Starting a care business in Iowa

For child care, the count of children present at one time decides your path. A home may care for five children, or six if at least one is school-aged, without registering. Your own children count unless they are in school or in full-time care elsewhere. Above that, you register with HHS as a child development home in Category A, B or C, which differ in capacity, age, experience and space. Seven or more children anywhere other than a registered home is a child care center, and the center license also covers preschools. Before you apply for a center license, DIAL must approve the building code review and a fire inspector must inspect the building. Center fees in 441 IAC 109 run from $50 to $150 depending on licensed capacity.

The adult programs DIAL certifies split by setting. Housing with personal or health-related care for three or more tenants is an assisted living program. A single-family house where a manager is on site 24 hours a day serving three to five unrelated adults aged 60 or older can be certified instead as an elder group home. Daytime care for two or more adults with a functional impairment is an adult day services program, and small programs get no exemption. All three charge $750 for initial certification and $1,000 to recertify. Assisted living and adult day programs can be certified through CARF accreditation for a $125 fee, but they still need building and fire approval.

Assisted living programs are exempt from Iowa's certificate-of-need requirement by statute, and Iowa's landlord-tenant act applies to them, so the people you serve are tenants under an occupancy agreement. Your building goes through DIAL's state plan review even where a city enforces its own code, and the blueprint review fee is $900. Elder group homes also pay $900 for plan review, and cities and counties must treat them as family homes for zoning. Local governments may still limit how close one is to another.

Iowa issues no state license for home care. DIAL does not list private-pay companion, homemaker or personal care agencies as a regulated facility type. Health care employment agencies register with DIAL each year, but only if they supply staff to health care facilities. Skilled home health agencies have no state license either, so billing Medicare or Iowa Medicaid depends on Medicare certification, with DIAL acting as the federal survey agency. Agencies that bill Iowa Medicaid home- and community-based services also have to meet its provider enrollment rules. A house renting rooms to three or more unrelated people who need help with daily tasks, and that no other agency regulates, must register as a boarding home with DIAL under Iowa Code 135O; it is a registration with occupancy reports, not a certification. Larger residential care facilities licensed under Iowa Code 135C are a separate category not covered here, though Iowa Code 135.62 exempts them from certificate-of-need review.

Several of these rules changed in 2025 and 2026. HHS readopted the center rules effective July 1, 2025. DIAL rewrote its assisted living, elder group home and adult day chapters effective March 11, 2026, and fire rules moved into 481 IAC 280 in September 2025. HHS has also proposed replacing the child development home rules with a new chapter that would add child care homes holding a Child Care Assistance agreement (ARC 0540D, September 2026). As of October 12, 2026, that change was still only a proposal.