Starting a care business in West Virginia

Child care runs on a headcount ladder set in W. Va. Code 49-1-206, and your own children under six living in the home count. Three or fewer children, or care only for close relatives, needs nothing, though you may register voluntarily under 78CSR20. Four to six children in your own residence needs a family child care home certificate of registration, issued on your self-certification under 78CSR19 and good for up to two years. Seven to 12 children, in a residence or a separate building, needs a family child care facility statement of certification under 78CSR18, with two staff on duty above six children, an annual State Fire Marshal inspection and an initial six-month license. At 13 or more children in a program open over 30 days a year per child, you need a child care center license under 78CSR1.

A center does not start with an application. You send a Needs Assessment and Letter of Intent to the Child Care Regulation Unit, line up State Fire Marshal, county health department and Department of Agriculture pest management approvals, and show verified access to at least six months of operating expenses; consumer credit cards do not count. The Division then mails the application, and the statute gives it 60 days to decide. The Division's packet says there is no application processing fee.

For adults who live in the home, the line is four residents. Giving personal assistance for more than 24 hours to one, two or three unrelated adults requires a free OHFLAC registration as a legally unlicensed health care home; you and every adult in the household must first clear WV CARES fingerprint checks, and one provider (a married couple counts as one) may run only one such home. A fourth unrelated resident makes the place an assisted living residence needing an OHFLAC license under 71CSR21. OHFLAC's application splits residences into small (4 to 16 beds) and large (17 or more), which changes administrator education, drawing and room-size rules. Nursing is capped at limited and intermittent care, and advertising a dementia unit needs a second license under 71CSR19. Separately, the Bureau for Social Services certifies subsidized Adult Family Care homes for up to three adults.

Adult day care is licensed only in its medical form. A medical adult day care center license from OHFLAC under 71CSR20 covers organized therapeutic, health and restorative day programs; mainly social and recreational programs fall outside the rule. Before an initial license, a project that is reviewable under the certificate of need law must pass the Health Care Authority's conformance review, and the statute does not say clearly whether a new center is reviewable, so ask the Authority first. Home health has no state license at all: W. Va. Code 16-2D-8 requires a certificate of need to establish a home health agency regardless of cost, and OHFLAC handles the federal certification of health facilities. Private-pay companion and homemaker agencies need no state license or registration, but providing personal care services also needs a certificate of need, a term the Code ties to agencies approved by the Bureau for Medical Services; confirm with the Authority before offering hands-on care privately.

Many forms still use old names. Senate Bill 300 (2024) moved assisted living and the small-home registration into Chapter 16B under the Office of Inspector General, and on May 28, 2025 the OHFLAC rules were renumbered from title 64 to title 71. The former Department of Health and Human Resources is now the Department of Human Services. An amended assisted living rule took effect May 1, 2026, and the child care center and home rules sunset August 1, 2028. Senate Bill 1056 of 2026, which would have widened informal family child care to 12 children, was last referred to the Senate Judiciary Committee and has not changed the law.