How to start a home care agency in New York

Updated October 16, 2026 · CensusDesk research

The short answer.In New York, an agency that gives hands-on personal care needs a Licensed Home Care Services Agency (LHCSA) license from the NYS Department of Health (DOH). Companionship and light housekeeping alone don’t need it. You apply online through NYSE-CON and pay a $2,000 application fee. DOH reviews public need in each county you want to serve, plus your finances and your owners’ character and competence. The Public Health and Health Planning Council (PHHPC) votes on it. Then you send in your policy manual and pass a pre-opening survey. DOH doesn’t publish a timeline, so check with DOH.

New York at a glance

What	New York
The license	Licensed Home Care Services Agency (LHCSA)
Who needs it	Agencies giving personal care, home health aide, or nursing services
Who doesn’t	Agencies giving only companionship and light housekeeping
Who licenses you	NYS Department of Health, with approval by the Public Health and Health Planning Council (PHHPC)
Where you apply	NYSE-CON, the state’s electronic Certificate of Need system
Application fee	$2,000
Public need review	Yes, county by county, up to five counties in a first application
Processing time	Not published. Check with DOH.
Aide training	Personal care aides: at least 40 hours. Home health aides: at least 75 hours.
Questions	DOH Bureau of Home Care Licensure and Certification: homecareliccert@health.ny.gov

Fees, forms, and need rules change. Check DOH’s Licensed Home Care Services Agencies page before you pay anything.

Step 1. Decide what kind of agency you are

This is the big fork in New York. If your caregivers only keep someone company and do light housekeeping, with no hands-on care, the state says you don’t need a LHCSA license. Once you help with bathing, dressing, toileting, or other personal care, you do. Most families need hands-on help sooner or later, so most agencies that want to grow end up licensed.

If you plan to offer skilled nursing or therapy billed to Medicare, that’s a different, certified home health agency. This guide covers the LHCSA path. Decide early, too, between private pay, Medicaid, or both. Private-pay families pay you directly. Medicaid billing comes with its own enrollment and contracts after you’re licensed.

Step 2. Form your business and line up your team

Most owners form an LLC or corporation, get a federal EIN from the IRS, and open a business bank account. New York adds one thing you need before you apply: DOH checks your finances, and you need working capital equal to at least two months of estimated operating expenses. Talk to an insurance agent about liability and workers’ compensation coverage now, too.

Step 3. Check public need in your counties

New York reviews whether each county you want to serve needs another agency. Each county is its own planning area. If a county already has five or more LHCSAs actively serving patients, DOH presumes there’s no need for more. That presumption can be rebutted, but you have to make the case with local data, county by county, such as waiting lists or a shortage of workers. A first application can cover up to five counties. Pick them with care before you spend money on anything else.

Step 4. Apply through NYSE-CON

DOH’s process for a new license:

Get access to the Health Commerce System and NYSE-CON.
Complete the LHCSA Certificate of Need application, including the public need section for each county.
Complete the ownership disclosure, with a statement of each principal’s qualifications.
Mail the $2,000 fee by check to the NYS Department of Health, with your NYSE-CON number on it, within 30 days of submitting.
DOH reviews public need, character and competence, and financial feasibility.
The Public Health and Health Planning Council (PHHPC) votes on your application.

DOH doesn’t publish how long this takes. Check with the Bureau of Home Care Licensure and Certification on where things stand.

Step 5. Pass your pre-opening survey

After PHHPC approval, you send your Policy and Procedures Manual to your DOH Home Care regional office. Don’t send it sooner; DOH won’t take it before approval. The regional office may ask for changes. Once the manual is accepted and any contingencies are met, the office schedules a pre-opening survey. When you pass, it tells the Bureau to issue your license. Plan your caregiver hiring around training: personal care aides need a DOH-approved course of at least 40 hours, and home health aides need at least 75.

What it costs to get licensed

Item	Cost	Source
LHCSA application fee	$2,000	Public Health Law 3605, DOH
Working capital you must show	At least two months of estimated operating expenses	DOH
Aide training	Varies by program. Check with DOH’s approved program list.	DOH
Business formation, insurance, bank	Varies	NY Department of State, your agent

Getting your first clients

A license doesn’t bring families to you. Here’s what the research says about where clients come from, and what that means for a new New York agency.

Referrals lead. Current and past clients are the top referral source for private duty home care, followed by discharge planners, home health, hospice, and rehab. A new agency has no past clients yet, so the referral engine starts slow.
Families search first. Most families looking for senior care start with a generic search like “home care near me,” and few search an agency by name. If your agency has no website, those families find someone else.
Directories charge per lead. Lead directories and paid search often run $50 to $150 per lead, and the family may be shopping three agencies at once.
Speed wins. On average about a third of home care inquiries become clients. A family coming home from the hospital may have only a day or two to decide.

What one client is worth in New York

Input	Number	Source
New York median rate, in-home care	$35 / hour	CareScout Cost of Care Survey 2025
National median	$35 / hour	CareScout Cost of Care Survey 2025
One client at 20 hours a week, one year	$36,400	$35 × 20 × 52

That’s why the first thing a new agency needs after its license is a front door that works when you can’t pick up the phone: a real website, a way for families to get answers at night, and every inquiry in your inbox the minute it happens.

Sources

NYS Department of Health, “Licensed Home Care Services Agencies (LHCSAs)” (CON application, NYSE-CON, policy manual after PHHPC approval), read October 16, 2026
NYS Department of Health, “Frequently Asked Questions, LHCSA Application Requirements” (fee, payment by check within 30 days, five-county cap, working capital, pre-opening survey), read October 16, 2026
NYS Department of Health, DAL DHCBS 22-14, “Licensed Home Care Services Application” (public need presumption and rebuttal), read October 16, 2026
New York Public Health Law, Section 3605, “Licensure of home care services agencies” (who must be licensed, $2,000 fee, PHHPC criteria), read October 16, 2026
10 NYCRR Section 765-1.16, “Determinations of public need,” the adopted LHCSA regulation (county planning areas, five-agency presumption), read October 16, 2026
New York Public Health Law, Section 3602, definitions of home care and personal care services (companionship and housekeeping alone are not a licensed service), read October 16, 2026
NYS Department of Health, personal care aide and home health aide training program guides (40 and 75 hour minimums), read October 16, 2026
CareScout Cost of Care Survey 2025, median hourly cost of non-medical in-home care by state
HCAOA Private Duty Benchmarking, via Activated Insights (referral sources)
Caring.com search behavior figures, via CoreCubed (generic search)
Home Care Pulse, via Home Health Care News (inquiry conversion benchmarks)
Sagapixel (directory and paid search cost per lead estimates)

Licensed is step one. Clients are step two. CensusDesk is the digital front desk for home care agencies: a modern website if you don’t have one, a free care report families take on your site day or night, and every new family in your inbox the same minute. We build it before you pay.

See your agency’s front desk