Start a Home Care Agency in North Carolina
Starting a non-medical home care agency in North Carolina requires understanding the state’s licensing requirements, regulatory structure, and approval process before providing services.
North Carolina is considered a fully regulated state, meaning agencies must obtain a license before offering personal care or companion services.
This guide explains North Carolina’s requirements in clear, simple terms so you know what to expect.
1️⃣ Understand North Carolina Home Care Licensing Requirements
In North Carolina, non-medical home care agencies are licensed as:
Home Care Agencies
These agencies are regulated by the:
North Carolina Department of Health and Human Services (NCDHHS)
Division of Health Service Regulation (DHSR)
If your agency provides:
• personal care (bathing, dressing, grooming)
• assistance with activities of daily living (ADLs)
• companionship and supervision
you are required to obtain a license before operating.
2️⃣ Determine Your Service Category
North Carolina licenses agencies based on the services they provide.
Most non-medical agencies fall under:
In-Home Aide Services
These services include:
• assistance with bathing, grooming, and hygiene
• mobility and transfer assistance
• meal preparation
• light housekeeping
• supervision and companionship
3️⃣ Complete Business Setup Requirements
Before applying for a license, you must:
• register your business (LLC or Corporation)
• obtain a Federal EIN
• secure general liability insurance
• establish a physical business location
• designate an agency administrator
North Carolina requires that your agency structure be clearly defined prior to application.
4️⃣ Prepare Your Policy & Procedure Manual
A comprehensive policy and procedure manual is required as part of the application process.
Your manual must include:
• administrative policies and organizational structure
• client care procedures and service delivery
• caregiver hiring, training, and supervision
• infection control and safety procedures
• emergency preparedness
• quality assurance and recordkeeping systems
The manual must align with North Carolina regulations for licensed home care agencies.
5️⃣ Submit Your Application to DHSR
Once your documentation is complete, you will:
• submit your home care agency license application
• pay the required licensing fees
• provide all required supporting documentation
Applications must be complete and accurate to avoid delays in processing.
6️⃣ Prepare for the State Survey
North Carolina requires a pre-licensure survey (inspection) before approval.
During the survey, the state will review:
• your policy and procedure manual
• employee and caregiver documentation
• client records and forms
• administrative and compliance systems
You must demonstrate that your agency is fully prepared to operate in compliance with state regulations.
7️⃣ Receive Approval and Begin Operations
You may begin providing services only after:
• your license has been issued
• your agency passes the required survey
• all regulatory requirements have been met
Medicaid Pathway in North Carolina
Home care agencies in North Carolina may participate in Medicaid programs, but enrollment typically occurs after licensure and may require additional approvals and contracts.
North Carolina Home Care Startup Checklist
✔ Register your business entity
✔ Obtain EIN and insurance
✔ Designate an administrator
✔ Prepare policy & procedure manual
✔ Create client and caregiver documentation
✔ Submit license application
✔ Prepare for state survey
✔ Receive approval and begin services
Prepare Your Home Care Agency Documentation
Starting a home care agency in North Carolina requires detailed administrative preparation.
Wise Caregiving® provides home care startup template bundles designed to help organize the documentation commonly required for licensing and operation.
These templates can help you prepare:
• policy and procedure manuals
• client intake forms
• caregiver documentation
• operational forms