Starting a care business in Louisiana

Child care has one license and one cutoff. Caring for six or fewer children in your home as the only caregiver needs no state license; you register with the Department of Education (LDOE) only if you take state or federal child care money. Once you care for seven or more unrelated children on a regular basis for at least 12.5 hours in a continuous seven-day week, you need an early learning center license. Its type follows your funding: Type I is for religious centers with no public funds, Type II allows only USDA food program money, and Type III is for centers paid with state or federal funds.

For adults who live where they receive care, Louisiana uses a single adult residential care provider (ARCP) license, issued at four levels. Level 1 covers 2 to 8 residents in a home-like setting, which is the license for a small care home. Level 2 covers 9 to 16 residents in a shared building, Level 3 covers 17 or more residents in apartments with kitchenettes, and Level 4 adds intermittent nursing. The license applies as soon as you house and care for two adults unrelated to you for pay. Act 740 of 2026 requires every licensed ARCP to have a generator or other backup power by July 1, 2027.

Louisiana has no certificate of need program. Its Facility Need Review (FNR) does a similar job. The personal care attendant, respite, supervised independent living and monitored in-home care modules of the home and community-based services (HCBS) license need FNR approval before you file a license application. The review costs $200 and approves you only if you show that people in your LDH region would likely face serious problems getting care without you. Adult day health care is not on the FNR list. The ARCP rule says Level 4 applicants licensed on or after August 1, 2022 no longer need FNR, but an LDH fee notice still refers to it, so confirm with the Health Standards Section.

Non-medical home care and social adult day programs both fall under the HCBS license, which has eight service modules. Hands-on personal care with daily activities, such as bathing, dressing and toileting, needs the personal care attendant module. A business that only provides sitting, housekeeping or meals is not an HCBS provider. Adult day care follows one of two routes. A medical-model program for two or more functionally impaired adults needs an adult day health care license, and a new center cannot open within 1,500 feet of another one unless both have the same owner. A social group program for ten or more such adults is licensed as the adult day care module of the HCBS license.

Home health is the hardest market to enter. R.S. 40:2116.32(F) bars LDH from issuing new home health agency licenses until it publishes a rule certifying that it can fund initial licensing surveys. LDH's home health page still refers applicants to this moratorium, and no such rule was found, so ask the Health Standards Section whether it is accepting new applications before you spend money. Medicare enrollment is blocked as well: a nationwide CMS moratorium on new home health agencies took effect May 13, 2026 for six months and can be extended. Louisiana Medicaid pays only for home health from Medicare-certified agencies.