How to start a home care agency in North Carolina and reach your first client faster
North Carolina licenses every home care agency, even one that only offers companionship, so you cannot serve a single client until DHSR approves your packet. First time owners need DHSR approved training, your policies and personnel files are reviewed before a license is issued, and hands on care needs an RN behind it. NC Medicaid then adds NCTracks enrollment, a site visit, health plan contracts and electronic visit verification. We put all of it in the right order for you.
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- 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 North Carolina rules10A NCAC 13J and NC Medicaid Clinical Coverage Policies 3L and 3K-2
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what North Carolina requires.
Home care for NC Medicaid PCS and CAP/DA members
- State license
- DHSR home care license with In-Home Aide Services (10A NCAC 13J), in every county you serve
- Who you deal with
- DHSR, NC Medicaid (Division of Health Benefits), NCTracks, NC LIFTSS, CAP/DA case management entities and the health plans in your region
- Must haves
- DHSR license, NCTracks enrollment with site visit and owner fingerprinting, PCS Provider Interface account, health plan contracts, CAP/DA provider enrollment through e-CAP, RN supervisor, EVV
- Realistic time to first client
- Several months after licensure
Orientation for North Carolina only. We confirm your exact path on the free call.
Three places new North Carolina agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
No clients until DHSR says yes
North Carolina has no unlicensed option: G.S. 131E-138 says no one may operate a home care agency without a license, and companion, sitter and respite care count. DHSR reviews your application, then asks for your policies and personnel records and reviews those too. DHSR says most applicants are not approved because they do not follow its checklist and the licensure rules.
What it costs: Months of rent and salaries with no billable clients while a packet goes back and forth.
Hands on care needs an RN and a map
Once you offer In-Home Aide Services, an RN must assess each client at home, write the plan of care, be available whenever aides are working and visit every client every 90 days. An LPN cannot do these visits. Aide services are also limited to your county, the counties next to it, or 90 minutes' drive from your licensed site.
What it costs: A license application that stalls, or clients you cannot accept, because the RN or the service area was not planned.
NC Medicaid is several systems, not one
NCTracks enrollment comes with a site visit and fingerprinting for owners. PCS referrals and service plans run through the NC LIFTSS Provider Interface. Many members are in Standard or Tailored Plans you contract with separately, while CAP/DA participants and people with both Medicare and Medicaid stay in NC Medicaid Direct, and each route has its own EVV system.
What it costs: Months with staff and no Medicaid clients if enrollment and plan contracts start after the license arrives.
What does a delay cost your agency?
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Home care vs home health vs hospice in North Carolina
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 | Companion, sitter and respite care, homemaker tasks, and hands on personal care through In-Home Aide Services | Nursing, physical, occupational and speech therapy, medical social services, home health aide services | Palliative and supportive care for people who are terminally ill, and their families, with bereavement support |
| State license | DHSR home care license, per site (G.S. 131E-138; 10A NCAC 13J) | DHSR home care license with clinical services; CON before Medicare certification | DHSR hospice license (G.S. 131E-200 to 131E-207; 10A NCAC 13K), after a CON |
| Certificate of Need | No | Required for a new Medicare certified agency or office; the 2026 plan and the proposed 2027 plan show no need anywhere | Required for any new hospice or hospice office, only in counties where the plan shows need |
| Main payers | Private pay, long term care insurance, NC Medicaid PCS and CAP/DA, health plans | Medicare and NC Medicaid home health (certified agencies only), private duty nursing, commercial insurance | Medicare hospice benefit, NC Medicaid (Medicare certified hospices only), commercial insurance |
| Medicare | Not covered | CON, licensure, survey, then Medicare enrollment; new enrollment paused since May 13, 2026 | CON, licensure, survey, then Medicare enrollment; new enrollment paused since May 13, 2026 |
| Key staff | Qualified agency director; RN available whenever In-Home Aide Services are provided | Agency director, RN supervising nursing and aides, licensed therapists, staff meeting 42 CFR 484.115 | Agency director, physician medical director, RN supervised nursing 24 hours a day, social worker, spiritual counselor, volunteer coordinator |
| Startup capital | Lowest, but you carry costs through licensure | Higher: clinical payroll before revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Months for the license, then more for Medicaid | Longest: CON need, licensure, survey, enrollment | Longest: CON need, licensure, survey, enrollment |
Most North Carolina owners start with a licensed home care agency, often with companion, sitter and respite care plus In-Home Aide Services, because it needs no Certificate of Need. A licensed agency can also add nursing for private pay clients. Medicare home health and hospice depend on the State Medical Facilities Plan showing need in your county, so we check the current plan with you before you spend on clinical leadership.
North Carolina requirements at a glance
| Home care license | Required for every home care agency, including In-Home Companion, Sitter and Respite and homemaker services (G.S. 131E-136 and 131E-138). Each site is licensed separately. |
|---|---|
| Licensing agency and rules | NCDHHS Division of Health Service Regulation (DHSR), Acute and Home Care Licensure and Certification Section; G.S. 131E-135 through 131E-142 and 10A NCAC 13J |
| Owner training | DHSR approved home care provider training before a license is issued, unless you can show you have owned or operated a home care agency (10A NCAC 13J .0903) |
| License fee and renewal | $510 initial application, $510 annual renewal, $510 change of ownership. Every license expires at midnight on December 31. |
| Certificate of Need | None for a licensed home care agency. Required for a new Medicare certified home health agency or office and for any new hospice, only where the State Medical Facilities Plan shows need |
| Medicaid | NC Medicaid (NCDHHS Division of Health Benefits), enrollment through NCTracks. Personal Care Services (Clinical Coverage Policy 3L) and the CAP/DA waiver, through Standard Plans, Tailored Plans or NC Medicaid Direct |
| Caregiver competency | Every task demonstrated to the supervising health care practitioner; Nurse Aide Registry listing for aides giving extensive assistance; RN supervisory visit every 90 days |
| Background screening | State or national criminal history check requested within five business days of a conditional job offer (G.S. 131E-265); no hires with a substantiated finding on the Health Care Personnel Registry |
| Electronic visit verification | Required for PCS, home health, CAP/DA, CAP/C, Innovations and TBI waiver visits. Sandata for NC Medicaid Direct, HHAeXchange for most health plans, CareBridge for Healthy Blue |
| Entity filing | North Carolina Department of the Secretary of State, Business Registration Division |
Summary of North Carolina requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in North Carolina
The order matters. Owner training, policies and personnel files all have to be ready before DHSR can approve you, and NCTracks enrollment and health plan contracts should be prepared while the license is in review, not after.
Form the business with the NC Secretary of State
File your LLC or corporation, get an EIN, register with the NC Department of Revenue for withholding and with the Division of Employment Security for unemployment insurance, and check local business rules for your office.
You do this; we give you the checklistChoose your services, counties and payers
Companion, sitter and respite only, or In-Home Aide Services too, which needs an RN. Pick an office location with the 90 minute rule in mind, and decide between private pay, NC Medicaid PCS, CAP/DA or all of them. Use the path finder above.
Decided on your free consultationComplete DHSR approved owner training
Unless you can show DHSR you have owned or operated a home care agency, a license cannot be issued until you finish training from a DHSR approved trainer. DHSR does not run the training itself; it publishes the list of approved trainers.
You do this; we specify what is requiredName your agency director and RN, and insure the agency
The agency director must meet 10A NCAC 13J .1001 (a lighter standard applies to companion, sitter and respite only agencies). Line up an RN for assessments, plans of care and 90 day visits. Arrange general and professional liability, auto coverage, and workers' compensation, which North Carolina requires once you have three employees.
You do this; we specify what is requiredWrite policies to 10A NCAC 13J
Scope of services, admission and discharge, supervision, plan of care, emergencies, service records, personnel qualifications, organizational chart, program evaluation, confidentiality, client rights, infection control and the geographic area for each service. DHSR reviews a sample of these before licensing.
We write this for youBuild compliant personnel files
For each employee: application, job description, reference checks, criminal history check requested within five business days of the conditional offer, Health Care Personnel Registry check, TB screening, Hepatitis B record, bloodborne pathogen training and documented competency for every assigned task.
We set up the system and trackerApply to DHSR
Mail the licensure application with the $510 fee (check or money order) and proof of training to DHSR. When DHSR asks, send your policies, procedures and personnel records for the initial review. Everything must be finished within 12 months of DHSR receiving your application.
We prepare the applicationEnroll in NC Medicaid and contract with health plans
Enroll through NCTracks, where home care agencies fall in the high risk group: expect a site visit, fingerprinting of owners and the federal application fee. Register in the NC LIFTSS Provider Interface for PCS referrals, complete the CAP/DA provider steps in e-CAP, and contract with the Standard and Tailored Plans in your region.
We prepare every plan's packetSet up electronic visit verification
Choose how you will capture visits before your first Medicaid client: Sandata for NC Medicaid Direct, HHAeXchange for most Standard and Tailored Plans, CareBridge for Healthy Blue, or an alternate EVV system registered with the state.
We walk you through setup
Caregiver competency, supervision and background checks
North Carolina does not set a fixed number of training hours for home care aides. Instead, 10A NCAC 13J requires every caregiver to demonstrate each assigned task to the supervising health care practitioner, and NC Medicaid adds training topics for PCS aides. Background and registry checks start at the conditional job offer.
- Competency by demonstration: Caregivers may only be assigned tasks they have shown they can do, and the agency keeps the documentation (10A NCAC 13J .1110).
- Core personal care skills: For In-Home Aides not on the Nurse Aide Registry, an RN verifies mobility, bathing, toileting, dressing, eating and continence care (10A NCAC 13J .1003).
- Nurse Aide Registry: Aides giving extensive assistance with daily activities must be listed on the Nurse Aide Registry; limited assistance does not require it (10A NCAC 13J .1107).
- RN supervision: An RN visits each client's home every 90 days and is available whenever aides are working. An LPN may not do assessments or supervisory visits for In-Home Aide Services.
- PCS aide training: NC Medicaid requires PCS aides to be 18 or older or high school graduates, trained in client rights, privacy, personal care skills, incident reporting, abuse and neglect, and infection control, with dementia training for members approved for extra hours.
- Criminal history checks: Request a state or national check within five business days of a conditional offer (G.S. 131E-265). NC Medicaid will not pay for PCS by anyone with the convictions listed in Policy 3L.
- Health Care Personnel Registry: Do not hire anyone with a substantiated finding, and report abuse, neglect, misappropriation, diversion and fraud to the registry.
- Health screening: Baseline TB test for hands on staff, Hepatitis B vaccination or declination, and bloodborne pathogen training every year. In service education hours are set by your own policy.
Six mistakes that slow North Carolina agencies down
We look for every one of these in the first week of an engagement.
Starting companion or sitter care without a license
- What it costs
- Operating without a license under G.S. 131E-138, which can follow you into the licensing review and Medicaid enrollment.
- How we prevent it
- Your first call ends with your exact North Carolina path and the order to do it in.
Applying before owner training is done
- What it costs
- DHSR cannot issue the license, and the 12 month window keeps running.
- How we prevent it
- We book approved training at the start so the certificate goes in with the application.
Letting an LPN do the supervisory visits
- What it costs
- A deficiency on every In-Home Aide client file, since the rules require an RN.
- How we prevent it
- A tracker that schedules RN assessments and 90 day visits for every client.
Using the PCS service plan as your plan of care
- What it costs
- DHSR does not accept it. Your RN still has to visit and write your own plan of care.
- How we prevent it
- We write plan of care forms and procedures to 10A NCAC 13J and Policy 3L.
Taking aide clients outside your service area
- What it costs
- Services beyond adjacent counties or 90 minutes from your site break the rule and may need a second licensed site.
- How we prevent it
- We map your service area before you choose an office.
Planning Medicare home health or hospice without checking need
- What it costs
- No CON is possible where the State Medical Facilities Plan shows no need, and new Medicare enrollment has been paused since May 2026.
- How we prevent it
- We check the current plan and the CMS moratorium on your first call.
In a free 30 minute call we confirm your North Carolina path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
North Carolina 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.
- North Carolina path and a dated launch plan
- Policy and procedure manual written to 10A NCAC 13J and NC Medicaid Clinical Coverage Policies 3L and 3K-2
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
NC Medicaid PCS ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to NC Medicaid PCS requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for NC Medicaid through NCTracks and each health plan in your region
- Survey and audit readiness
- North Carolina city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to DHSR 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 North Carolina 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 10A NCAC 13J and NC Medicaid Clinical Coverage Policies 3L and 3K-2 |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for NC Medicaid through NCTracks and each health 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 North Carolina home care startup checklist
Every North Carolina 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 services, counties and payer mix
- Form your LLC or corporation with the NC Secretary of State
- Get an EIN and register for NC withholding and unemployment insurance
- Buy liability and auto coverage, and workers' compensation from your third employee
- Complete DHSR approved home care provider training
- 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 North Carolina
- 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 North Carolina cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, NC Medicaid 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 North Carolina
| Item | Notes |
|---|---|
| DHSR home care license | $510 initial application, $510 annual renewal and $510 change of ownership, all nonrefundable (DHSR fee schedule) |
| DHSR hospice license | $450 initial application, $400 annual renewal, after a Certificate of Need |
| Owner training | Set by each DHSR approved trainer |
| Entity formation | NC Secretary of State filing fee for your entity type |
| Criminal history checks | Per applicant, through the Department of Public Safety or a private vendor |
| NC Medicaid enrollment | Federal application fee for high risk providers ($750 in 2026) plus the state enrollment fee and fingerprinting costs |
| RN time | Salaried or contracted RN for assessments, plans of care, availability and 90 day visits |
| Insurance | Workers' compensation, general and professional liability, auto coverage |
| EVV and scheduling software | State and plan EVV options are free; an alternate system and scheduling software cost extra |
| Operating reserve | Covers payroll, rent and insurance while the license, NCTracks enrollment and plan contracts are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in North Carolina
Months: DHSR does not set a processing time, and nothing can be billed until the license is issued. All requirements must be met within 12 months of your application.
Several more months after licensure: NCTracks enrollment with a site visit, then health plan contracts, the PCS Provider Interface and EVV.
Longest: a CON is only possible where the State Medical Facilities Plan shows need, followed by licensure, survey and Medicare enrollment, which CMS has paused for new agencies since May 2026.
Demand follows North Carolina's metro areas and its retirement communities: families search for care in Charlotte, Raleigh, Durham, Greensboro, Winston-Salem, Fayetteville, Wilmington and Asheville, often from out of state. The 90 minute rule means one licensed site can only serve aide clients near it, so rural and mountain counties are reached by choosing the office location carefully or adding sites. Many older Medicaid members also have Medicare and stay in NC Medicaid Direct, so agencies that serve both Medicaid Direct and the health plans reach more referrals. A Google Business Profile and county service area pages help families find you.
Frequently asked questions
Do I need a license to start a nonmedical home care agency in North Carolina?
Yes. In-home companion, sitter, respite and homemaker services are home care services under G.S. 131E-136, and G.S. 131E-138 says no one may operate a home care agency without a license. DHSR issues a separate license for each site.
How much does a North Carolina home care license cost?
DHSR lists a $510 nonrefundable fee for an initial application, $510 for a change of ownership and $510 for each annual renewal. Budget separately for owner training, staff, insurance and software.
What training does the owner need?
If you cannot show DHSR that you have owned or operated a home care agency, DHSR will not issue a license until you complete training it has approved, covering the licensure requirements, the process and the rules (10A NCAC 13J .0903). DHSR publishes a list of approved trainers.
How long does it take to get licensed?
DHSR does not set a fixed time. It depends on how complete your application is, whether more information is needed and staff workload. You must finish all requirements within 12 months of DHSR receiving your application and fee.
Do I need a Certificate of Need?
Not for a licensed home care agency. A CON is required for a new Medicare certified home health agency or office and for any new hospice, and it can only be approved where the State Medical Facilities Plan shows need. The 2026 plan shows no home health need anywhere, and hospice need only in Haywood, Johnston and McDowell counties.
Can I open a Medicare home health agency or hospice in North Carolina now?
It is difficult. Besides the CON limits, CMS paused new Medicare enrollment of home health agencies and hospices nationwide on May 13, 2026, for six months, with possible extensions. Check the current CMS status before you invest.
How do North Carolina home care agencies get Medicaid clients?
Get licensed for In-Home Aide Services, enroll through NCTracks, register in the NC LIFTSS Provider Interface for Personal Care Services referrals, contract with the Standard and Tailored Plans in your region, and complete the CAP/DA provider steps. Members choose a licensed agency after their independent assessment.
When does the license need to be renewed?
Every home care license expires at midnight on December 31. A renewal received after January 1 takes effect only on the date received, and an expired license can affect your NC Medicaid enrollment. DHSR inspects licensed agencies every three years without notice.
Is a franchise a better way to start a home care agency in North Carolina?
A franchise gives you a brand and playbook in exchange for fees and ongoing royalties, and you still need your own DHSR license. Starting independently with Lunaria costs one fixed price, and you own 100% of your agency with no franchise fees or royalties.
How much does North Carolina home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, NC Medicaid or clinical. You receive the price in writing after a free 30 minute consultation. There are no hourly charges, and we work in all 50 states and DC.
Sources checked for this guide (34)
- DHSR Home Care Frequently Asked Questions (revised 5/30/25)
- DHSR Requirements for Establishing a Home Care Agency
- DHSR Requirements for Establishing a Home Health Agency
- DHSR Requirements for Establishing a Hospice Agency
- DHSR Home Care Provider Training (approved trainers)
- DHSR Acute and Home Care fee schedules
- 10A NCAC 13J, Licensure of Home Care Agencies (OAH)
- 10A NCAC 13K, Hospice Licensing Rules (OAH)
- North Carolina 2026 State Medical Facilities Plan (CON categories, home health and hospice need)
- Proposed 2027 State Medical Facilities Plan
- NC Medicaid Clinical Coverage Policy 3L, PCS in In-Home Settings (amended January 1, 2026)
- NC Medicaid Personal Care Services page
- NC Medicaid CAP/DA provider page
- NC Medicaid Clinical Coverage Policy 3K-2, CAP/DA (amended July 1, 2021)
- NC Medicaid Clinical Coverage Policy 3A, Home Health Services
- NC Medicaid Clinical Coverage Policy 3D, Hospice Services
- NC Medicaid Clinical Coverage Policy 3G-1, Private Duty Nursing
- NC Medicaid Electronic Visit Verification
- NC Medicaid LTSS Provider Enrollment and Taxonomy Updates webinar, April 15, 2026 (risk levels, site visits, fees)
- NC Medicaid Provider Enrollment
- NC Medicaid health plans and programs (NC Medicaid Direct groups, WellCare merger)
- NC Medicaid: WellCare of North Carolina and Carolina Complete Health merge April 1, 2026
- NC Medicaid Tailored Plans
- NC Medicaid October 1, 2025 rate reduction questions and answers (rates restored December 10, 2025)
- CMS Provider Enrollment Moratoria (HHAs and hospices, May 13, 2026)
- Federal Register 2026-09717, moratorium on Medicare enrollment of home health agencies
- Federal Register 2026-09718, moratorium on Medicare enrollment of hospices
- NC Industrial Commission FAQ (workers' compensation, three or more employees)
- NC Secretary of State, Business Registration Division
- NC Department of Revenue, withholding tax
- NC Division of Employment Security, employers
- 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 North Carolina requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the NC Division of Health Service Regulation, NC 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.