How to Start a Home Health Care Business in California

October 29, 2026

If you plan to send nurses into patients' homes in California, you are starting a regulated business. Skilled nursing care in a home requires a home health agency license from the California Department of Public Health (CDPH), Licensing and Certification Program. This guide explains how to start a home health agency in California in the order most founders need it: what the law counts as a home health agency, how the license works, how to certify aides, and how Medicare and Medi-Cal fit in. It also covers the business formation steps that should come first.

Disclaimer: This article is informational content, not legal or tax advice. Licensing rules, fees, and deadlines change, and your facts may differ. Talk to a California health care attorney and a CPA before you form your entity, sign a lease, or hire staff.

What Makes an Organization a Home Health Agency

A home health agency (HHA) is an organization that provides or arranges skilled nursing services in a person's home. Under Health and Safety Code (HSC) 1727, skilled nursing services are services provided by a registered nurse (RN) or a licensed vocational nurse (LVN). No organization may provide or arrange skilled nursing in the home without a home health agency license from CDPH (HSC 1725 and 1726).

The word “arranges” matters. The requirement covers organizations that employ the nurses and organizations that arrange for them. Before you market the business, describe your staffing model to CDPH in writing and confirm how the state treats it.

Two name rules apply from day one. An unlicensed organization may not use “home health agency,” “home health,” “in-home health,” “skilled,” or “nursing” in its name or advertising to imply that it is licensed (HSC 1726(b)). A licensed hospital does not need a separate home health agency license, but it must still be approved (HSC 1732). If a hospital is part of your plan, confirm that approval path with CDPH.

Do not confuse a home health agency with a Home Care Organization (HCO). A licensed home health agency is not an HCO. If you also want to offer non-medical help such as companionship or housekeeping, that work requires a separate license from the Department of Social Services (HSC 1796.17). Our separate home care guide covers that license, so this article does not discuss it.

Materials and Documents You Will Need

Gather these items before you start the license process. Some of them take weeks to assemble, and a missing document will slow your application.

• Entity formation documents: Articles of Organization (Form LLC-1) for an LLC, or Articles of Incorporation for a stock corporation, filed with the Secretary of State
• A California registered agent: an individual who lives in California or a corporation holding a Corporations Code 1505 certificate
• A California office address: an LLC must keep an office in California, which need not be a place of business activity
• The CDPH home health agency application packet: the sworn application form and the supporting items the packet requires
• The CDPH fee: one fee for the main office and one for each branch. Confirm the current amount with CDPH, since the fee is set under HSC 1266
• A staffing plan: the RNs, LVNs, and certified home health aides you expect to employ or arrange
• Financial and policy documents: the packet specifies what you must provide. Confirm the list with CDPH
• A federal employer identification number (EIN) from the IRS
• State tax and employer accounts: a CDTFA seller's permit if you sell taxable goods, and an EDD employer account if you have employees
• Local registration: a city business tax or registration certificate, where your city requires one

Step-by-Step: Getting Your Home Health Agency License

1. Choose your entity type and form it with the Secretary of State. Most founders choose an LLC or a corporation. An LLC filing with Form LLC-1 costs $70. Stock corporation articles cost $100. You can reserve a name for $10, which lasts 60 days. An LLC name must include “limited liability company,” “L.L.C.,” or “LLC,” and may not include words such as “bank,” “trust,” “inc.,” “corporation,” or “corp.” California does not allow a domestic series LLC. An LLC also cannot render a licensed professional service, and professional corporations are used instead. Whether your nursing services require a professional corporation is a question for an attorney. Start at the Secretary of State's Business Programs Division or file through bizfile Online.

2. Calendar your Statement of Information. An LLC files Form LLC-12 within 90 days of filing its articles and then every two years, at $20 each time. A corporation files Form SI-550 within 90 days and then every year, at $25 each time. A $250 penalty applies if the filing is missed after a Secretary of State notice, so track these deadlines from the start.

3. Plan for franchise tax. Every LLC organized or registered in California in 2024 through 2026 owes the $800 minimum annual franchise tax from its first year. An LLC whose first taxable year begins in 2027, 2028, or 2029 pays $400 in year one under RTC 17941(g)(2), so confirm that amount with the Franchise Tax Board. The LLC fee is $900, $2,500, $6,000, or $11,790 once California-source total income reaches $250,000, $500,000, $1,000,000, or $5,000,000. A newly incorporated corporation or S corporation owes no $800 minimum in its first taxable year. Review these figures with a CPA before you set your budget.

4. Register with the state tax and employment agencies. If you sell taxable goods, such as medical supplies, register with the California Department of Tax and Fee Administration (CDTFA) for a seller's permit. The permit is free. The statewide base sales tax is 7.25%, and city rates with district taxes run from 7.25% to 11.75%. If you have employees, register with the Employment Development Department (EDD). Visit CDTFA, EDD, and the Franchise Tax Board for current forms.

5. File a fictitious business name statement if needed. If your agency will operate under a name other than its legal name, file a Fictitious Business Name Statement with the county clerk-recorder within 40 days of starting to do business. You must publish it in a newspaper once a week for four weeks, and the statement expires after five years. The statutory filing fee is $10 plus $2 per additional name or owner, but counties charge more and the newspaper publication fee is separate. Check your county's fee schedule. Details are at the Secretary of State's fictitious business names page.

6. Check local requirements. California has no general statewide business license. Most cities charge a local business tax or registration certificate, and 445 of 483 cities report revenue from one. There is no common formula, so the answer depends on your city. Counties license only regulated activities. Ask your city's business license office what applies to your address.

7. Obtain the CDPH packet and complete the sworn application. Request the home health agency application packet from CDPH. The application is sworn, so every answer must be accurate. Ask CDPH to confirm the current fee, the required administrator and director of nursing qualifications, the financial and policy requirements, and whether any moratorium on new licenses applies in your county. Those points change, and this article does not state them as settled figures.

8. Submit the application and respond to CDPH follow-up. Submit the completed packet with the fee for your main office and each branch (HSC 1728 and 1729). Expect CDPH to review the file and ask questions. Ask CDPH how long its review takes. This article does not quote a licensing timeline, because the time depends on the application's completeness and CDPH's current workload.

9. Operate under the license and renew on time. A home health agency license expires 12 months after issuance. You must renew it every year, and the renewal must be filed at least 30 days before expiration (HSC 1730). Put that deadline on your calendar the day you receive the license, and track any change in ownership, address, or branch status with CDPH.

Certifying Home Health Aides

Home health aide services are personal care provided under a plan of treatment prescribed by the patient's physician and surgeon (HSC 1727(d)). Aides are part of the agency's care model, so plan their certification at the same time you prepare the license application. Each certified aide must meet these requirements:

• Training: complete a state-approved training program of at least 75 hours, or pass an equivalent competency evaluation (HSC 1736.1)
• Criminal record clearance: submit fingerprints for a criminal record clearance through the Department of Justice (HSC 1736.6)
• Convictions: certain convictions bar certification (HSC 1736.5). Review the current list with CDPH before you extend an offer, and do not rely on a summary from a third party

Wages are part of the same hiring plan. California's minimum wage is $16.90 in 2026 and is scheduled to rise to $17.40 on January 1, 2027. These figures come from a secondary source, so verify both before you set pay rates. Build fingerprinting and clearance into your hiring workflow so you know each aide's status before you assign a patient.

Medicare and Medi-Cal

A state license does not make an agency eligible for Medicare or Medi-Cal payments. These are separate processes with their own applications and surveys, and each one takes time and paperwork of its own. Plan for them as distinct projects.

Medicare certification is a federal process administered through the Centers for Medicare & Medicaid Services (CMS). If you intend to serve Medicare beneficiaries, you must complete its enrollment and certification steps. Confirm the current requirements with CMS at cms.gov and ask CDPH how its state licensing review relates to the federal survey.

Medi-Cal enrollment is a separate state process through the Department of Health Care Services (DHCS). Check the enrollment requirements at dhcs.ca.gov. Ask DHCS which documents and licenses it needs before it will approve your enrollment, and whether your license must be in place first.

Common Mistakes to Avoid

• Using restricted words too early. Do not put “home health” or “skilled nursing” in your name, website, or ads before you hold a license (HSC 1726(b))
• Treating an HCO as a shortcut. A home health agency license does not cover non-medical care, and an HCO license does not cover skilled nursing. Each requires its own application
• Missing the 40-day fictitious name deadline. File the statement with the county clerk within 40 days of starting to do business, and complete the four weeks of newspaper publication
• Letting the Statement of Information lapse. The $250 penalty is avoidable with a calendar reminder
• Forming an LLC without checking the professional services rule. An LLC cannot render a licensed professional service, so ask an attorney how that applies to your nursing services before you choose the entity
• Assuming the county is open for new licenses. Ask CDPH whether a moratorium on new licenses applies in your county before you sign a lease or hire staff
• Waiting until renewal to check the deadline. The renewal must be filed at least 30 days before the license expires (HSC 1730)
• Relying on old timelines and cost estimates. Many online sources quote licensing timelines and application hours with no source. Confirm each figure with the agency that sets it
• Hiring aides before their clearances are complete. Track fingerprinting and training status for every aide in a written log

Expected Results

A well-prepared application may help move your agency through CDPH review with fewer follow-up requests. A complete entity filing, tax registration, and local permit set may help you open your books and begin operating on schedule. Results depend on your facts, your county, your staffing, and how completely you answer CDPH's questions. No one can guarantee a license approval date, a patient referral volume, or Medicare or Medi-Cal enrollment. Treat each milestone as a step to confirm with the responsible agency, not as a promise.

Next Steps

Start with the entity filing and the CDPH packet request, since those two items set the pace for everything else. Write down your staffing model, confirm your county's status with CDPH, and build a deadline calendar for the Statement of Information, the franchise tax, the fictitious name publication, and the license renewal. Then bring that plan to a California health care attorney and a CPA. The Secretary of State, CDPH, CMS, and DHCS will each confirm the current requirements for your specific situation.

Reminder: This article is informational content, not legal or tax advice.