Starting a care business in Hawaii

Child care is sorted by how many unrelated children you care for at one time. Two or fewer needs nothing from DHS. Three to six in your own residence needs a family child care home registration, and the cap counts your own children under six who are in your care. Seven to twelve in a home that may be extended or modified is a group child care home, licensed under the same rule chapter as a group child care center. That chapter, HAR 17-892.2, only allows children aged two and older; infant and toddler centers apply under HAR 17-895.1, and before- and after-school programs under HAR 17-896.1. Neither DHS's application materials nor the rule chapters list a fee, so ask your island's licensing unit.

For housing adults, the model is the adult residential care home (ARCH), not assisted living. A Type I ARCH is licensed for five or fewer residents (six at DOH's discretion) and a Type II for six or more. After six months of satisfactory operation, an ARCH can apply to become an expanded ARCH and take residents who need nursing-home-level care. A home caring for just two or three adults may instead fit a Community Care Foster Family Home certificate of approval under HAR 11-800, which has no guide here; it costs $200 to obtain against $350 for an ARCH. An assisted living facility under HAR 11-90 is a building complex of private apartments of at least 220 square feet, each with its own bathroom and cooking capacity. OHCA listed only 17 of them in April 2026.

Daytime care for four or more disabled adults needs an adult day care center certificate of approval. Its rule is an old DHS chapter, HAR 17-1424, but OHCA runs the program and collects the $1,000 fee. If participants need nursing oversight, that is a freestanding adult day health center under HAR 11-96, which requires the SHPDA step first.

In-home care has two licenses and a firm line between them. A home care agency license ($1,500) covers personal care such as bathing and dressing, homemaker help and respite; a 2025 amendment to HRS 321-14.8 bars these agencies from providing nursing unless a licensed nurse does it. Skilled nursing plus at least one other therapeutic service to homebound patients needs a home health agency license ($2,750). SHPDA issues a certificate of need to agencies seeking Medicare or Medicaid certification and a no-CON letter to private-pay agencies. Separately, CMS stopped enrolling new home health agencies in Medicare nationwide on May 13, 2026.

Assisted living facilities and extended care ARCHs are exempt from Hawaii's certificate of need law (HRS 323D-54). The ALF rule, unchanged since 1999, is listed by DOH as pending amendment, with no draft posted as of October 12, 2026. OHCA's fees come from HAR 11-103.1, on schedules dated May 1, 2022; it refuses personal checks and cash.