Last reviewed: October 2026
TL;DR — Key Takeaways
- A business that arranges nonmedical home care by registered aides needs a home care organization license from the Department of Social Services before it starts.
- Each aide must be listed on the home care aide registry, and cleared, before the business places that aide with a client.
- Skilled nursing at home, meaning services by a registered nurse or licensed vocational nurse, needs a home health agency license from the Department of Public Health.
- The Department of Public Health is not issuing new home health agency licenses or branch offices during a moratorium, except on a written finding of unmet need.
- A home care organization license does not cover skilled nursing, and its aides may not help with medication that needs a licensed professional.
- A home care organization license is renewed every two years; a home health agency license expires 12 months after it is issued.
- Operating without the license brings a daily civil penalty for unlicensed home care and misdemeanor exposure for unlicensed home health.
A California business that arranges nonmedical help in clients’ homes, such as bathing, dressing, meals and companionship, needs a home care organization license from the State Department of Social Services before it starts. Each caregiver it places must be on the home care aide registry first. A business that provides or arranges skilled nursing in the home needs a home health agency license from the State Department of Public Health. New home health licenses are on hold under a moratorium, with an exception only on a written finding of unmet need in the area.
Which license fits what your business does
California splits care in the home between two licenses issued by two departments. The one you need depends on the kind of service your business provides or arranges, so start by describing each service plainly.
California’s Home Care Services Consumer Protection Act governs nonmedical care. Home care services are nonmedical services and assistance that a registered home care aide gives a client who cannot perform them because of advanced age or a physical or mental disability. In the home care law, the department is the State Department of Social Services. Subject to the Act’s listed exclusions, no individual or entity may arrange home care services by a registered home care aide for a client in California before it obtains a home care organization license.
The license is not the only gate. An affiliated home care aide must be listed on the home care aide registry before giving home care services to a client. A caregiver whose listing is still pending is not yet ready to go to a client’s home.
Skilled care follows a different law. Skilled nursing services are services provided by a registered nurse or a licensed vocational nurse. A home health agency is an organization that provides or arranges skilled nursing services for people in their temporary or permanent residence. Unless an exception in the statute applies, no private or public organization may provide, or arrange for, skilled nursing services in the home in California without first obtaining a home health agency license. That license comes from the State Department of Public Health.
If your plan mixes the two, look at each service line on its own. Help with bathing and meals is a home care service when a registered home care aide gives it to a client who, because of advanced age or physical or mental disability, cannot do these things. A visit by a registered nurse or licensed vocational nurse falls under the home health law.
If you want to know how this applies to your own situation, call Bay Legal at (650) 668-8000 in Northern California or (213) 668-8000 in Southern California, or reach us through baylegal.com/contact-us.
Can a new home health agency get licensed now?
For a business planning skilled nursing in the home, the first question today is whether a license is available at all. California has paused new home health licensing.
Except under the exception described below, the State Department of Public Health may not issue a new home health agency license or add a branch office to an existing license. That bar runs from the effective date of the act that added it until no later than 90 days after the department’s revised home health regulations take effect. This moratorium has applied since June 29, 2026.
In the department’s guidance, the moratorium reaches four kinds of applications: initial licensure, a new branch office, a change of service area, and a move outside the agency’s approved service area. An existing agency that wants to grow into new territory is inside the moratorium too, not only a first-time applicant.
The door is narrow but open. The department may grant an exception to the moratorium on a written finding that the applicant has shown an unmet need for home health services where it proposes to operate. That showing is based on the concentration of all existing home health services in that area.
The department’s guidance sets the order of steps. The guidance says a new applicant should begin with an exception request: a written justification and supporting documents showing need based on geographic concentration. Only if the Centralized Applications Branch finds a need may the applicant submit an application.
Two practical points follow. A complete application, on its own, does not produce a license while the moratorium lasts. And because the end point is tied to the revised regulations rather than to a calendar date, a business cannot plan around a known reopening day.
What the home care law covers, and what it leaves out
The definition of home care is broad, but it has a ceiling. Home care services let the client stay at home. They include help with bathing, dressing, feeding, grooming, moving about, toileting, medication the client takes on their own, housekeeping, meals, laundry, transportation, errands and companionship, among other things.
Medication is where the ceiling shows. A registered home care aide may not help with self-administered medication that would otherwise need administration or oversight by a licensed health care professional. A home care organization license does not authorize skilled nursing either; that work needs the home health agency license described above.
The Act also defines who holds the license. A home care organization is an individual 18 or older, or an entity of any form, that arranges home care services by an affiliated home care aide for a client and is licensed under the Act. Each home care organization is licensed separately, so a second organization needs its own license.
Some providers fall outside the definition. A home care organization does not include:
- a licensed home health agency;
- a licensed hospice;
- a licensed health facility.
The statute lists other exclusions too. Hospice has its own license, which this post does not cover.
Your business name is regulated as well. Unless it is licensed, and subject to limited exceptions in the statute, a person or organization may not use the terms “home care organization,” “home care” or “in-home care” in its name. Check the name on your entity filings, signage and website before launch rather than after.
Choosing the entity that will hold the license is a separate decision from the license itself. Our page on forming a professional nursing corporation in California covers one entity form. Buying an existing practice raises its own questions, covered on our page for healthcare clinic attorney services in California.
Getting and keeping a home care organization license
Within the Department of Social Services, the Home Care Services Branch licenses home care organizations, processes applications, handles complaints, makes unannounced visits, and runs the aide application process and the Home Care Aide Registry.
Among the statute’s licensing requirements:
- An applicant files a complete home care organization application with the required fees.
- The applicant must pass a background examination and complete a department orientation.
The department’s instructions are to mail the completed application with the application fees to the Home Care Services Branch. This post does not list the fees. A home care organization license must be renewed every two years, so the renewal belongs on your compliance calendar from the first day.
The license also carries standing duties. A licensee keeps a workers’ compensation policy covering its aides and an employee dishonesty bond, including third-party coverage, of at least $10,000. It also keeps general and professional liability insurance of at least $1,000,000 per occurrence and $3,000,000 in the aggregate. Your insurance broker or carrier prices and places these policies; the minimums come from the statute.
A licensee posts its license and business hours where clients and aides can see them. It also reports suspected or known elder, dependent adult and child abuse as the law requires.
Falling short puts the license itself at risk. The department may deny, suspend or revoke a home care organization license for a violation of the Act or its rules, among other grounds.
If you are getting ready for this step, we can help you check the papers and the timing first. Call (650) 668-8000 in Northern California or (213) 668-8000 in Southern California, or use baylegal.com/contact-us.
Registered home care aides: who can go into a client’s home
The Act ties every placement to the registry. An affiliated home care aide is an individual 18 or older employed by a home care organization to give home care services and listed on the home care aide registry.
The organization carries the duty to check. A home care organization must make sure each affiliated aide is cleared on the registry before placing the aide in direct contact with clients. That makes the registry a scheduling gate as well as a hiring step: a new aide’s first client visit waits for the clearance.
Two further duties run through each aide’s employment. The organization requires its aides to show they are free of active tuberculosis disease. It also notifies the department immediately when it no longer employs someone as an affiliated aide.
These duties are easy to lose in a busy intake process. Tie each one to a record in your files: the registry clearance before the first visit, the tuberculosis showing, and the notice to the department when an aide leaves.
Home health agencies: what licensing involves
Where the department grants an exception to the moratorium, or once the moratorium ends, home health licensing has its own steps. The moratorium lasts until no later than 90 days after the department’s revised home health regulations take effect.
The persons who must submit an application to the State Department of Public Health and fingerprints for a criminal record review include the owners of a private home health agency who are individuals. Where a corporation, partnership or association owns the agency, each person with a 5 percent or greater interest in that owner does so. That reaches each person at the 5 percent level, not only owners who are individuals.
For an agency that has not been licensed before, the department may issue only a provisional license at first. That provisional license ends six months after it is issued. Apart from any provisional license, a home health agency license expires 12 months after it is issued. The renewal, with its fee, is filed with the department at least 30 days before expiration. A missed renewal results in the license expiring.
A home health agency must have an administrator, an administrator designee, a director of patient care services and a designee for that director. Plan for all four roles in your staffing model.
The name rule has a home health version. Unless it is licensed, an organization may not use “home health agency,” “home health” or “in-home health,” or similar spellings and combinations, in its name.
A hospice is not required to hold a home health agency license under the section that requires one.
Operating without the license
The two laws enforce in different ways, and both are serious.
When the Department of Social Services finds unlicensed home care services, it sends a written notice of noncompliance and assesses a civil penalty of $900 a day for each calendar day of each violation. On that notice, the Attorney General, a district attorney or a city attorney may issue a cease and desist order that lasts until the business is licensed. If the business does not comply within 20 calendar days, that office may apply for an injunction. Because the penalty accrues by the calendar day, delay in getting licensed carries its own cost.
On the home health side, a violation of the home health agency law or its rules is a misdemeanor. On conviction, it is punished by a fine of up to $1,000, up to 180 days in county jail, or both. The department’s director may also sue to stop an actual or threatened violation of the section requiring the license, in the superior court of the county where the violation occurred or is about to occur.
When the answer is no, or not yet
An honest licensing analysis sometimes ends with a business changing its plan. The recurring patterns:
- The plan puts nurses in clients’ homes, but the business holds or plans only a home care organization license. Skilled nursing needs a home health agency license.
- Aides would help with medication that needs a licensed professional’s administration or oversight. A registered home care aide may not do that.
- A new home health agency or branch is planned in an area already served by many home health providers. Without a written finding of unmet need, the department issues no new license during the moratorium.
- A new aide is ready to start but not yet cleared on the registry. That aide waits.
- The business name or website already uses home care or home health wording before the license issues.
None of this has to end the venture. Some businesses scale the plan to the license available: nonmedical home care that stays within an aide’s limits, while any home health plans wait on the exception process or the end of the moratorium.
If you are deciding what to do next, we would rather talk it through early than after the fact. Call Bay Legal at (650) 668-8000 in Northern California or (213) 668-8000 in Southern California, or reach us through baylegal.com/contact-us.
Our page on healthcare regulatory compliance attorney work in California covers ongoing compliance, and our California healthcare business attorney page covers the wider practice. When we review a home care or home health business plan, we look at:
- each planned service, sorted between the home care law and the home health law;
- how the registry clearance fits into hiring and scheduling;
- the insurance, bond and workers’ compensation minimums;
- the business name and how it is used;
- for skilled nursing, whether an exception request can show unmet need in the proposed area.
Frequently Asked Questions
Do I need a license to start a home care agency in California?
Yes, if the business arranges nonmedical home care by registered home care aides. Subject to the Act’s exclusions, it needs a home care organization license from the State Department of Social Services before it arranges those services. If it will provide or arrange skilled nursing in the home, it needs a home health agency license from the State Department of Public Health.
Can a home care organization provide nursing care or give medication?
No. Skilled nursing, meaning services by a registered nurse or licensed vocational nurse, needs a home health agency license. A registered home care aide may help with medication the client takes on their own, but not with medication that would otherwise need administration or oversight by a licensed health care professional.
Can a caregiver start work before appearing on the home care aide registry?
No. An affiliated home care aide must be listed on the registry before giving home care services. The organization must make sure the aide is cleared before placing the aide in direct contact with clients.
Is California issuing new home health agency licenses?
Generally not, while the moratorium lasts. The Department of Public Health issues no new license and adds no branch office except on a written finding that the applicant has shown an unmet need. That showing is based on the concentration of existing home health services in the area. The department’s guidance has applicants start with an exception request.
How long does each license last?
A home care organization license is renewed every two years. A home health agency license expires 12 months after issuance, and the renewal is filed at least 30 days before expiration. An agency licensed for the first time receives a provisional license that ends six months after issuance.
Legal References
- Home Care Services Consumer Protection Act, Cal. Health & Safety Code § 1796.10 et seq., including §§ 1796.12, 1796.14, 1796.17, 1796.34, 1796.35, 1796.37, 1796.38, 1796.42 and 1796.43
- Home health agency licensing, Cal. Health & Safety Code § 1725 et seq., including §§ 1726, 1727, 1728.1, 1728.2, 1728.9, 1728.95, 1730, 1739 and 1740
- Cal. Welfare & Institutions Code § 15630 and Cal. Penal Code §§ 11164-11174.3 (abuse reporting, referenced by Health & Safety Code § 1796.42)
- California Department of Public Health, home health agency moratorium guidance (exception request to the Centralized Applications Branch)
- California Department of Social Services, Home Care Services Branch, home care organization application process
