How to start a home care agency in New York

New York requires a Licensed Home Care Services Agency (LHCSA) license from New York State Department of Health (Bureau of Home Care Licensure and Certification), with approval by the Public Health and Health Planning Council (PHHPC) to operate a home care agency. Fee: $2,000. Processing time: No fixed time frame. Applications are reviewed in order of acknowledgment, then placed on a PHHPC agenda (PHHPC meets six times a year), followed by policy manual review and a pre-opening survey.

License required

Yes

License

Licensed Home Care Services Agency (LHCSA) license

Issuing agency

New York State Department of Health (Bureau of Home Care Licensure and Certification), with approval by the Public Health and Health Planning Council (PHHPC)

Fee

$2,000

Fee details

$2,000 non-refundable application fee for a new LHCSA, change of ownership, or expansion of a restricted license (PHL 3605(13) and 361-a(3)); check due within 30 days of submission.

Renewal

Every year · No renewal fee stated; licensed agencies must complete annual LHCSA registration (PHL 3605-b). Late registration costs $500 per month in default, and missing two annual periods triggers revocation proceedings.

Processing time

No fixed time frame. Applications are reviewed in order of acknowledgment, then placed on a PHHPC agenda (PHHPC meets six times a year), followed by policy manual review and a pre-opening survey.

Survey and inspection

Pre-opening survey by the DOH home care regional office before licensure.

Certificate of need

Required

Regulation

N.Y. Public Health Law Article 36 (3602, 3605, 3605-b); 10 NYCRR 765-1 (incl. 765-1.16 public need)

1. Check the county 'presumption of no need' report; if 5+ LHCSAs actively serve 25+ patients in a county, include a data-driven rebuttal
2. Work with a CPA to document working capital exceeding the first two months of projected expenses
3. Submit the application through NYSE-CON on the Health Commerce System
4. Mail the $2,000 fee within 30 days, referencing the NYSE-CON submission number
5. Department reviews need, character and competence, and financial feasibility, then places the application on a PHHPC agenda
6. After PHHPC contingent approval, submit a policy and procedures manual to the DOH home care regional office
7. Pass a pre-opening survey; DOH issues the license
8. Register the LHCSA every year

Program

New York State Medicaid (NYS Department of Health; eMedNY)

Enrollment portal

NYS Medicaid Provider Services Portal (PSP)

Fiscal agent

eMedNY (NYS DOH's Medicaid claims system). Revalidation notices come from ProviderEnrollment@acentra.com. The eMedNY pages we reviewed do not name the claims contractor.

Application fee

Under 42 CFR 455.460, certain provider types and enrollment transactions owe an application fee, and the PSP tells you when one is due. The fee is waived if the provider is enrolled in Medicare or another state's Medicaid/CHIP program, or already paid the fee to Medicare. A hardship waiver can be requested with the application; New York forwards it to CMS. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.

Fingerprinting

High-risk providers undergo a fingerprint-based background check for every owner holding 5% or more. ABA providers, 1915(c) HCBS waiver providers and Licensed Home Care Services Agencies are newly designated high risk. Results of a Medicare screening can count toward fingerprinting.

Site visit

Moderate- and high-risk providers get pre- and post-enrollment site visits. Results of a Medicare screening can count toward the site visit requirement.

Revalidation

Revalidation frequency depends on risk level: high-risk every 3 years, moderate every 4, limited every 5. Since May 2026 all revalidation is done in the PSP; paper processes have ended. Under an April 2026 CMS directive, every provider is being revalidated over 24 months. Phase 1 covers high-risk, DME and providers not revalidated since the COVID-19 emergency began. Phase 2 (early 2027) covers newly high-risk ABA, 1915(c) HCBS and LHCSA providers. The remaining providers follow through June 2028. Wait for an individual notice before revalidating. Missing the deadline ends enrollment.

Full New York Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need (CON)

Agency

New York State Department of Health, Division of Planning & Licensure; Public Health and Health Planning Council (PHHPC) acts on establishment and full-review applications

Services covered

• hospitals
• nursing homes
• diagnostic and treatment centers (including ambulatory surgery and dialysis)
• midwifery birth centers
• certified home health agencies
• licensed home care services agencies
• long term home health care programs
• hospice
• establishment / transfers of ownership or control
• construction, renovation and major medical equipment

New York certificate of need details →

Model

open/provider choice

Services in scope

• personal care
• home health

Alternate EVV allowed

Yes

Program

https://www.health.ny.gov/health_care/medicaid/redesign/evv/2022-jan_hhcs.htm

New York EVV requirements →

State minimum wage

$16.00 an hour

Effective

2026-01-01

Scheduled increases

No change on 2027-01-01: an off-ramp condition in the indexing law was met, so rates stay $17.00 (NYC, Long Island, Westchester) and $16.00 (rest of state).

Direct-care wage floor

Home care aide minimum wage: $19.65/hour in New York City, Long Island and Westchester and $18.65 elsewhere (from 2026-01-01), rising on 2027-01-01 to $20.00 and $19.00. Covers home health aides, personal care aides and similar in-home workers.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Personal care / in-home supportive care organizations — active organization NPIs (NPPES)

658 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

6,380,652 (as of Jun 1, 2026)

All New York Home care Medicaid rates, ranked →

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New York waivers and waiting lists →