Starting a care business in Indiana

Indiana has no license called assisted living. What triggers a license is giving residents medication or residential nursing care: a health facility that does either needs a residential care facility license from IDOH, and no minimum bed count applies. A building that offers only room, meals, housekeeping, activities and limited help with daily activities needs no license, and a licensed home health agency may give medication or nursing care inside it, even under common ownership, provided each resident stays free to contract with other agencies. Indiana's certificate of need statute is written around comprehensive care (nursing home) beds, and no certificate of need for residential care beds appears in it.

In-home care splits on a single question: does the service need a health care professional's order? If not, attendant care, homemaker and companion services all fall under one personal services agency license, $250 a year through the IDOH Gateway. The only exemption for a working caregiver covers an individual serving family, or no more than 3 people per residence and 7 at once. Ordered care, such as nursing, therapy or home health aide visits, needs a home health agency license: State Form 4008, a $250 fee, a 90-day provisional license, and at least three active patients before IDOH surveys you. A licensed home health agency can add personal services without a second license.

Home health has a funding problem in late 2026. Since July 1, 2026, Indiana Medicaid has required home health agencies to be enrolled in Medicare, and since May 13, 2026, CMS has refused new home health enrollments nationwide under a six-month moratorium. The state license is not frozen and a private-pay agency can open, but the official bulletins do not say how a new agency can bill Medicaid while Medicare enrollment is closed.

Child care licensing starts at six children who are not your relatives in your own home, which requires a licensed child care home license: Class I for up to 12 children plus 3 school-age children, Class II for 13 to 16. Outside a residence there is no small-program floor, so even one child in paid care makes a licensed child care center, unless a church with 501(c)(3) status registers the program as a child care ministry instead. No license fee for either was found on FSSA's pages or in the rules. A 2025 law moved center ratios into statute from December 1, 2025, and FSSA is rewriting both the home and center rules, with January 1, 2027 listed as the anticipated effective date.

Two adult services have no guide because Indiana does not license them. Adult Family Care, where up to 4 waiver participants live with an unrelated caregiver, needs only FSSA waiver certification; a home that gives private-pay residents medication or nursing care is a different case and may fall under the residential care rule. No state license for adult day centers was found either: Medicaid waiver providers are certified by FSSA, each location separately, and no official page says whether a private-pay-only center needs anything, so ask FSSA before you open.