Starting a care business in Massachusetts

All child care runs under one regulation, 606 CMR 7.00, and the setting decides which license you need. Care in your own home needs a family child care license. EEC charges nothing to apply and estimates 2 to 6 months for the process. Every new provider starts at a maximum of 6 children, because the 7-8 and 9-10 child tiers require years of experience as an FCC licensee or certified assistant. Outside a private residence, 10 or fewer children needs a Small Group license and 11 or more needs a Large Group license; both are explained in the group and school age child care guide. Occasional care and informal arrangements among relatives or neighbors fall outside licensing, within limits EEC's policy spells out.

Assisted living is certified, not licensed, but certification is mandatory, and the penalty for operating without it is up to $500 a day. ALR certification applies once you provide room and board plus personal care to three or more unrelated adults and charge for that help. Personal care includes simply reminding residents to take their medication. Massachusetts has no separate license for small adult family homes, so a house with three such residents is an assisted living residence whatever its size. The application goes to EOAI at least 90 days before opening. Fees as published are $200 per application and $125 per certified unit every two years. Injections, oxygen management and the other Basic Health Services need a second EOAI certification under the rules reissued on July 31, 2026.

Massachusetts has a Determination of Need program, but certified assisted living residences are outside it, and DPH says the same of adult day health programs. Any program that offers nursing care, supervision and health support in a group day setting to adults 18 or older needs a DPH license before serving its first participant, whether or not it accepts MassHealth. MassHealth froze new adult day health enrollment for six months starting May 19, 2026. The freeze does not stop licensing, but a new program may not be able to bill MassHealth when it opens. DPH's pages do not say whether a purely social day program needs a license, and no official source states the adult day health fee. Rest homes are different: they are DPH-licensed institutions caring for 4 or more ambulatory people, and applicants must first meet any applicable Determination of Need and Plan Review requirements.

Care in clients' homes is in transition. As of October 12, 2026, Massachusetts requires no statewide license for non-medical home care. Chapter 180 of the Acts of 2026, approved August 6, 2026, will require a home care agency license for anyone who provides home care services or uses the words "home care" to describe them. Before that happens, EOHHS must issue temporary licenses within 180 days of the act's effective date (to applicants verified as contracted with an aging services access point or MassHealth), adopt full regulations within one year, and then set a compliance date no later than one year after adopting them. Skilled home health has no state license either: DPH states that its laws do not license home health agencies. An agency that wants to bill Medicare goes through Medicare certification, which DPH handles for CMS and which requires skilled nursing plus at least one other qualifying service. A home health agency that acts as an employment agency also needs a license from the Department of Labor Standards.