Starting a care business in Oklahoma

Hours a week, not headcount, decide whether a child care program is covered. Caring for unrelated children 15 or fewer hours a week is exempt, and so are programs on tribal land, a military base or other federal property. Above 15 hours, care in your own house is a family child care home for up to 7 children. Your own children under 5 count toward that limit. The large-home tier for 8 to 12 children is open only after six months running a licensed Oklahoma family home. Outside a residence, 30 or more hours a week makes the program a child care center, and it cannot take a single child until it passes a fire inspection and, unless it serves only limited food, a state health inspection. Neither OKDHS rule book lists a license fee.

OSDH's Health Facility Systems licenses the three residential and day settings, and the line between the first two is nursing. A residential care home gives housing, meals and supportive help to residents who can walk or wheel themselves and do not routinely need nursing. The Residential Care Act sets no bed count and expressly covers homes with three or fewer residents. Once two or more unrelated residents need personal care or nursing supervision, you need an assisted living center license, which takes an establishment approval and an initial license, both filed on ODH Form 624. An adult day care center is licensed when it serves unrelated impaired adults for more than four hours in a 24-hour period. Since November 1, 2023, OSDH has licensed the administrators of assisted living centers and residential care homes as Tier 2 long-term care administrators. State law also lists adult day center administrators under Tier 2, but the adult day rules do not say when a center must have one, so ask OSDH.

Home-based services go through OSDH's Home Services Division. An agency that only offers companionship, errands, meals and household help still needs a companion/sitter agency license before it provides or even advertises the service. Bathing, dressing or nursing requires a home care agency license. That one license covers both personal and skilled care, and your administrator must already hold an OSDH home care administrator certificate when you apply. Both licenses cost $1,000 to apply for. SoonerCare pays home health agencies only if they are Medicare certified or deemed, and CMS has not enrolled new home health agencies in Medicare since May 13, 2026.

None of these businesses needs a certificate of need. Oklahoma requires one only for the nursing part of a continuum of care facility, not for a stand-alone assisted living center, residential care home or adult day center. Several rules are moving. From November 1, 2025, Laws 2025, chapter 357 wrote the assisted living quality assurance committee into statute and widened what the medication rules must cover, and OSDH's posted copy of its assisted living rules predates that law. The center rules in Publication 14-05 took effect November 1, 2025, and in 2026 OSDH opened a consultation on changing the home care rules for ownership transfers. Ask the agency for the current text before you file.