Starting a care business in District of Columbia

OSSE's license starts at more than two unrelated children cared for on a regular basis. In your own home, a child development home takes up to six children, and an expanded home takes up to 12 with at least two caregivers. In a home the licensee has to live in the dwelling, and in an expanded home the primary caregiver does. You also need a Home Occupation Permit from the Department of Buildings, which is not available in multifamily buildings with more than two units. More than 12 children in a building that is not your home makes a child development center. Licenses run three years, and the initial center fee is $600 to $1,500 depending on capacity. OSSE's staff credential rules were amended in a final rule adopted May 7, 2025.

For adults who need a place to live, DC Health issues two licenses. An assisted living residence combines housing, health services and personal help under individual service plans. The statute sets no minimum number of residents, and DC Code § 44-110.12 exempts ALRs from the Certificate of Need. The license is renewed every 12 months at $100 plus $6 per licensed resident. Since July 19, 2024, the DC Board of Nursing has regulated the required assisted living administrator license. A community residence facility offers a sheltered living environment to adults 18 and older, with yearly licenses whose fees are set by bed count. Mental health community residences are licensed by the Department of Behavioral Health instead. DC Health issues no new licenses for intellectual disability group homes while the ICF/IID enrollment freeze that began June 1, 2018 continues.

Home care is divided by skill level. An agency whose aides provide personal care, with no skilled services, needs a home support agency license under 22-B DCMR Chapter 99 (effective August 7, 2020). It must keep a staffed office inside DC and starts on a 90-day provisional license. A permanent license requires at least five clients. Whether an agency offering only companion services needs this license is not settled in the rules, so ask DC Health. An agency providing skilled nursing plus at least one other therapeutic service needs a home care agency license, and the application must list a SHPDA Certificate of Need. SHPDA tells applicants to allow about six months for the CON. A nationwide CMS moratorium on new Medicare home health enrollment also began on May 13, 2026.

Adult day care has no DC Health license category. An adult day health program that wants to bill DC Medicaid needs a provider agreement with the Department of Health Care Finance (DHCF), a Certificate of Need and a readiness review. A program that will not bill Medicaid should ask SHPDA whether it needs a CON as a medically supervised day care. Since May 3, 2023, DC Health has accepted license applications, renewals and payments only through its online licensing portal.