Starting a care business in Arizona

For children, the number five decides almost everything. Caring for up to four children for pay in your own home, plus your own children, needs no ADHS certificate; the Department of Economic Security (DES) separately certifies family child care homes of up to four children, and contracts with providers paid through child care assistance. At five paid children through age 12, a home needs a child care group home certificate: the provider must live in the residence, no more than 10 paid children and 15 children in total may be present, and ADHS's published fee is $330 a year. Care for five or more unrelated children anywhere other than a certified group home, including any group above 10, requires a child care facility license, and in that law a child is anyone through age 14.

Arizona has no separate personal care home or residential care home license. Every residence that gives supervisory, personal or directed care on a continuous basis is an assisted living facility, sized as an adult foster care home (1 to 4 adults), an assisted living home (10 or fewer residents) or an assisted living center (11 or more). The adult foster care home is narrow: its residents must be Arizona Long Term Care System (ALTCS) participants or under a U.S. Department of Veterans Affairs contract, and the sponsor or manager must live there, so a small private-pay home needs the assisted living home license. You name one care level on the application, and except in an adult foster care home the manager needs a certificate from the Board of Examiners of Nursing Care Institution Administrators and Assisted Living Facility Managers.

A paid, regular day program for five or more unrelated adults needs an adult day health care facility license from the same bureau that licenses assisted living; four or fewer are exempt. The optional therapeutic services it may offer do not include behavioral health services (A.R.S. 36-401), and ADHS must approve your building plans and pass a licensing inspection before you open. Its fee schedule is shared with assisted living, but ADHS's sources do not say whether a day program pays the $280 no-capacity rate or $70 per participant on top, so ask the bureau before you budget.

In-home care splits in two. Nurses, therapists or home health aides sent to patients under a physician's plan need a home health agency license from the Bureau of Medical Facilities Licensing: a $50 application fee, a $365 annual licensing fee, no building plan review, and a fingerprint clearance card for an individual applicant or each owner of 10% or more. Since May 13, 2026, a federal moratorium has blocked new home health agencies from enrolling in Medicare, though ADHS can still license an agency for private-pay or AHCCCS (Medicaid) clients. Companion, homemaker and personal care agencies without nursing fit no health care institution class in A.R.S. 36-401, so no state license appears to apply to private-pay work; ADHS does not say so outright, so confirm with the bureau, and expect AHCCCS or DES contract rules if you serve state programs.

The ADHS licenses for assisted living, adult day health care and home health do not expire as long as you pay the licensing fee every year, and ADHS must inspect each assisted living facility at least once a year. Several rules changed recently: home health agencies, assisted living facilities and other employers covered by A.R.S. 36-411 have had to check the adult protective services registry before hiring since January 1, 2025; staff at facilities licensed for directed care need memory care training under a statute effective after June 30, 2025; and since April 6, 2026, a person who receives no care may live in an assisted living unit if the facility allows it.