North Carolina home care agency license: in-home aide and companion services

One statute, two licenses since November 2023

North Carolina regulates in-home care under the Home Care Agency Licensure Act, G.S. 131E-135 through 131E-142. The NC Medical Care Commission writes the rules (10A NCAC 13J), and DHSR’s Acute and Home Care Licensure and Certification Section issues the licenses ⁠⁵. G.S. 131E-138(a) says no person or governmental unit may “operate a home care agency or a home assistance services provider without a license obtained from the Department” ⁠².

Those two terms divide the non-medical market:

• Home care agency. This is any organization that provides “home care services.” The list covers nursing, therapy, medical social services, infusion nursing and pulmonary care, plus “in-home aide services that involve hands-on care.” It also covers companion, sitter, respite and homemaker services when you provide them together with other home care services ⁠¹.
• Home assistance services provider. This is an organization “predominantly engaged” in companion, sitter or respite care, or in homemaker services combined with those. The statute says these “are not home care services,” and the definition excludes any organization that mainly provides home care services ⁠¹.

The dividing line is touch. North Carolina defines homemaker services as household tasks, shopping, meals, transportation, socialization and medication reminders “that do not require the service provider to touch the client” or to have skills verified by a registered nurse ⁠¹. Once an aide helps a client bathe, dress, use the toilet, move or eat, the business is providing in-home aide services and needs a home care agency license.

S.L. 2023-150 created the home assistance category. It was enacted and took effect on November 9, 2023. The same law set a $510 fee for an initial home assistance license and lowered the initial home care license fee from $560 to $510 ⁠¹⁵. Before that law, any agency offering companion, sitter or respite services had needed a full home care agency license.

As of 2026-10-12, DHSR’s home care pages, fee schedule and application form describe only the home care agency license, and the application still lists “Companion / Sitter / Respite” as a home care service ⁠⁵⁠⁷⁠⁹. DHSR’s published pages did not describe a separate application, fee procedure or checklist for home assistance services providers. Before you file for a companion-only business, ask the section at 919-855-4620 which form and which fee DHSR applies to it.

Neighbouring licenses you might confuse it with

For the skilled route, see the North Carolina home health overview. If you plan to house residents, see the adult care home or family care home guides. Group day programs are covered in the adult day care certification guide.

Rules that shape the business before you apply

Three rules in 10A NCAC 13J decide where you can operate and who must sign the application. Settle them before you sign a lease.

Every office is a separately licensed premises. Each agency premises must have its own license ⁠¹⁰. The rules define “premises” broadly: any location where the agency provides home care services, keeps client service records, or “advertises itself as a home care agency” ⁠¹⁰. DHSR wants a separate application for each site, and separate legal entities that share one office must each file their own ⁠⁹. The checklist asks for proof of premises, including a commercial lease if you have one ⁠⁸. The license must be displayed where the public can see it, and the rules also require a sign at the public entrance showing the agency name ⁠¹⁰.

Hands-on aides have a service radius. For in-home aide services, your geographic service area is limited to the larger of two areas: your county plus the counties next to it, or everywhere within 90 minutes’ drive of your licensed site ⁠¹⁰. DHSR says the 90-minute limit applies only to in-home aide services, so that aides can be supervised ⁠⁶. To serve a wider area with aides, you need another licensed site. To add counties inside the limit, give DHSR 30 days’ written notice ⁠⁶⁠¹⁰. The application asks you to list each service by county and to say whether you provide it directly or through a contractor ⁠⁹.

Your license lists the services you may provide. The license shows the services the agency provides ⁠¹⁰. To add one of the services in G.S. 131E-136(3)(a)-(f), such as nursing, you must notify DHSR in writing at least 30 days before serving any client. DHSR approves it only after checking your staff and policies against the rules for that service ⁠⁶⁠¹⁰. If you stop providing a listed service for six continuous months, you must also tell DHSR ⁠¹⁰.

Owner training and the agency director

Pre-licensure training. Under 10A NCAC 13J .0903(a), if the applicant “cannot demonstrate” to DHSR that they have ever owned or operated a home care agency, DHSR “shall not issue a license” until the applicant has completed DHSR-approved training. The training covers licensure requirements, the licensure process and the operating rules ⁠¹⁰. G.S. 131E-140(a)(5) authorizes this requirement ⁠³. DHSR does not run the course itself. It publishes a list of approved trainers ⁠¹¹. Your application packet must include either proof of previous ownership or operation, or your training certificate ⁠⁵⁠⁸.

Agency director. Every agency must name an agency director who has administrative authority ⁠¹⁰. For an agency licensed for in-home aide or other home care services, the director must meet at least one of these qualifications ⁠¹⁰:

• a health care practitioner as defined in G.S. 90-640(a);
• at least two years of supervisory or management experience in home care or at another provider licensed under G.S. 131E or 122C; or
• a bachelor’s degree in health, business or public administration science plus at least one year of supervisory or management experience in home care or another licensed health care program.

An agency licensed only for companion, sitter and respite services has a lower bar. The director must have a high school diploma or GED and must be a health care practitioner or have one year of experience in home care, companion, sitter or respite services, or at another 131E or 122C provider ⁠⁶⁠¹⁰.

You must also designate a supervisor for each type of service. That person can be the director ⁠¹⁰. If the director position becomes vacant, notify DHSR in writing within five working days. Include the replacement’s name and documents showing they qualify, such as a resume and licenses ⁠⁶⁠¹⁰.

Staffing hands-on care: the RN, aides and supervision

You do not need a nurse to run a companion-only agency. You do need one to run hands-on in-home aide services.

A nurse or other practitioner assesses and supervises. Before you write a plan of care, a health care practitioner must do the initial assessment in the client’s home. The assessment covers social, mental, physical, environmental and economic status, plus activities of daily living ⁠¹⁰. DHSR’s FAQ says a registered nurse must be available for supervision and consultation whenever aides are working. An LPN “may not perform assessments or conduct supervisory visits for in-home aide services” ⁠⁶. Even when Medicaid’s independent assessment entity has already assessed a client, DHSR says the agency’s RN must still visit the home to develop the plan of care ⁠⁶.

Plans of care and visits run on a 90-day cycle. The practitioner reviews each plan of care every 90 days ⁠¹⁰. For aides who are not subject to an occupational license, the practitioner makes a supervisory visit to each client’s home every 90 days, with or without the aide there. At least once a year, the visit must happen while the aide is providing care ⁠¹⁰. DHSR says the client or responsible party should sign the plan of care before services start ⁠⁶.

Aide qualifications depend on how much help the client needs. Plans of care rate each daily activity as limited or extensive assistance. Extensive assistance means hands-on help more than half the time during an activity, for clients who also meet the rule’s further criteria ⁠¹⁰. If a plan requires extensive assistance, the aide must be listed on the Nurse Aide Registry. Aides giving only limited assistance do not need to be listed ⁠¹⁰. If an aide is not on the registry, a registered nurse must verify six core skills: mobility, bathing or showering, toileting, dressing, eating and continence care ⁠¹⁰. Aides may help clients take their own medications, but they may not administer medications ⁠⁶⁠¹⁰.

Companion staff are supervised differently. For companion, sitter and respite staff, the designated supervisor contacts each client every three months. The supervisor also visits each client’s home at least every six months, and at least once a year while the companion is working ⁠¹⁰.

Personnel files the surveyor will read

Under 10A NCAC 13J .1003, every employee needs a personnel file containing ⁠¹⁰:

• an application or resume;
• a signed job description;
• reference checks;
• credential verification;
• competency verification;
• an annual performance evaluation.

Hands-on staff also need ⁠¹⁰:

• a baseline TB skin test;
• hepatitis B immunization or a signed declination;
• airborne and bloodborne pathogen training, updated every year.

Keep each file for at least one year after the employee leaves ⁠¹⁰. You may not hire anyone, directly or as a contractor, who has a substantiated finding on the NC Health Care Personnel Registry ⁠¹⁰.

Criminal history checks. Under G.S. 131E-265, a job offer for a position that involves entering clients’ homes is conditional on the applicant consenting to a criminal history check. Applicants who have lived in North Carolina for less than five years need a state and national check, including fingerprints ⁠¹². You may employ someone conditionally while the check is pending if you have their consent and submit the request within five business days after they start ⁠¹². A conviction for a relevant offense does not automatically bar employment, but you must weigh the factors the statute lists ⁠¹². Home assistance providers follow a separate rule: a check in every state where the worker lived during the past seven years ⁠².

What goes in the application, and how DHSR reviews it

DHSR says the main reason applicants are not approved is that they “do not understand and/or comply with the initial survey checklist and/or NC licensure rules” ⁠⁵. Use the Initial Home Care Survey Checklist (rev. 9/21) as your build list. It ties each item to a rule ⁠⁸.

Supporting documents ⁠⁸:

• proof of prior ownership, or a certificate from a DHSR-approved training course;
• an organization chart;
• proof of premises;
• articles of incorporation or organization, if you formed an entity;
• an annual projected budget.

Administrative policies ⁠⁸⁠¹⁰:

• scope of services;
• emergency preparedness;
• geographic service area;
• job descriptions for the director, supervisors and other staff;
• annual program evaluation and client record review;
• infection control, with employee risk categories;
• bloodborne pathogens, TB and hepatitis B;
• an exposure control plan.

Client care policies ⁠⁸:

• client rights under G.S. 131E-144.3;
• acceptance of clients and initial assessment;
• a no-smoking policy (G.S. 131E-143);
• supervision of staff;
• contracts with other agencies;
• discharge;
• a complaint policy that includes the state hotline numbers;
• Health Care Personnel Registry reporting.

Personnel policies ⁠⁸:

• competency verification;
• personnel records;
• annual evaluations;
• orientation and in-service training;
• criminal background investigation under G.S. 131E-265.

You also submit complete sample personnel files for your director, service supervisor, in-home caregivers and companions ⁠⁸. Before services begin, every client must receive written notice of the DHSR hotline number ⁠⁴. If you will use contractors, each contract must cover the ten items in 10A NCAC 13J .1111, including the counties the contractor will serve, and you must review contracts every year ⁠¹⁰.

Steps to licensure, in DHSR’s order

1. Complete approved training,

   unless you can document that you have owned or operated a home care agency before ⁠¹⁰⁠¹¹.

2. Secure the office and write the policies

   Prepare the premises, policies and personnel files the checklist lists. DHSR will ask for them after you file ⁠⁵⁠⁸.

3. File form DHSR-4204

   Complete the application for the site, check each service you will offer, list the counties served, and fill in the ownership disclosure ⁠⁹. Mail it with the $510 fee and your proof of training or prior operation to Division of Health Service Regulation, 2712 Mail Service Center, Raleigh, NC 27699-2712. Pay by check, money order or certified check made out to the N.C. Division of Health Service Regulation ⁠⁵⁠⁷.

4. Watch for two emails

   DHSR first confirms that it received your packet and fee. It then emails a request for your policies, procedures and personnel documents ⁠⁵.

5. Initial survey

   For this license, the initial survey is a review of the documents you submit, checked against the licensure rules ⁠⁵. DHSR discards the documents afterward and does not return them ⁠⁶.

6. Approval

   If DHSR needs nothing more, it emails an approval letter with instructions for printing your license from DHSR’s Enterprise system ⁠⁵.

You must finish every requirement within 12 months of the date DHSR receives your application and fee. DHSR states that all fees are nonrefundable ⁠⁶⁠⁷, so ask what happens to your fee if you cannot finish in time. DHSR does not publish a processing time. Its FAQ says “it is not possible to establish specific time frames” because timing depends on completeness, follow-up requests and surveyor workload ⁠⁶.

Accredited agencies. Under G.S. 131E-138(g), an agency accredited for all of the home care services it provides is “deemed” to meet licensure requirements and can be licensed without further review or inspection ⁠². To use this route, attach the accrediting organization’s full inspection report to the application. The form lists the Joint Commission, CHAP and ACHC ⁠⁹. Deemed agencies must send DHSR every new accreditation report within 30 days of receiving it, and DHSR may still conduct validation surveys ⁠¹⁰.

Fees, renewal and inspections

Source: ⁠⁷. G.S. 131E-138(c) sets the annual license fee at $510 in statute ⁠².

Renewal. A license lasts one year ⁠¹⁰, and every home care license expires at midnight on December 31 ⁠⁶. Renewals received by December 31 take effect January 1. A renewal received after January 1 takes effect on the date DHSR receives it, so you are unlicensed in the gap. DHSR says it may refer agencies operating without a license to the Division of Health Benefits, which runs Medicaid ⁠⁶.

Inspections. DHSR must inspect every home care agency at least once every three years ⁠³. Its FAQ says routine inspections and complaint investigations are unannounced ⁠⁶. Surveyors may review client records and, with permission, visit clients at home ⁠⁴⁠¹⁰. You must file a plan of correction within 10 working days after receiving cited deficiencies ⁠¹⁰. For a substantial failure to comply, DHSR may suspend, revoke or amend the license ⁠⁴.

Changes. Give DHSR written notice at least 30 days before a change of ownership or name ⁠¹⁰. A license cannot be transferred without DHSR’s written approval ⁠², and DHSR processes a change of ownership only for an agency with a valid license ⁠⁶. Report address changes in writing too. DHSR, NC Medicaid and NCTracks keep separate records, so a change filed with one does not reach the others ⁠⁶.

Getting paid: Medicaid personal care services

Most hands-on agencies in North Carolina serve Medicaid clients through State Plan Personal Care Services (PCS), governed by Clinical Coverage Policy 3L (amended January 1, 2026). Only a home care agency licensed by DHSR “to operate in the county or counties where the PCS Services are being provided” can bill PCS. The agency also needs a signed DHHS Provider Administrative Participation Agreement ⁠¹⁴. Under PCS ⁠¹⁴:

• a Comprehensive Independent Assessment Entity assesses each client;
• adults can be authorized for up to 80 hours a month under the basic hour limits;
• agencies must enroll in the Provider Interface;
• aides must have a high school diploma or equivalent, or be at least 18;
• aides must be trained in beneficiary rights, confidentiality, personal care skills, incident reporting, recognizing abuse and neglect, and infection control.

PCS agencies must also use electronic visit verification. You can register with the state’s system or use another system that meets the 21st Century Cures Act requirements. You must tell beneficiaries about EVV in writing, and you must train staff on it when they start and at least once a year ⁠¹⁴. Remember that the Medicaid PCS service plan does not replace your licensure plan of care ⁠⁶.

If you contract through the Division of Aging and Adult Services under the Home and Community Care Block Grant or the Social Services Block Grant, the in-home aide service level rules in 10A NCAC 06A and 06X apply as well ⁠¹⁰.

A home assistance services provider is barred from this market. It may not submit claims to any private or government-funded insurer, managed care organization or health plan for services to a North Carolina resident ⁠².

Running a companion-only business under the 2023 law

If you never provide hands-on care, G.S. 131E-138(h) and (i) set the duties of a home assistance services provider ⁠²:

• maintain liability insurance;
• tell every new client that you do not provide health care or hands-on care;
• run a criminal background check in every state where each employee or contractor lived during the past seven years;
• keep proof that each worker has a valid driver’s license, vehicle registration and insurance, plus an official driving record from the NC Division of Motor Vehicles;
• make sure all services are delivered safely and lawfully;
• attest each year that you comply.

You may not employ or contract with anyone convicted of a relevant offense under G.S. 131D-40(d), or anyone listed on the National Sex Offender Public Website, and you may not bill insurers ⁠². Operating without a license carries the same Class 3 misdemeanor penalty as for home care agencies: a fine of up to $500 per offense. DHSR can also seek an injunction ⁠⁴.

What remains unclear is how DHSR handles these licenses in practice. The statute directs the Commission to adopt rules for home assistance providers ⁠³. The companion, sitter and respite rules in 10A NCAC 13J Section .1500 still describe those services as part of a home care agency’s license ⁠¹⁰. The official sources do not say which rules and which application DHSR applies to a companion-only business licensed after November 9, 2023. Ask DHSR whether it will license you under the home care application and Section .1500 or under a separate procedure, and get the answer in writing.

Recent history worth knowing

• 2010: companion and sitter agencies first needed home care licenses. DHSR’s announcement says that from January 1, 2010, agencies providing companion, sitter, respite or combined homemaker services had to be licensed as home care agencies ⁠¹⁷.
• 2019: a moratorium on new home care licenses for in-home aide services ran through June 30, 2019. DHSR announced it was lifted on July 1, 2019 ⁠¹³.
• November 9, 2023: S.L. 2023-150 split companion-only providers into the home assistance license and cut the initial home care fee from $560 to $510 ⁠¹⁵.
• January 1, 2026: Medicaid’s PCS policy 3L was last amended ⁠¹⁴.

Sources

1. 1
   North Carolina General Assembly, G.S. 131E-136: definitions (Home Care Agency Licensure Act) Checked 12 Oct 2026 · Back to text ↑
2. 2
   North Carolina General Assembly, G.S. 131E-138: licensure requirements Checked 12 Oct 2026 · Back to text ↑
3. 3
   North Carolina General Assembly, G.S. 131E-140: rules and enforcement Checked 12 Oct 2026 · Back to text ↑
4. 4
   North Carolina General Assembly, Chapter 131E, Article 6 (G.S. 131E-139, -141, -141.1 and -142) Checked 12 Oct 2026 · Back to text ↑
5. 5
   NC DHHS, Division of Health Service Regulation, Requirements for Establishing a Home Care Agency Checked 12 Oct 2026 · Back to text ↑
6. 6
   NC DHHS, Division of Health Service Regulation, Home Care Frequently Asked Questions (revised 5/30/25) Checked 12 Oct 2026 · Back to text ↑
7. 7
   NC DHHS, Division of Health Service Regulation, Fee Schedules: Home Care Checked 12 Oct 2026 · Back to text ↑
8. 8
   NC DHHS, Division of Health Service Regulation, Home Care Initial Survey Checklist (rev. 9/21) Checked 12 Oct 2026 · Back to text ↑
9. 9
   NC DHHS, Division of Health Service Regulation, Licensure Application for Home Care, Nursing Pool, and Hospice, DHSR-4204 (rev. 07/21) Checked 12 Oct 2026 · Back to text ↑
10. 10
    NC Office of Administrative Hearings, North Carolina Administrative Code, 10A NCAC 13J: The Licensing of Home Care Agencies Checked 12 Oct 2026 · Back to text ↑
11. 11
    NC DHHS, Division of Health Service Regulation, Home Care Provider Training Checked 12 Oct 2026 · Back to text ↑
12. 12
    North Carolina General Assembly, G.S. 131E-265: criminal history record checks of employees of certain providers Checked 12 Oct 2026 · Back to text ↑
13. 13
    NC DHHS, Division of Health Service Regulation, Acute and Home Care Announcements Checked 12 Oct 2026 · Back to text ↑
14. 14
    NC Medicaid, Division of Health Benefits, Clinical Coverage Policy 3L: State Plan Personal Care Services (PCS) in In-Home Settings (amended January 1, 2026) Checked 12 Oct 2026 · Back to text ↑
15. 15
    North Carolina General Assembly, Bill Summaries: S274 (2023-2024 Session), S.L. 2023-150 Checked 12 Oct 2026 · Back to text ↑
16. 16
    NC DHHS, Division of Health Service Regulation, Requirements for Establishing a Home Health Agency Checked 12 Oct 2026 · Back to text ↑
17. 17
    NC DHHS, Division of Health Service Regulation, In-Home Companion, Sitter, and Respite Care Services or Homemaker Services (announcement) Checked 12 Oct 2026 · Back to text ↑

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