Starting a care business in Utah

The Office of Licensing (OL) works under two sets of rules. Assisted living, personal care agencies and home health agencies are health care facilities under Utah Code Title 26B, Chapter 2, Part 2 and the R432 rules. Adult day care is a human services program under R501-13. Child care falls under R430 for homes and R381 for centers. OL's procedures rule, R380-600, sits on top of all of them, so every license runs one year, renewal is due 30 days before expiry, and a two-year license only becomes available after two consecutive license periods in good standing.

Residential care has no small-home shortcut. Utah has no adult foster or adult family home license for older adults, so a house caring for two to five unrelated residents is a limited capacity assisted living facility under the same R432-270 rule as a 100-bed building. You license as Type I if every resident can get out in an emergency without help, or Type II if they need limited help from one person; only Type II may run a secure dementia unit. A licensed assisted living facility can add respite and day services without a second license. A stand-alone day program needs an adult day care license once it serves three or more functionally impaired adults for at least four hours a day.

In-home care is licensed whether or not it is medical. Two or more people helping clients bathe, dress or eat need a personal care agency license, and that agency may not go beyond personal care. Nursing, therapy or aide visits by two or more direct care staff need a home health agency license. Both agency types, like assisted living, must run every caregiver through the state's Direct Access Clearance System (DACS), the state-run background clearance for workers with direct patient access. Medicare is a separate hurdle: a nationwide CMS moratorium on enrolling new home health agencies has been in place since May 13, 2026.

For children, the setting decides the license. In your own home, eight or fewer qualifying children are exempt (registration for background checks still applies), an optional residential certificate covers up to ten counting your own, and licensed family child care starts at nine unrelated children or more than ten in total. Away from a home, a child care center license applies from the fifth unrelated child; programs serving only children five and older fall under the out-of-school-time rule, R381-70. Both home child care rules were amended effective June 5, 2026, and the center rule, R381-100, on July 7, 2026.

The rules reviewed for these guides contain no certificate of need or moratorium for any of these businesses. Costs vary widely. OL's approved FY 2027 schedule charges $990 for a new adult day care license plus $24 per licensed place. The Legislature's FY 2027 fee proposal lists $62 plus a $200 new-center fee and $1.75 per child for a child care center, and a $2,138.52 category fee for a home health agency. The health facility fee schedule for assisted living and personal care agencies could not be retrieved, so ask OL for those amounts.