Florida home health agency license: AHCA rules, money tests and Medicare
Any business that sends its own nurses, therapists or home health aides into Florida homes needs a home health agency license from the Agency for Health Care Administration (AHCA). The license lists each service you may provide and whether it is skilled. Skilled agencies must also be accredited within 120 days of applying. Medicare enrollment is a separate federal step, and CMS has blocked new home health enrollments nationwide since May 13, 2026.
Contents15 sections
Key takeaways
- Since July 1, 2018, every Florida home health license lists the services you may provide and whether they count as skilled. Providing or advertising a service that is not on the license counts as unlicensed activity.2
- Skilled agencies must show full accreditation (not conditional or provisional) and an accreditation survey within 120 days after AHCA receives the application. Agencies that provide only non-skilled care are exempt from this.3
- Your CPA-compiled projections must cover the first two years and may not show an operating margin of 15% or more in any month of year one. Funding must cover at least 3 months of average projected expenses.35
- AHCA published a $1,705 biennial license fee plus a $300 biennial assessment (checked October 12, 2026).10
- CMS stopped enrolling new home health agencies in Medicare nationwide on May 13, 2026, for an initial six months. A Florida license does not get you around this.1314
Quick facts
| Agency | AHCA, Laboratory and In-Home Services Unit, Tallahassee |
|---|---|
| Law | Fla. Stat. ch. 400 Part III and ch. 408 Part II; Fla. Admin. Code 59A-8 and 59A-35 |
| Fees | $1,705 biennial license fee + $300 biennial assessment (as published on 2026-10-12) |
| Insurance | Malpractice and liability, at least $250,000 per claim |
| Accreditation | Skilled agencies only: ACHC, CHAP or The Joint Commission, within 120 days of application |
| Certificate of need | Not required for home health agencies |
| Medicare | New enrollments frozen nationwide since May 13, 2026 |
Fees as shown on AHCA's Home Health Agency application checklist, checked October 12, 2026. AHCA may adjust fees each year by up to the change in the Consumer Price Index.
Skilled, non-skilled, or not a home health agency at all
Florida defines a home health agency as any person that provides one or more home health services. Those services are nursing; physical, occupational, respiratory or speech therapy; home health aide services; dietetics and nutrition; and prescribed drugs and biologicals.1 Help with bathing, dressing, toileting, transfers and other hands-on personal care is a home health aide service, so it needs this license even if no nurse ever visits.1
The first decision you make is which services go on the license. Every license issued since July 1, 2018 lists the services you may provide and states whether they count as skilled. If you provide or advertise a service that is not listed, Florida treats it as unlicensed activity.2 The choice changes almost everything that follows:
| Skilled agency | Non-skilled agency | |
|---|---|---|
| What it covers | Nursing, or physical, occupational, respiratory or speech therapy, by Florida-licensed professionals1 | Home health aides, CNAs, homemakers and companions9 |
| Accreditation within 120 days | Required3 | Exempt3 |
| Director of nursing | Required if you provide skilled nursing; the agency may not operate more than 30 days without one4 | Not required7 |
| Adding services later | Adding skilled care later takes an addition-of-skilled-services application with financial proof and accreditation3 | — |
Several neighboring credentials come up in founders’ plans, and each has its own rules:
- Homemaker and companion registration. If you only provide companionship, meal preparation, housekeeping, shopping and errands, with no hands-on personal care, you register with AHCA instead of getting a license. The registration costs $50 per biennium.15 See Florida homemaker and companion registration.
- Nurse registry. A nurse registry places nurses, CNAs, aides, companions and homemakers who work as independent contractors and are paid by fees. It is exempt from home health licensure but needs its own nurse registry license, with a fee capped at $2,000 per biennium.161 If your caregivers are W-2 employees and you provide personal care, you are a home health agency.
- Home infusion therapy. A home infusion provider must be licensed as either a home health agency or a nurse registry.2
- Exemptions. The law lists exemptions, including a licensed professional working alone and “a person that provides skilled care by health care professionals licensed solely under” the nursing, therapy and dietetics practice acts.2 An exempt business can ask for a voluntary certificate of exemption. It lasts up to 2 years, and AHCA may charge $100 for it.2 Offering skilled services that need a license without having one is a third-degree felony.5
There is no certificate of need. Florida’s certificate-of-need program covers only skilled nursing facilities, hospices and intermediate care facilities for the developmentally disabled.17
The Medicare freeze in effect since May 13, 2026
Effective May 13, 2026, CMS stopped enrolling new home health agencies, branches and practice locations in Medicare anywhere in the United States. Only applications that a Medicare contractor received before that date are still being processed.13 CMS’s survey memo to the states adds the following rules:14
- Initial enrollment applications filed during the moratorium are denied and must be filed again after it is lifted.
- CMS regulations allow no exceptions for individual providers.
- During the moratorium, accreditation from ACHC, CHAP or The Joint Commission will not produce Medicare deemed status for a new agency.
- An appeal can argue only that the moratorium does not apply to you.
The moratorium lasts six months and can be extended in six-month increments. Any extension will be announced in the Federal Register.13 As of October 12, 2026, the only Federal Register notices found were the May 15 announcements, so the first six-month period runs to about mid-November 2026. Check the Federal Register or the CMS moratoria page before you file, because an extension or an early end would change your timeline.25
Three details matter for Florida founders:
- Buying a young agency does not work around the freeze. Under 42 CFR 424.550(b), an agency that goes through a non-exempt change in majority ownership within 36 months of its initial enrollment must enroll as a new agency. The moratorium blocks that new enrollment.13
- Extra screening after the freeze. Once the moratorium is lifted, agencies that apply within 6 months are assigned the “high” screening level.13
- Medicaid is left to the states. CMS left it to each state to decide whether to freeze Medicaid and CHIP enrollment of home health providers.13 Florida’s June 12, 2026 Medicaid integrity announcement said AHCA had imposed enrollment moratoriums on high-risk provider categories “including” durable medical equipment suppliers and adult day care providers; it did not name home health agencies.24 If you plan to serve Medicaid clients, ask AHCA’s Medicaid provider enrollment office whether new home health agencies can enroll before you build your plan around Medicaid revenue.
The state license itself is not frozen. AHCA says agencies may apply to Medicare or Medicaid after the state license is issued, using information that matches the license application. AHCA’s Medicaid note for home health agencies reads “Deemed status accreditation required.”12 A private-pay or non-skilled agency can still be licensed and operate.
Choosing your counties: the geographic service area
A Florida home health license is tied to specific counties. You apply for one or more counties inside the health service planning district where your main office is located, and you may not serve patients in counties that are not on your license.7 The state has 11 districts. Some are large: District 3 has 16 counties. Others cover only one or two counties: District 10 is Broward alone, and District 11 is Miami-Dade and Monroe.17
To serve another district, you need a separately licensed office there.2 Moving your office to a service area that is not on your license requires a brand-new initial application.3 Within your area you can add two kinds of locations:
- Satellite offices must be in the same service area and share administration with the main office. They do not need their own license.7
- Drop-off sites are workstations for field staff. They need no license, but you may not contact prospective patients or do billing there.7
If AHCA confirms that you refuse to serve patients in a county listed on your license, it removes that county.7
Proving you can pay for it: Form 3100-0009
Statute and rule require all of the following with the initial application:358
- A signed business plan that explains how you will obtain patients and how you will recruit and keep staff.3
- Two years of projected financial statements: a balance sheet, an income and expense statement, and a statement of cash flows, prepared under GAAP and compiled and signed by a CPA.38 They go on AHCA Form 3100-0009, Proof of Financial Ability to Operate.8
- A startup funding statement that shows the sources of funds through break-even. It must cover at least 3 months of average projected expenses for startup costs, working capital and contingency funding, and the contingency portion may not be less than 1 month of expenses.5 AHCA’s rule describes the contingency fund as covering events such as “a delay in Medicare and/or Medicaid certification.”8 Under the 2026 Medicare moratorium, that delay lasts at least until CMS lifts the moratorium.13
- Independent evidence that the startup, working capital and contingency funds exist and will be available.5
- A cap on projected profit. “An applicant may not project an operating margin of 15 percent or greater for any month in the first year of operation.”3 AHCA’s rule defines operating margin as net patient service revenue minus operating expenses, divided by net patient service revenue.8
Two more requirements apply only to some applicants:
- Applicants and controlling interests who are nonimmigrant aliens must file a surety bond of at least $500,000. This applies at initial licensure, renewal and change of ownership.5
- Renewals do not need new financial proof unless the agency has shown financial instability, such as bounced checks, delinquent bills or missed payroll.8
Accreditation within 120 days (skilled agencies)
An agency that applies with skilled services must submit accreditation, or an application for accreditation, from an accrediting organization AHCA recognizes. Within 120 days after AHCA receives the license application, it must then provide:3
- proof of accreditation that is not conditional or provisional, and
- a survey showing compliance with Florida law.
The accreditation must stay in place for as long as the agency holds the license.3 Florida’s rule names three accrediting organizations: the Accreditation Commission for Health Care (ACHC), the Community Health Accreditation Partner (CHAP) and The Joint Commission.7 AHCA lists all three as accepted for state licensure and as offering a Medicare deemed-status option.11
Once you are accredited and authorize release of the accreditor’s survey report, AHCA accepts that survey in place of its own routine licensure surveys. You lose that substitution if your accreditation becomes provisional, conditional, deferred or denied, or if AHCA does not receive the report.37 Non-skilled agencies do not need accreditation. All agencies are surveyed before initial licensure and then at least every 36.9 months without notice.7
Administrator and director of nursing
Both people must be direct employees, which means the agency, its management company or its employee leasing company pays their withholding taxes.1
| Position | Who qualifies | Limits |
|---|---|---|
| Administrator | A Florida-licensed physician, physician assistant or RN, or anyone with at least 1 year of supervisory or administrative experience in home health, a hospital, a nursing home or an assisted living facility1 | May run only 1 agency, or up to 5 with identical controlling interests; must name a qualified alternate administrator in writing4 |
| Director of nursing | A Florida-licensed RN, graduated from an approved nursing school, with at least 1 year of supervisory experience as an RN1 | May serve 2 agencies, or up to 5 under conditions, all with identical owners and in one service area or an adjoining county4 |
If the administrator qualifies through experience rather than a license, send a résumé with the application.10
An administrator who is a physician, PA or RN may also serve as director of nursing, but only while the agency has 10 or fewer full-time-equivalent employees and contracted personnel.4 The rule puts this limit at fewer than 10.7 If your director of nursing leaves, you must notify AHCA within 10 business days. A skilled agency that goes more than 30 days without one commits a class II deficiency.4
Hours are set by rule. The administrator and director of nursing, or their alternates, must be available for eight consecutive hours between 7 a.m. and 6 p.m., Monday through Friday. When an AHCA surveyor arrives unannounced, one of them must be on site within an hour, and a current patient list must be ready within two hours if the surveyor asks for it.7 Skilled agencies need a 24-hour on-call nursing system.7
What goes in the application package
The application is the Health Care Licensing Application for home health agencies, AHCA Form 3110-1011 (July 2024 edition), plus the Health Care Licensing Application Addendum, Form 3110-1024. You can file on paper or through AHCA’s online portal, but renewals must be filed online.8 AHCA’s checklist lists these supporting documents for an initial application:10
- proof of general liability and malpractice insurance, each at least $250,000 per claim3
- accreditation documentation (skilled agencies)
- Form 3100-0009 with the CPA-compiled projections
- proof of your legal right to occupy the office, such as a deed or lease
- documentation from your local government official that the office meets local zoning requirements
- the addendum and any disclosures about Medicare, Medicaid or CLIA actions against the owners
- a surety bond, if one applies to you
The personnel section asks for the administrator, alternate administrator, RN, director of nursing, alternate director of nursing, financial officer and a safety liaison.10 The application must also say which services agency employees will provide directly and which will be contracted. You must provide at least one service directly.7
Fees as published
| Item | Amount |
|---|---|
| Biennial license fee | $1,70510 |
| Biennial assessment fee | $30010 |
| Replacement license certificate, or a name, address, county, office or service change | $2510 |
| Statutory cap on the license fee | $2,000 per biennium3 |
Fees are non-refundable.8 If you send an application without the fee, AHCA returns it unprocessed.8 Government agencies are exempt from the license fee.3 AHCA may raise license fees each year by no more than the change in the Consumer Price Index, so confirm the amount when you file.26
Filing order and AHCA’s clock
Settle services and counties
Decide on skilled or non-skilled services and pick the counties in your district, because both are printed on the license.27
Secure the office
Get the lease and the local zoning sign-off before you file.10
Line up the money
Fund the account, then have the CPA compile Form 3100-0009 and the startup funding statement.5
Complete Level 2 background screening through AHCA
It covers the owner if an individual, the administrator, the financial officer, every controlling interest, and staff who will give care.19 The administrator and financial officer must be screened and qualified before they are appointed.8
File Form 3110-1011 with the fee
Skilled applicants should start the accreditation process at the same time, because the 120-day clock starts when AHCA receives the application.3
Answer AHCA’s questions within 21 days
AHCA reviews the application within 30 days and lists any errors or omissions. If you do not send the missing items within 21 days, the application is withdrawn and the fee is forfeited.6
Pass the inspection
AHCA does not authorize the licensure inspection until your documents, fees and screening results are complete. The application counts as complete only after a satisfactory inspection.8
Get a decision within 60 days
AHCA must approve or deny within 60 days after the application is complete.6 Florida licenses run for two years.6
Staff training once you are open
- Home health aides need either 40 hours of training under an RN with at least two years of nursing experience, one of them in home health, or a passing score on AHCA’s competency test. A pass means all 14 practical tasks performed correctly and 90 of 104 written questions answered correctly.7
- Training your own aides. An agency may train its own aides but may not charge them for the course.7
- CPR and in-service. Aides and CNAs need yearly in-service training and current CPR certification.7
- Medication. Assisting with self-administered medication takes 2 hours of training.7 Giving medication under RN delegation takes a 6-hour initial course and a 2-hour course every year.20
- HIV/AIDS. Every employee, except licensed professionals covered by their own board’s HIV/AIDS course requirement (s. 456.033), completes a one-time HIV/AIDS course within 30 days of hire.7
- Dementia. Staff who give personal care or have regular contact with patients complete a 1-hour Alzheimer’s course from the Department of Elderly Affairs within 30 days.21
- Rescreening. Screened staff are rescreened every 5 years.19
Every agency must also have a comprehensive emergency management plan on AHCA Form 3110-1022. The county health department reviews it within 90 days. If you fail to submit the plan or make requested changes within 30 days after written notice, AHCA can fine you $5,000.187 At renewal, AHCA asks for the plan’s approval letter or proof that you submitted it within the last 365 days.10
Renewal, sanctions and the 5,000-resident rule
Renewal applications must reach AHCA 60 to 120 days before the license expires.6 Florida also has a renewal bar. In any county with more than one home health agency per 5,000 residents, AHCA may not renew the license of an agency sanctioned in the previous 2 years for any of these acts:3
- fraudulent records
- billing for services not provided
- going 60 days without providing at least one service directly
- paying discharge planners or case managers who refer patients
- serving or staffing an assisted living facility for less than fair market value
The same conduct also carries flat fines. A pattern of billing for services that were not provided costs $5,000 per incident.22 Class I violations cost $15,000 and class II violations $5,000, per occurrence per day.23 Your advertising must show your AHCA license number. Leaving it off draws a fine of at least $100, and $500 for each later offense.2
Rule changes in 2026
AHCA amended chapter 59A-8 several times in 2026:7
- January 26: licensure requirements and exemptions (59A-8.003 and 59A-8.005).
- May 5: definitions and scope of services (59A-8.002 and 59A-8.008).
- May 31: personnel and training (59A-8.0095), and training for home health aides for medically fragile children (59A-8.0099).
- July 8: geographic service areas (59A-8.007).
- October 12: the Excellence in Home Health award rule (59A-8.0248). Award applications are due March 15 or September 15.9
Common questions
What is an AHCA license for home health?
It is the state license that Florida's Agency for Health Care Administration (AHCA) requires before any person provides a home health service: nursing, therapy, home health aide services, dietetics and nutrition, or prescribed drugs and biologicals in a patient's home.12 The license is issued for two years and lists each service you may provide.62
Do I need an AHCA license for non-medical home care in Florida?
Not if you provide only companion or homemaker services: you register with AHCA instead, for $50 per biennium.15 Hands-on personal care such as bathing, dressing or toileting is a home health aide service, so it needs the home health agency license.1
How long does AHCA take to approve a home health agency application?
AHCA has 30 days to notify you of errors or omissions, you have 21 days to send what is missing or the application is withdrawn and the fee forfeited, and AHCA must approve or deny within 60 days after the application is complete.6 The application must include satisfactory inspection results.6
Is AHCA certification the same as an AHCA license?
No. The AHCA license lets you operate in Florida; Medicare or Medicaid enrollment is a separate federal step you apply for after the state license is issued.12 CMS's moratorium page, checked November 11, 2026, still listed the nationwide freeze on new home health enrollments that began May 13, 2026, and any extension comes in six-month increments.25
Does a Florida home health agency need a certificate of need?
No. Florida's certificate-of-need law defines the facilities it covers as skilled nursing facilities, hospices and intermediate care facilities for the developmentally disabled; home health agencies are not on that list.17
Sources
- 1
- 2
- 3 The Florida Legislature, Fla. Stat. 400.471, Application for license; fee Checked 12 Oct 2026 · Back to text ↑
- 4 The Florida Legislature, Fla. Stat. 400.476, Staffing requirements Checked 12 Oct 2026 · Back to text ↑
- 5
- 6 The Florida Legislature, Fla. Stat. 408.806, License application process Checked 12 Oct 2026 · Back to text ↑
- 7
- 8
- 9 Agency for Health Care Administration, Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
- 10
- 11
- 12 Agency for Health Care Administration, Home Health Agencies: Medicare/Medicaid Checked 12 Oct 2026 · Back to text ↑
- 13
- 14
- 15
- 16 The Florida Legislature, Fla. Stat. 400.506, Licensure of nurse registries Checked 12 Oct 2026 · Back to text ↑
- 17
- 18
- 19 The Florida Legislature, Fla. Stat. 408.809, Background screening Checked 12 Oct 2026 · Back to text ↑
- 20
- 21
- 22 The Florida Legislature, Fla. Stat. 400.474, Administrative penalties Checked 12 Oct 2026 · Back to text ↑
- 23
- 24
- 25 Centers for Medicare & Medicaid Services, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑
- 26 The Florida Legislature, Fla. Stat. 408.805, Fees required; adjustments Checked 12 Oct 2026 · Back to text ↑
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Related guides
Florida and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| Florida (this guide) | Home Health Agency license | Sending your own nurses, therapists or aides into homes | $1,705 biennial license fee + $300 biennial assessment |
| Georgia | Home Health Agency license | Skilled home health; certificate of need required first | $300 application processing + $1,000 a year |
Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.