filing fee, $50 Certificate of Publication fee, plus newspaper costs that vary by county |
| Aide training | Training program tuition per aide, or the cost of running your own DOH approved program |
| RN supervision | Salaried or contracted RN time for assessments, plans of care and aide supervision |
| Insurance | Workers' compensation, disability and paid family leave, general and professional liability, auto coverage |
| Medicaid enrollment | eMedNY lists a $750 application fee for LHCSA enrollment; check the current fee when enrollment reopens |
| EVV and scheduling software | Chosen and paid for by the agency; required for Medicaid personal care and home health visits |
| Accreditation (CHHA, hospice) | Accrediting organization application and survey fees |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in New York
Many months. The Department publishes no standard processing time: need and financial review, a PHHPC vote, manual review and a survey all come before your first client.
Longer still. After licensure you need NY Medicaid enrollment, which is paused for new LHCSAs for at least six months from July 27, 2026, and then plan contracts.
Longest: a separate need review and PHHPC approval, a certification survey and Medicare enrollment, which CMS paused for new agencies in May 2026.
New York demand is strongest where the state is most crowded with agencies. The Department's 2022 survey found five or more active LHCSAs in 20 counties, including all of New York City, Long Island, Westchester and the Albany, Buffalo, Rochester and Syracuse areas, so new applicants there must prove need with data. The 42 counties with presumed need are upstate and in the North Country, where long drives make reliable staffing your selling point. Families search by borough, county and town, often for a parent from out of state, so a complete Google Business Profile and county pages matter.
Frequently asked questions
Do I need a license to start a home care agency in New York?
Yes, if you provide nursing, home health aide or personal care services. Public Health Law section 3605 requires a Licensed Home Care Services Agency (LHCSA) license from the Department of Health. A business limited to companionship, housekeeping and chores is not named in that requirement, but it cannot provide hands on care.
How much does a New York LHCSA license cost?
The state application fee is $2,000, and it is not refunded once the Department acknowledges the application. The larger costs are working capital above two months of projected expenses, CPA and legal work, insurance and RN supervision.
Can I open a LHCSA in New York City or on Long Island?
You can apply, but those counties carry a presumption of no need because five or more LHCSAs already actively serve 25 or more patients there. You must include a data based rebuttal for each such county. Buying an existing LHCSA that actively serves at least 25 patients avoids the need review, though the change of ownership still goes to PHHPC.
How long does it take to get a LHCSA license?
The Department publishes no standard timeframe. Applications are reviewed in the order acknowledged, PHHPC meets six times a year, and the manual review and survey come after approval. Complete applications and quick responses to questions shorten it.
Does New York require a Certificate of Need for home health or hospice?
Yes. A certified home health agency needs PHHPC approval with a public need finding under 10 NYCRR 760.5, and a hospice needs one under 10 NYCRR 790.16. The LHCSA application is also a Certificate of Need filing.
Can a new LHCSA serve Medicaid clients?
Only after it enrolls in NY Medicaid and contracts with MLTC or other managed care plans. Since July 27, 2026 the state has paused new Medicaid enrollments for LHCSAs for at least six months, and plans may contract with only a limited number of LHCSAs under Public Health Law 4403-f.
What training do New York home care aides need?
Personal care aides need at least 40 hours and home health aides at least 75 hours through a DOH approved program, recorded on the Home Care Registry. Each year home health aides need 12 hours of in service education and personal care aides six hours.
Can a new home health agency or hospice enroll in Medicare right now?
CMS put a nationwide six month moratorium on new Medicare enrollment of home health agencies and hospices starting May 13, 2026. It can be extended in six month steps, so check its status before you plan Medicare revenue. Applications received before that date were not affected.
How much does New York home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay LHCSA, Medicaid or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges, and no one can guarantee a state or health plan decision.
Do you only work in New York?
No. Lunaria works with owners in all 50 states and DC, so you can expand into a second state with the same team. You own 100% of your agency, with no franchise fees or royalties.
Sources checked for this guide (42)
- NYSDOH Licensed Home Care Services Agencies page (revised January 2026)
- NYSDOH FAQ: LHCSA Application Requirements (fee, NYSE-CON, PHHPC, counties, working capital, change of ownership)
- NYSDOH DAL 22-14, LHCSA application changes (need factors, financial feasibility)
- NYSDOH LHCSA County Presumption of No Need Report (2022 survey)
- NYSDOH DAL DHCBS 25-03, LHCSA administrative licensure amendments (August 8, 2025)
- NYSDOH DAL DHCBS 26-02 and revised amendment procedure (January 13, 2026)
- NYSDOH Home Care Information for Health Care Providers (training programs, Home Care Registry)
- NYSDOH Guide to the Operation of a Personal Care Aide Training Program (May 2022)
- NYSDOH Guide to the Operation of a Home Health Aide Training Program (August 2021)
- NYSDOH MLTC LHCSA Contract Limitation Guidance
- NYSDOH Managed Long Term Care page
- NYSDOH CDPAP page (statewide fiscal intermediary, Minimum Needs Requirements from September 1, 2025)
- NYSDOH NYS Medicaid Provider Revalidation and enrollment moratoriums (revised November 2026)
- NYSDOH Medicaid BPE office hours slides (moratorium effective July 27, 2026, minimum six months)
- NYSDOH Medicaid provider revalidation webinar slides (July 30 and August 6, 2026)
- eMedNY enrollment, Licensed Home Care Service Agency (LHCSA/PCA), category of service 0264
- NYSDOH NY Medicaid Electronic Visit Verification Program
- NYSDOH Certificate of Need page
- Public Health Law 3602, definitions (NY Senate)
- Public Health Law 3605, LHCSA licensure (NY Senate)
- Public Health Law 3605-B, LHCSA annual registration (NY Senate)
- Public Health Law 3606, CHHA establishment (NY Senate)
- Public Health Law 3614-C, home care worker wage parity (NY Senate)
- Public Health Law 3614-F, home care worker minimum wage (NY Senate)
- Public Health Law 4004, hospice establishment (NY Senate)
- Public Health Law 4403-F, MLTC plans and LHCSA contract limits (NY Senate)
- Senate Bill S4400 (2025 to 2026), proposed LHCSA moratorium from April 1, 2027, in committee
- 10 NYCRR 766.11, LHCSA personnel (NYCRR)
- 10 NYCRR Part 402, Criminal History Record Check (NYCRR)
- 10 NYCRR 760.5, CHHA public need (NYCRR)
- 10 NYCRR 790.16, hospice public need (NYCRR)
- 10 NYCRR Part 794, hospice organization and administration (NYCRR)
- NY Department of State, Certificate of Publication for Domestic LLC
- NYS Workers' Compensation Board, employer coverage
- New York Paid Sick Leave (ny.gov)
- Federal Register 2026-09717, nationwide moratorium on Medicare enrollment of HHAs (effective May 13, 2026)
- Federal Register 2026-09718, nationwide moratorium on Medicare enrollment of hospices
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- 10 NYCRR Part 763, CHHA minimum standards (Cornell LII)
- Holland & Knight, New York Freezes Medicaid Enrollment, July 31, 2026 (secondary, pointer only)
- Barclay Damon alert on the NY Medicaid enrollment moratorium (secondary, pointer only)
This guide is general information and reflects New York requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the New York State Department of Health, the Public Health and Health Planning Council, New York 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.