California home health agency license: the SB 164 freeze and what CDPH requires

Do you need a home health agency license at all?

The test turns on one service: skilled nursing in the home. No organization, public or private, may “provide, or arrange for the provision of, skilled nursing services in the home” without an HHA license.⁠¹ The statute defines skilled nursing as services provided by a registered nurse or a licensed vocational nurse.⁠¹ Placing even a single RN or LVN in a patient’s home under your agency’s name puts you inside the law.

Once licensed, an HHA may add physical, speech and occupational therapy, medical social services and home health aide services.⁠¹ Home health aide services are personal care given under a physician’s plan of treatment. They must be provided by an aide whom CDPH has certified as a home health aide.⁠¹

California carves out a few neighboring businesses:

• Non-medical home care. Bathing, dressing, meals and companionship by registered home care aides fall under a different license, the Home Care Organization license from the California Department of Social Services. See the California home care organization guide. The SB 164 freeze does not apply to that license.
• Nurses’ registries and employment agencies. These are exempt while they do only registry or employment-agency work under Civil Code §1812.500 et seq. They lose the exemption once they start doing what an HHA does.⁠¹
• Hospices. Hospices do not need an HHA license.⁠¹
• Licensed hospitals. A licensed hospital does not need a separate license to run a home health agency, but it needs CDPH’s approval to set one up.⁠¹

The name rules also apply to unlicensed businesses. Without a license you may not use “home health agency,” “home health,” “home-health,” “homehealth” or “in-home health” in your business name. You also may not use “skilled” or “nursing” in a way that implies you are a licensed HHA.⁠¹ A home care organization named “Golden State Home Health” would break the law even if it never sent a nurse anywhere. Check your entity name before you file with the Secretary of State.

The SB 164 moratorium, in detail

AFL 26-28 is CDPH’s All Facilities Letter on the bill, dated August 27, 2026. It and the statute set these rules:⁠²⁠³

• What is frozen: new initial licenses and new branch offices. CDPH also treats three other applications as covered: a change of geographic service area, a move outside your approved service area, and a branch for an existing agency.⁠³
• What is not frozen: renewals and other reports of change. Examples are a move within your existing service area and a new mailing address.⁠³
• How long: until no later than 90 days after the effective date of the HHA regulations that SB 164 orders CDPH to revise.⁠² Those regulations must set a maximum travel time and distance to patients, adjusted for traffic and for rural or urban areas. They must also cap how many agencies one manager can be involved with at the same time, and set office-space requirements.⁠² CDPH had not published an effective date for those rules as of October 12, 2026. The end date of the freeze is therefore unknown.
• The only way through: CDPH may grant an exception by making a written finding that the applicant has shown an unmet need for home health services in the area it proposes to serve. The finding is “based on the concentration of all existing home health services in that area.”⁠²⁠³

Applications that were pending on June 29, 2026

CDPH had to stop processing every new-license application that had not been granted by June 29, 2026. It wrote to each pending applicant with two options. One was to withdraw and receive a refund of fees already paid. The other was to file a justification for an exception with the Centralized Applications Branch (CAB) by October 9, 2026. CDPH automatically withdraws applications that sent neither by that date.⁠³ If you had a file in the queue and missed the deadline, you are back to the start: an exception request.

Applying after June 29, 2026: exception first

CDPH tells new applicants to begin with an exception request, not an application packet. You send a written justification and supporting documents to CAB showing unmet need based on geographic concentration. You may submit the full application only after CAB notifies you that it found a need.⁠³⁠⁴ CDPH may ask for more evidence.⁠² The statute and AFL do not say what counts as proof or how CDPH weighs it. The request should therefore be specific to your counties: the area you will serve, the agencies already licensed there, and why patients there are not being served.

Send exception requests by mail to California Department of Public Health, Licensing and Certification Program, Centralized Applications Branch, P.O. Box 997377, MS 3207, Sacramento, CA 95899-7377. Questions about the moratorium go to [email protected]. General CAB questions go to [email protected] or 916-552-8632.⁠³

Unmet need is now permanent

Many founders miss this point. SB 164 did more than pause licensing. It added a lasting rule to Health and Safety Code §1728.1(g): every applicant for an HHA license or a branch office must show unmet need for home health services in its geographic service area.⁠² The rule still applies after the moratorium ends. CDPH says it covers provisional licenses and licenses issued on the strength of accreditation.⁠³ It is written into §1728.3 (provisional licenses) and §1728.7 (accredited agencies).⁠¹

California once let an HHA accredited by a CMS-approved national accrediting organization get a license largely on that basis. That route still exists, but the accredited agency must now also show unmet need and file the application and fees.⁠¹ Accreditation no longer lets you skip the need test.

Choosing the geographic service area

Your service area is the basis of the need case, so it is worth more thought in California than in most states. CDPH’s checklist asks for every current and proposed county you will serve and a map of the area. A parent HHA’s service area may not extend more than four hours of surface travel from the agency. The exception is an agency serving a rural, scarcely populated area, under conditions in the regulations (tit. 22, §§74607, 74663, 74664).⁠⁶ SB 164’s coming travel-time rule may tighten this. Until those regulations are adopted, the four-hour limit in the checklist is what applies.⁠²⁠⁶

Because a later change of service area is also caught by the moratorium, choose the counties you can defend from the start.⁠³

Who must be named, fingerprinted and qualified

Owners

Every applicant must be of good moral character. For an entity, that means all principal managing members and the person in charge of the agency.⁠¹ The following people submit fingerprints electronically to the California Department of Justice:

• individual owners of a private agency
• anyone with a 5 percent or greater interest in a corporation, partnership or association that owns the agency
• the administrator

The DOJ processing fee is capped at $32 per submission. Fingerprinting and transmission charges are extra and are paid by the person fingerprinted.⁠¹⁠³ A conviction for a felony or a crime showing unfitness leads to denial unless the person proves rehabilitation to CDPH.⁠¹ Live Scan requests use form BCIA 8016 with ORI number A1226. Out-of-state applicants contact CAB for fingerprint clearance.⁠⁶

SB 164 added new grounds for denial, suspension or revocation:⁠¹⁠³

• an HHA you owned, operated or managed was terminated from Medicare or Medi-Cal for noncompliance, or had its license suspended or revoked
• an HHA you owned, operated or managed showed a pattern and practice of violations in the last three years
• you are on the HHS Office of Inspector General’s List of Excluded Individuals/Entities
• management did not cooperate with an inspection or complaint investigation
• the agency did not report a change in owner, management, service area or location

The four management positions

Since June 29, 2026, every HHA must have four management positions: an administrator, an administrator designee, a director of patient care services (DPCS) and a DPCS designee.⁠¹ For each of the four, the initial application must include:

• form HS 215A
• a résumé
• a list of every licensed facility and HHA where the person currently serves in any of those four roles

Report any change within 10 business days. Agencies already licensed must file this information by March 31, 2027. Branch offices are exempt.⁠¹⁠³ CDPH verifies each manager’s professional license and may phone past employers to check work history.⁠¹⁠³

The HS 215A asks for ten years of employment history. It also needs a facility information sheet for every facility the person has been involved with in the past three years, including facilities licensed by the Department of Social Services. The administrator must state the hours worked per week at each agency.⁠⁶ These details matter because SB 164 also orders CDPH to cap how many agencies one manager may serve at the same time.⁠²

The DPCS must hold an active California registered nurse license under tit. 22, §74703. CDPH asks for a printout from the Department of Consumer Affairs license search.⁠⁸ Under §74703(b), the DPCS must be a registered nurse with either a baccalaureate or higher degree in nursing or a related health field plus three years of experience in the last five years, or four years of experience in the last five years without the degree. The experience must be in a home health agency, primary care clinic or health facility, and at least one year of it in a supervisory or administrative capacity.⁠⁹ For the administrator, §74717 says only that the governing body must appoint a “qualified administrator.”⁠¹⁰ The sources reviewed give no experience or education minimum for that role, so ask CAB what it will accept before you name someone.

No management companies

CDPH’s checklist says HHAs have “no authority to allow management companies.” A skilled nursing facility management company’s authority cannot be used for an HHA. CDPH also does not accept interim management agreements between a buyer and the current owner.⁠⁶ The licensee runs the agency itself.

What the application packet contains

You submit this packet only after CAB clears your exception request. It goes to CAB at the Sacramento P.O. box, never to a CDPH district office.⁠⁴ CDPH asks for the documents in the order of its provider checklist:⁠⁴⁠⁶

1. Cover letter on letterhead

   Include contacts for invoices, application correspondence, day-to-day business, emergencies, All Facilities Letters, public listing and your privacy officer. The emergency contact must be reachable 24/7/365 through the California Health Alert Network (CAHAN).⁠⁶ CDPH sends the fee invoice to the invoice email you list.

2. HS 200, Licensure and Certification Application

   Give the licensee’s EIN, not a Social Security number. An organization counts as a parent company only if it owns 100 percent of the licensee.⁠⁶

3. Proof of capital for licensed-only agencies

   An agency that will not bill Medicare or Medi-Cal must show it can operate for its first three months (tit. 22, §74661(a)(6)). Provide projected expenses for the first 90 days broken out by rent, utilities, salaries and overhead, plus an official bank statement or certificate of deposit in the licensee’s name.⁠⁶

4. IRS document

   showing the legal name and EIN, such as Form 941. Add an organizational chart for corporations, LLCs and partnerships showing owners and percentages, EINs, directors, officers, members, managers and partners.⁠⁶

5. Property documents

   grant deed, bill of sale, lease or sublease for the office, plus a floor plan of the office space.⁠⁶

6. HS 215A and résumés

   for the administrator, the DPCS, every owner, director, officer, LLC member or manager, and each holder of 5 percent or more. Attach facility information sheets.⁠⁶

7. HS 309

   , Administrative Organization and Organizational Structure, with Secretary of State filings and articles of incorporation or organization.⁠⁴⁠⁶

8. Criminal record forms

   CDPH 322, CDPH 325 and BCIA 8016 for owners and the administrator.⁠⁴⁠⁶

9. Service area documentation

   list of counties and a map.⁠⁶

10. CMS 1572

    , Home Health Agency Survey and Deficiency Report. Licensed-only agencies need it too, because the district office uses it to plan the survey.⁠⁶

11. Certification forms

    if you want Medicare or Medi-Cal: HS 328, CMS 1561, CMS 855A, HHS 690, DHCS 9098, and Attachment F-1 for Medi-Cal. Attachment F-1 replaces the old DHCS 6207 disclosure.⁠⁴⁠⁶

Fees as published

CDPH charges a license fee for the main office and for each branch.⁠¹ The amounts are set each fiscal year.

The fee table runs July 1, 2026 through June 30, 2027 and lists 4,266 licensed home health agencies. The FY 2025-26 rates were the same.⁠⁵ In Los Angeles County, the license fee alone comes to $5,049 per year per office.⁠⁵ CDPH says it will refund fees already paid by pending applicants who withdraw because of the moratorium, with some delay expected. Those who continue remain subject to the fee.⁠³

Provisional license, surveys and the 90-day goal

A first-time licensee gets only a provisional license, which ends six months after it is issued.⁠¹ Within the 30 days before it ends, CDPH does a full inspection. It issues a regular license if you meet every requirement. If you do not yet comply but have made substantial progress, it renews the provisional license once for another six months. If there is no substantial progress, CDPH issues no further license.⁠¹ You can contest a denial at a hearing under Health and Safety Code §100171.⁠¹ A separate provisional license under §1728.3 depends on unmet need and substantial compliance. It lasts no more than six months and cannot be renewed.⁠¹

The statute tells CDPH to make “every effort” to finish the paperwork and any licensure survey within 90 calendar days of a complete application. For agencies seeking Medicare or Medi-Cal, it should do an unannounced certification survey within 90 days after that, or within 90 days of your readiness letter. If it cannot meet those targets, CDPH must tell you in writing and give an expected survey date.⁠¹ These are targets, not guarantees, and the clock starts only once your application is complete.

Medicare and Medi-Cal: the federal freeze

For most home health agencies, Medicare is the main payer. CMS’s notice imposed a six-month nationwide moratorium effective May 13, 2026. No new HHAs, branches or practice locations will be enrolled unless the Medicare contractor received the enrollment application before that date.⁠⁷ CMS may extend the moratorium in six-month increments and will announce any extension in the Federal Register.⁠⁷

The notice leans heavily on California. CMS reports that HHAs in Los Angeles County grew more than 40 percent between 2019 and 2023. Well over 1,000 new HHAs enrolled there since 2019, and the county holds roughly 12-15 percent of all HHAs nationwide.⁠⁷ CMS considered limiting the moratorium to southern California but chose a nationwide one instead.⁠⁷ For Medicaid and CHIP, CMS left the decision on a moratorium to each state.⁠⁷ The Department of Health Care Services (DHCS) lists only discontinued Medi-Cal enrollment moratoriums, none of them for home health agencies, as of October 12, 2026.⁠¹¹ Ask DHCS Provider Enrollment about Medi-Cal enrollment before you plan on it.

An HHA that wins a California exception while the CMS freeze lasts cannot enroll in Medicare, because CMS enrolls no new HHAs unless the application was received before May 13, 2026.⁠⁷ Until the moratorium ends, a new agency is licensed-only for Medicare purposes, which is why the three-month capital proof for licensed-only agencies matters.⁠⁶⁠⁷ Medi-Cal certification is a separate DHCS and CDPH process, so ask CAB and DHCS Provider Enrollment how it applies to you. Licensed-only agencies are inspected by CDPH at least once a year. Agencies certified for Medicare or Medi-Cal are exempt from that annual state inspection.⁠¹

Staff the state regulates directly

The law sets several standing obligations:⁠¹

• Every patient receiving skilled nursing needs a plan of treatment.
• Clinical records are kept on all patients.
• A registered nurse supervises licensed and unlicensed staff. A physical, speech or occupational therapist may supervise within that therapist’s scope of practice.
• A group that includes a physician and a registered nurse reviews the agency’s patient-care policies every year.
• A group that includes a physician, a pharmacist and a registered nurse reviews the policies on purchasing, storing and transporting legend devices every year.

Home health aides must be certified by CDPH. That requires a training program of at least 75 hours, or an approved competency evaluation, plus a criminal record clearance.⁠¹ Since January 1, 2026 (AB 1495), aide classroom and practical training may be taught without a teaching credential by one of two people. The first is an RN with at least two years of nursing experience, one of them in home health. The second is an LVN under that RN’s general supervision.⁠¹

Renewal, changes and selling the agency

A license expires 12 months after it is issued. CDPH mails a renewal application at least 45 days before expiry. You file it with the fee at least 30 days before expiry, and the license expires if you miss that.⁠¹ The moratorium does not affect renewals.⁠³

Report changes in owner, management, service area or location. Failing to report any of them is now a ground for revocation.⁠¹ Most management and ownership changes are due within 10 business days.⁠¹

You cannot transfer a license. SB 164 bars CDPH from approving a change of ownership within five years of the date the license was first issued. CDPH may allow an earlier sale only if the agency proves one of two things. One is that the sale is needed for continuity of care for existing patients. The other is that the agency faces financial hardship and its closure would leave an unmet need in its service area.⁠¹⁠³ After five years, a buyer can keep the existing service area without a new need showing. That applies if the agency earlier qualified by showing unmet need, or if it can show it is meeting a need now. Any new counties require a fresh showing.⁠¹ Change-of-ownership applications that were pending on June 29, 2026 are also subject to the five-year bar.⁠³

Related California licenses

If skilled nursing is not essential to your plan, consider other California licenses. A home care organization covers non-medical in-home help. An adult day program or a residential care facility for the elderly serves older adults in a facility. The Department of Social Services licenses all three, and none of them falls under the SB 164 moratorium.

Sources

1. 1
   California Legislative Information, Cal. Health & Safety Code, Division 2, Chapter 8, Home Health Agencies (§§1725-1742) Checked 12 Oct 2026 · Back to text ↑
2. 2
   California Legislative Information, SB 164 (Chapter 27, Statutes of 2026), bill text Checked 12 Oct 2026 · Back to text ↑
3. 3
   California Department of Public Health, AFL 26-28: SB 164, Home Health Agency Licensure: Moratorium on New Licenses and Expansion of Licensure Requirements Checked 12 Oct 2026 · Back to text ↑
4. 4
   California Department of Public Health, Home Health Agency Initial Application Packet Checked 12 Oct 2026 · Back to text ↑
5. 5
   California Department of Public Health, Fiscal Year 2026-27 Health Care Facility License Fees Checked 12 Oct 2026 · Back to text ↑
6. 6
   California Department of Public Health, Home Health Agency Initial and CHOW Provider Checklist Checked 12 Oct 2026 · Back to text ↑
7. 7
   Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (91 FR, May 15, 2026) Checked 12 Oct 2026 · Back to text ↑
8. 8
   California Department of Public Health, HHA Change of Director of Patient Care Services Provider Checklist Checked 12 Oct 2026 · Back to text ↑
9. 9
   Legal Information Institute, Cornell Law School, Cal. Code Regs. tit. 22, §74703, Director of Patient Care Services Checked 12 Oct 2026 · Back to text ↑
10. 10
    Legal Information Institute, Cornell Law School, Cal. Code Regs. tit. 22, §74717, Governing Body Checked 12 Oct 2026 · Back to text ↑
11. 11
    California Department of Health Care Services, Discontinued Enrollment Moratoriums Checked 12 Oct 2026 · Back to text ↑

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