Starting a care business in Pennsylvania

Child care is certified by the Office of Child Development and Early Learning (OCDEL), part of the Department of Human Services, through its regional offices. The license is called a certificate of compliance. One to three unrelated children need no certificate. Four to six in your home makes you a family child care home. Seven to 12 (or up to 15 older school-age children) makes you a group child care home, which can also operate in a residence. Seven or more anywhere else is a child care center. DHS charges no fee for these certificates, but a center cannot be certified without a certificate of occupancy under the state's child day care building standards, so local zoning and building approval usually sets the schedule. OCDEL is rewriting the certification rules: it expects public comment on the proposed rules in spring 2027 and final rules around mid-2028.

Residential care for adults has no small-home tier. Food, shelter and help with daily activities for more than 24 hours to four or more unrelated adults needs a license from the Bureau of Human Services Licensing in DHS's Office of Long-Term Living, and you choose between two models. A personal care home gives personal care and supervision but may not provide supplemental health care services, and its fee is $15 to $50 depending on bed count. An assisted living residence must make supplemental health care available, meet heavier building and staffing rules, and pay a $300 application fee plus a per-bed fee. Only an assisted living residence may use the words "assisted living". DHS counts about 1,000 personal care homes and 100 assisted living residences statewide.

Below four residents, the closest arrangement is a domiciliary care home. It is not an operating license: a local Area Agency on Aging certifies the home to house adults that the agency itself places there, so this site has no guide for it. Adult day care belongs to the Department of Aging, which issues an Older Adult Daily Living Center license to centers serving four or more non-relatives at once. A new center starts on an interim license after an onsite inspection, keeps one staff member for every seven clients, and pays $10 to $40 a year.

Both kinds of home-based care are licensed by the Department of Health's Division of Home Health. Non-medical personal care, household help and companionship need a home care agency or home care registry license, $100 a year for each office location, and since March 31, 2026 applications are accepted online only. Skilled nursing plus at least one other service needs a home health agency license ($250, one year). Pennsylvania's certificate of need authority terminated under section 904.1 of the Health Care Facilities Act, so neither license needs one. The real obstacle is federal: a nationwide moratorium on new Medicare home health enrollments took effect May 13, 2026, and Pennsylvania Medical Assistance pays only Medicare-certified agencies.