Starting a care business in Illinois

The child care switch changed names as well as offices. The Child Care Act now speaks of "early care and education" homes and centers, but the rules, now 23 Ill. Adm. Code 2007 and 2008, still say "day care," and some forms and pages still carry the DCFS name. The thresholds stayed low. Caring for more than 3 children under 12 in your own home, counting your own children, requires a day care home license (up to 12 children, or 16 in a group day care home). Care for more than 3 children anywhere other than a family home is a day care center. The state charges no fee for either license. A new center gets one six-month permit and must earn its full license within that time, and in Chicago it also needs a city license. Starting July 1, 2027, some part-day programs for 3- and 4-year-olds, school-age camps and after-school programs will be able to register as Recognized Alternative Providers instead of getting a license, but no implementing rules for that registration had been found as of 2026-10-12.

For older adults, one law covers both residential models: the Assisted Living and Shared Housing Act (210 ILCS 9), administered by IDPH's Division of Assisted Living. Sleeping accommodations and the required services for 3 or more unrelated adults, at least 80% of them 55 or older, make you an assisted living establishment ($2,000 plus $20 per unit, as published). Illinois has no adult family home license. Its small-home option is the shared housing establishment, a free-standing residence for 16 or fewer people ($1,000). Neither needs a certificate of need, because the Health Facilities Planning Act excludes both. The real constraint is Section 75 of the Act: you may not admit or keep anyone who needs total help with 2 or more daily activities or more than minimal help to evacuate, among other limits. Both are private pay: resident contracts must say Medicaid does not cover services, apart from one Department on Aging demonstration project. The Medicaid-funded setting is HFS's Supportive Living Program, which is separate. Homes for 8 or fewer people with developmental disabilities go through CILA certification instead.

In-home care falls under a second IDPH statute, the Home Health, Home Services, and Home Nursing Agency Licensing Act (210 ILCS 55), and its rule, 77 Ill. Adm. Code 245. Non-medical help with daily activities, housekeeping, laundry or companionship requires a home services agency license: $1,500 a year, starting with a 240-day provisional license. The ban covers advertising as well as operating. Placement agencies, whose workers become the client's employees, need their own license. Skilled nursing plus at least one other service requires a home health agency license ($1,500 for two years). Shift nursing for Medicaid EPSDT or waiver clients is licensed separately as a home nursing agency.

The money question hits home health hardest. The HFS handbook gives a home health agency no Medicaid enrollment route without Medicare certification, and a nationwide CMS moratorium has blocked Medicare enrollment of new home health agencies since May 13, 2026. It runs for six months and can be extended in six-month steps. On the non-medical side, IDPH says the license covers private-pay and privately insured clients. Medicaid clients come through the Department on Aging's Community Care Program or DHS, and each approves providers separately.

For adult day care, the Department on Aging certifies Adult Day Service providers that serve Community Care Program participants aged 60 and over, under its program rules (Sections 240.1550 to 240.1560). None of the official sources reviewed requires a state license for a private-pay-only center, but none says such centers are exempt either. Ask the Department on Aging and IDPH before you open.