Starting a care business in Colorado

Child care licensing at CDEC starts above a fixed exemption: up to four children in your home, your own included, with no more than two under age 2, needs no license, and CDEC no longer issues exemption letters. Past that, a family child care home license comes in five types, and a first-time provider usually qualifies only for the regular license of six children plus two school-age. A child care center license is small up to 15 children and large from 16. Both apply at least 60 days before opening, and any program enrolling children 5 or younger must join the Colorado Shines rating system. As published on 2026-10-12, the state fees in 8 CCR 1402-1 are $65 a year for a regular home license and $200 for a small center, while a large center pays a $175 or $300 base plus $3 per child, capped at $1,800, again every year.

Adult residential care has a single door. Room, board, personal services and 24-hour supervision for three or more adults not related to the owner requires an assisted living residence license, and Colorado has no adult family home or other small-home license, so a three-bed house follows the same rules as a large building. The 2026/2027 initial fee starts at $7,789.94 for 3-8 beds. CDPHE will not issue the license until the Division of Fire Prevention and Control sends a Certificate of Compliance, and it says the process typically takes 3 to 12 months. A 2025 law, HB25-1213, says ALRs that are not new construction or major renovations must be exempt from FGI design guidelines, yet the rules and fee schedule still list FGI plan review for every initial license, so ask CDPHE before you budget for it.

Home care uses one CDPHE license in two classes. A Class B home care agency provides personal care only, and Colorado counts companionship, housekeeping, laundry and medication reminders as personal care, so a companion-care company with employees needs the license; only housekeeping-only businesses and people working alone without staff fall outside it. Any skilled service, including certified nurse aide work under a licensed professional's supervision, requires a Class A license, which costs $3,709.49 initially against $2,720.30 for Class B on the 2026/2027 schedule and carries a $500,000 per-occurrence insurance minimum against $100,000. Neither class needs a fire or FGI plan review, but both need an on-site survey with zero deficiencies before the license issues.

Medicaid rules shape the business case. Since Community First Choice began on July 1, 2025, Health First Colorado pays for personal care only through Class A or Class B licensed agencies. Medicaid home health and private duty nursing require a Class A agency that is also Medicare-certified, and CMS has blocked new Medicare home health enrollments nationwide since May 13, 2026. Adult day care has no guide here because Colorado has no state adult day license: a program applies to CDPHE for a survey and certification only to bill Medicaid waivers, and CDPHE's page does not address private-pay-only programs, so confirm with CDPHE.

CDPHE posts new fee schedules by March 1 each year, effective July 1, so its figures above apply to applications filed from July 1, 2026. HB26-1107, signed in May 2026, will require every licensed facility offering dementia care to hand out a CDPHE dementia care services form from October 1, 2027.