Starting a care business in New York

Public need runs through New York's adult care rules. A licensed home care services agency (LHCSA) license covers all home care, with no cheaper non-medical tier: once a worker bathes, dresses or feeds a client, the license is required. It needs approval from the Public Health and Health Planning Council (PHHPC) and a $2,000 application fee, and since April 1, 2020 every application must show need county by county. Based on a 2022 survey, DOH presumes there is no need in 20 counties, including all five New York City boroughs. A certified home health agency (CHHA) faces its own county need formula in 10 NYCRR 760.5, and a new one must agree to serve its whole planning area and give charity care worth at least 2% of its projected operating costs.

Assisted living is two approvals stacked on top of each other. DOH first issues an adult care facility operating certificate, usually for an adult home or enriched housing program serving five or more unrelated adults, and operating one without DOH's written approval is a class A misdemeanor. DOH can deny a new adult home for lack of public need alone. The assisted living residence license sits on top of that certificate and is required before you use the words "assisted living". It has no need test, but its fee is $500 plus $50 for each resident whose income is above 400% of the federal poverty level, capped at $5,000. Residents who need hands-on help to transfer or walk, or who have dementia, call for the enhanced or special needs certifications.

Below five residents, the regulator changes. A family type home for adults is run by one or more individuals, never a corporation, who live in the home and care for four or fewer unrelated adults. You apply through your county department of social services, which inspects the house and recommends a decision, and OCFS issues a certificate for up to four years. Neither the rule nor OCFS's application pages list a fee.

Child care is sorted by headcount and by the New York City line. Caring for three to six children in your home for more than three hours a day per child requires a family day care registration, and seven to twelve children requires a group family day care license. OCFS sets the rules for both, and inside New York City the city Health Department handles the process. Centers split differently. Outside the city, OCFS licenses a child day care center for seven or more children and registers small centers for three to six. Social Services Law 390 does not apply to centers in the five boroughs, which need a city Group Child Care permit under Article 47 of the Health Code ($200 application fee as published on NYC Business). From June 5, 2027, state registrations and licenses can run up to six years instead of four.

New York has no stand-alone license a founder can get for an adult day program. Social adult day care has no specific license or certification, but a DOH managed long term care policy requires providers to meet the standards in 9 NYCRR 6654.20. Medical adult day health care exists only as an approved program on the operating certificate of a licensed nursing home, or at an approved extension site. For skilled home health, federal rules add one more gate: a CHHA must qualify for Medicare, and CMS has blocked Medicare enrollment of new home health agencies nationwide since May 13, 2026, for six months unless extended.