Starting a care business in Alabama

Child care is DHR's job, and the bar is low: caring for even one unrelated child away from the child's own home for more than four hours in a day requires a license. A family day care home may take up to 6 children, counting your own children under school age; 7 to 12 children in a home is a group day care home, which needs a second adult on duty. Above 12 children you need a day care center license, valid for two years. Care after 7:00 p.m. is licensed as a nighttime home or center. A preschool that is part of a church ministry or a religious nonprofit school may run license-exempt under Code of Ala. 38-7-3, but it still files fire and health reports with DHR every year. All initial and renewal applications have gone through DHR's Arise online portal since November 22, 2024.

Any home or building that provides any combination of residence, health supervision and personal care to three or more adults who need help with daily activities needs an assisted living facility license from ADPH. New facilities are licensed as group (3 to 16 adults) or congregate (17 or more). There is no small-home license: the family assisted living category for two or three adults closed to new licenses on October 1, 2015, and ADPH grants no new license under three beds. Residents with dementia-level impairment need a separate specialty care assisted living license under rule 420-5-20, and the administrator must hold a license from the Board of Examiners of Assisted Living Administrators. The ADPH fee is $240 plus $18 per bed a year. Alabama's State Health Plan says assisted living is available on a private-pay basis only.

Certificate of need is the main blocker. Specialty care beds go through it, and the State Health Plan adds none in a county that already has six or more such beds per 1,000 residents aged 65 and older, apart from narrow adjustments. Regular assisted living is not on the certificate-of-need list, but the rules do not say outright that it is exempt, so get written confirmation from the State Health Planning and Development Agency (SHPDA) before you buy or build.

Alabama does not license skilled home health agencies. An agency needs a SHPDA certificate of need, and the State Health Plan shows need for one more agency in a county only when its projected unmet need reaches 100 or more persons served. The agency then seeks Medicare and Medicaid certification through ADPH. Since May 13, 2026, a six-month federal moratorium has also stopped new home health agencies from enrolling in Medicare.

Two types have no state license. Adult day care programs are not licensed by any Alabama department. A center that wants public funding is approved by the paying agency: DHR, the Department of Senior Services or the Alabama Medicaid Agency. No state license or registration was found for private-pay companion or homemaker agencies, and ADPH's provider categories do not include them. Agencies paid through the Medicaid Elderly and Disabled Waiver must meet that waiver's provider rules. Check city and county business licensing for either type.