Care business licenses by type
States license care businesses by what they do and for whom: children or adults, in a home or a facility, with or without nursing. Each type below has its own page comparing the license, the agency and the size limits in all 50 states and DC.
7 business types
With the number of jurisdictions, of 51, that require a state license or registration
- Family child care homeChild care for a small group of children in the provider's own home. License or registration in 49 of 51.
- Child care centerDaycare in a non-residential building, licensed in every state. License or registration in 51 of 51.
- Assisted living facilityHousing with personal care and supervision for adults, licensed in every state. License or registration in 51 of 51.
- Small residential care homeAdult family, foster and care homes for a few residents in a home setting. License or registration in 47 of 51.
- Adult day careDaytime care and activities for adults who live at home. License or registration in 33 of 51.
- Non-medical home care agencyPersonal care and companion services in clients' homes, without skilled nursing. License or registration in 33 of 51.
- Home health agencySkilled nursing and therapy at home, licensed by the state or certified by Medicare. License or registration in 44 of 51.
How care licensing fits together
Two separate approvals often apply to the same business. The state license is permission to operate at all, issued by the agency that inspects the program. Certification for Medicaid or Medicare is permission to bill those programs, and it comes with its own conditions. Some states license a type of care directly; others leave it to the funding programs, which is why a few types show “certification only” in some states.
Cities and counties add zoning, business licenses, fire inspections and occupancy rules on top of the state license. Each type page shows the state-level answer for every state and links to the agency that issues it.
The federal and business steps that come with any license, from the EIN and NPI to Medicaid enrollment and electronic visit verification, are in order in Beyond the state license.
Federal programs
- Medicare
- Certification of home health agencies under the CMS Conditions of Participation
- Medicaid waivers
- Home and community-based services such as adult day and personal care, run by each state
- CCDF
- Child care subsidies, with health and safety rules for providers who accept them