Starting a care business in Georgia

Georgia's CON program sits in the Office of Health Planning. A new home health agency cannot finish its HFRD application without a CON, and DCH's batching notices of October 1, 2025, April 1, 2026 and September 30, 2026 accepted no new or expanded home health applications, not even under the need-formula exceptions. The next assessment is due on or around March 31, 2027. For care homes the trigger is size plus Medicaid: DCH's fact sheet requires a full CON only for "personal care homes with 25 or more beds that are Medicaid certified," but every initial application at 25 beds or more needs a letter of determination from the same office, a $500 request under Rule 111-2-2, which DCH revised effective January 13, 2025. HB 1339, signed April 19, 2024, added CON exemptions; anyone who believes a project is exempt must still request a letter of determination before starting it. A private home care provider needs no CON as long as it does not operate as a home health agency or personal care home.

Residential care for adults starts with a personal care home permit from the second unrelated adult who gets housing, meals and one personal service. The rule has no small-home tier, but DCH's checklist requires sprinklers from 7 beds, and at 25 beds the administrator needs a license from the State Board of Long-Term Care Facility Administrators and the file needs a CPA financial stability affidavit. "Assisted living" is a protected tier: only a home of 25 or more residents holding an assisted living community permit may provide assisted living care, defined as personal services, medication administration by certified medication aides and limited nursing, and a personal care home may not use the term in its name or marketing. Its building is held to a health care level of fire code under the Safety Fire Commissioner's rules, Chapter 19 or Georgia's own Chapters 34 and 35 of NFPA 101, and new buildings must be fully sprinklered.

Care in clients' homes has two very different doors. One private home care provider license covers companion or sitter work, personal care and nursing; HFRD's checklist updated August 6, 2026 asks for a registered nurse even on a companion-only application, and approval brings a three-month provisional license in which you must admit at least three clients and request the initial survey. Only a person working alone, with no employees, contractors or referral arrangements, is exempt. Skilled home health adds the CON gate and a federal one: CMS stopped enrolling new home health agencies in Medicare on May 13, 2026 for six months, and as of November 11, 2026 it had published no extension in the Federal Register. Buying a licensed agency is a change of ownership that needs no CON, though unless an exception applies, a majority ownership change within 36 months of Medicare enrollment counts as a new enrollment, which the moratorium blocks.

A paid daytime program for three or more aging adults needs an adult day center license, filed in HFRD's GAHLES portal as a social model or a medical model with a registered nurse. Staffing is at least one direct-care staff member or volunteer per eight participants, and an amendment to the personnel rule covering background checks, training and employee health screening took effect July 29, 2026. HFRD's checklist wants zoning approval and a fire inspection dated within six months before you file.

Child care runs through DECAL's KOALA portal, and licensure orientation comes before either application (up to 16 hours for a center). Caring in your own home for three to six unrelated children under 13 needs a family child care learning home license, held by a provider aged 21 or older with an early childhood credential; its staffing and supervision rule, 290-2-3-.07, was last amended effective September 22, 2026. Seven or more children under 18 needs a child care learning center license, and the State Fire Marshal summary in DECAL's applicant guide places centers for more than 12 children under state fire jurisdiction, with plans submitted for new buildings and conversions. Both licenses run on the calendar year, so every current license expires December 31, 2026 with the 2027 fee due by December 1, and only programs that are Quality Rated or in provisional or probationary status receive CAPS subsidy payments.