Starting a care business in Washington

Resident count decides the residential license. Giving room, board and personal care to one unrelated adult needs no license, but a second resident does: two to six unrelated adults in a residential home is an adult family home, and DSHS can later approve seven or eight. A building planned for seven or more residents from the start needs an assisted living facility license, and no new three-to-six-bed ALF licenses are issued. Neither needs a certificate of need, but an ALF's construction plans must be approved by DOH Construction Review Services before DSHS will license it. Since July 1, 2026, an ALF that markets memory care or has a unit with restricted egress also needs a separate DSHS memory care certification.

Child care centers and family homes share one rule chapter, WAC 110-300. Caring regularly for even one unrelated child in your own home requires a family home early learning program license for up to 12 children, though a provider with less than a year of licensed experience can request no more than six. Regular group care outside a family home needs a center early learning program license; nursery schools where no child is enrolled for more than four hours a day and seasonal camps of three months or less are excluded. Both start on a six-month initial license that DCYF can extend to two years before issuing a nonexpiring license. State fees are small: $30 a year for a family home, and $125 for a center's first 12 children plus $12 for each additional child.

DOH issues a single in-home services agency license with separate service categories, and it applies once you employ or contract with two or more people to provide care. Non-medical personal care, homemaking and respite need the home care category; two or more services such as nursing, therapy or home health aide visits need the home health category. Under fees in effect since June 1, 2026, each category costs $5,000 for the initial 12-month license, and DOH issues it only after an on-site survey. The license itself needs no certificate of need, but an agency that will be certified for Medicare or Medicaid needs DOH certificate of need approval for every county it serves. A CMS moratorium has also stopped Medicare enrollment of new home health agencies since May 13, 2026.

Adult day care is the one type with no state license. DSHS rules (WAC 388-71-0702) set requirements for adult day care and adult day health centers that contract with DSHS and say they also apply to privately paid centers, yet no license or registration for an adult day center appears in Washington's statutes or rules, and DSHS is not required to contract with any center. Ask DSHS before opening a private-pay-only program. A licensed assisted living facility may run adult day services on its premises for nonresidents, limited to ten continuous hours with no overnight stay.