Starting a care business in Rhode Island

Child care rules changed in summer 2026. DHS amended its center rule effective July 7 and rewrote its family home rule effective August 9, and both applications now run through its RISES online system. A family child care home license applies once you care for four or more unrelated children in a home you live in, and you need at least one approved assistant before licensure even if you plan to work alone. You may care for 6 children alone or 8 with an assistant on site; going to 12 requires group home qualifications and local zoning compliance. A child care center has no minimum count: any program outside a home that cares for a child under 16, paid or unpaid, needs a license. The statute sets fees of $100 for a family home, $250 for a group home and $500 for a center, and each new license starts with six provisional months.

For residential care the dividing line is six adults. Lodging, meals and personal assistance for six or more unrelated adults require an assisted living residence license, which names a fire level (F1 or F2) and a medication level (M1 or M2) and, as published on 2026-10-12, costs $330 a year plus $70 per licensed bed. Assisted living is not on the state's certificate-of-need list. Two to five adults make an adult supportive care home, but only an operator that already holds a RIDOH license as a home nursing care provider, nursing facility, assisted living residence or adult day program can get one. As of 2026-10-12, RIDOH had published no rule, application form or fee for these homes.

An adult day care program license is free as published on 2026-10-12, and the rule sets no minimum participant count, although at least 51% of average daily attendance must be 55 or older. Licenses expire March 31 of each odd-numbered year. You need your certificate of occupancy, a State Fire Marshal inspection and a RIDOH food service license before you apply, and you need a nurse on site at least 6 hours a day.

In-home care is where the law is in flux. No companion-only exemption exists: an agency that sends homemakers or nursing assistants needs a home care provider license, and one that sends its own RNs, LPNs or licensed therapists needs a home nursing care provider license. Both cost $650 a year, require $10,000 per-loss bonding and $500,000 per-occurrence liability insurance, and must be accredited within two years of first licensure. Until June 12, 2026, both also needed a certificate of need. Article 12 of the FY2027 budget (P.L. 2026, ch. 84) struck both agency types from the certificate-of-need statute, effective on passage, June 12, 2026, but as of 2026-11-11 RIDOH's rule and web pages still make a certificate of need a precondition for both, so ask RIDOH in writing whether it still expects a Letter of Intent before you file one.

Payer freezes also limit new home agencies. Rhode Island Medicaid is approving no new Severely Disabled Nursing Homecare (Type 65) or Personal Care Aide (Type 72) providers from July 1, 2026, to January 1, 2027. Its home health program pays only Medicare-certified agencies, and CMS has denied initial Medicare enrollments from home health agencies nationwide since May 13, 2026. A RIDOH license alone still lets you serve private-pay clients.