HomeCareAtlas Team · Updated November 2026
Researched from primary state regulatory sources.
How to Start a Home Care Agency in New York
Starting a home care agency in New York costs roughly $100,000 - $200,000 and takes 9-18 Months. Here's every step, fee, and deadline — sourced directly from New York State Department of Health (NYSDOH).
Starting a home care agency in New York is not like other states. Agencies that give home health aide, personal care, or homemaker services need a Licensed Home Care Services Agency (LHCSA) license. The rules are in 10 NYCRR Parts 765 and 766. Since April 1, 2020, every new LHCSA must prove public need. It must also show it can pay its bills. You file the LHCSA Certificate of Need (CON) application online in NYSE-CON (DOH LHCSA Application Requirements FAQ). The fee is $2,000 (PHL Section 3605(13)). Some counties already have 5 or more LHCSAs actively serving patients. There, the state presumes there is no need. DOH counts an agency as "actively serving" at 25 or more patients. You must rebut that with data. The Public Health and Health Planning Council (PHHPC) reviews public need, character and competence, and money. After PHHPC approval, you send your policy manual and pass a pre-opening survey. DOH does not give a set timeline. Our estimate is 9 to 18 months, and approval is not sure. That is why many people buy an agency or partner with one instead.
To start a non-medical home care agency in New York, you need a Licensed Home Care Services Agency (LHCSA) from the New York State Department of Health (NYSDOH). The application fee is $2,000 (lhcsa application fee (phl §3605(13))), the process takes approximately 9-18 months, and total startup costs range from $100,000 - $200,000. Every new LHCSA must prove public need through the NYSE-CON system (10 NYCRR 765-1.16) and pay a $2,000 fee. Approval is not guaranteed. Many founders buy an agency or partner with one instead.
- License Required
- Yes — Licensed Home Care Services Agency (LHCSA)
- Regulatory Body
- New York State Department of Health (NYSDOH)
- Application Fee
- $2,000 (lhcsa application fee (phl §3605(13)))
- Timeline
- 9-18 Months (typical estimate for a new lhcsa (doh gives no set timeline))
- Total Startup Cost
- $100,000 - $200,000
- Key Requirement
- Every new LHCSA must prove public need through the NYSE-CON system (10 NYCRR 765-1.16) and pay a $2,000 fee. Approval is not guaranteed. Many founders buy an agency or partner with one instead.
- Last Verified
- November 2026 against New York State Department of Health (NYSDOH) regulations
LHCSA Application Fee (PHL §3605(13))
Source: N.Y. Public Health Law §3605(13) · Checked Oct 2026
Typical Estimate for a New LHCSA (DOH Gives No Set Timeline)
This is our best guess. Check with the New York State Department of Health (NYSDOH).
Residents Age 70+
Moderate Opportunity
How New York compares to neighboring states
| State | License Fee | Timeline | Startup Cost |
|---|---|---|---|
| New York ← | $2,000 | 9-18 Months | $100,000 - $200,000 |
| New Jersey | $500 | Varies | $55,000 - $100,000 |
| Connecticut | $375 | 1-3 Months | $35,000 - $70,000 |
| Pennsylvania | $100 | 10-20 Weeks | $12,000 - $38,000 |
| Massachusetts | $0 (no license) | 4-8 Weeks | $55,000 - $100,000 (our estimate) |
In This Article
New York Licensing Overview
The New York State Department of Health (NYSDOH) oversees all non-medical agencies.Starting a home care agency in New York is not like other states. Agencies that give home health aide, personal care, or homemaker services need a Licensed Home Care Services Agency (LHCSA) license. The rules are in 10 NYCRR Parts 765 and 766. Since April 1, 2020, every new LHCSA must prove public need. It must also show it can pay its bills. You file the LHCSA Certificate of Need (CON) application online in NYSE-CON (DOH LHCSA Application Requirements FAQ). The fee is $2,000 (PHL Section 3605(13)). Some counties already have 5 or more LHCSAs actively serving patients. There, the state presumes there is no need. DOH counts an agency as "actively serving" at 25 or more patients. You must rebut that with data. The Public Health and Health Planning Council (PHHPC) reviews public need, character and competence, and money. After PHHPC approval, you send your policy manual and pass a pre-opening survey. DOH does not give a set timeline. Our estimate is 9 to 18 months, and approval is not sure. That is why many people buy an agency or partner with one instead.
Public Need Review (NYSE-CON) — Biggest Barrier
Since April 1, 2020, every new LHCSA must prove public need (10 NYCRR 765-1.16). You file through the NYSE-CON system. If a county has 5 or more LHCSAs actively serving patients, the state presumes no need (10 NYCRR 765-1.16). DOH counts an agency as actively serving at 25 or more patients (DOH LHCSA FAQ). You must rebut that with data. Examples: a group no one serves, a language gap, or a service no one offers. You can ask for up to 5 counties in one DOH region (DOH LHCSA FAQ). This is the biggest barrier to entry.
Many Founders Enter Through Acquisition or Partnership
New approvals are hard and not sure. So many owners buy a licensed agency or partner with one. They skip a new LHCSA application.
A Very Large Market
About 3.86 million New Yorkers are 65 or older. That is out of about 20 million people (U.S. Census 2025 estimate). Only California, Florida, and Texas have more seniors.
High Pay Rules: Minimum Wage + Wage Parity
In 2026, the home care aide minimum wage is $19.65/hr in NYC, Long Island, and Westchester. It is $18.65/hr in the rest of the state (PHL 3614-f). Wage parity adds more for Medicaid work downstate (PHL 3614-c). Our estimate for private-pay rates is $24-$45/hr.
Rigorous LHCSA Application
Your application must show character and competence, public need, and that you can pay your bills. Your working capital must cover at least your first two months of costs (DOH DAL 22-14). A CPA must check your money forms. After PHHPC approval, you send your policy manual and pass a pre-opening survey.
Fingerprint Background Checks (CHRC)
You must ask DOH for a fingerprint Criminal History Record Check (CHRC) on each new worker you plan to hire (10 NYCRR 402.6). Fingerprints go to the NYS Division of Criminal Justice Services and the FBI. Owners and key people get a character and competence review in the CON application.
Estimated Startup Costs (2026)
Budget for $100,000 - $200,000 to ensure 3-6 months of runway.
| Category | Low Est. | High Est. |
|---|---|---|
| LHCSA Application Fee (PHL §3605(13)) | $2,000 | $2,000 |
| CPA and Consultant Help for the NYSE-CON Application | $0 | $5,000 |
| Background Checks & Fingerprinting (CHRC) | $200 | $500 |
| Business Formation (LLC/Corp) | $200 | $1,000 |
| General Liability Insurance ($1M/$3M) | $2,500 | $5,000 |
| Workers' Compensation Insurance | $2,000 | $5,000 |
| Office Space (6 months) | $12,000 | $36,000 |
| Initial Marketing & Branding | $2,000 | $8,000 |
| Working Capital (6 months) | $30,000 | $80,000 |
We map every cost and file your New York license for you.
The 7-Step LHCSA Application Journey
4-8 Weeks
Public Need Research (NYSE-CON)
Every new LHCSA must prove public need. Check the DOH LHCSA Need Report. It lists the counties where the state presumes no need. You must rebut that with data for each such county. Examples: a group no one serves, a language gap, or a service no one offers. You can ask for up to 5 counties in one DOH region.
2-3 Weeks
Business Formation
Form your business with the NYS Department of State. Get an EIN from the IRS. Register with the NYS Tax Department.
2-4 Weeks
Secure Office Space
Plan an office. The rules say it must be big enough to run the agency well (10 NYCRR 766.9). They do not set a size. Ask DOH before you use a home office.
2-3 Weeks
Insurance & Financial Documents
Get liability insurance. Work with a CPA on your budget. Your working capital must cover at least your first two months of costs (DOH DAL 22-14).
1-2 Weeks
Submit LHCSA CON Application in NYSE-CON
File the LHCSA CON application online in NYSE-CON. Include your public need rebuttal, money documents, and character and competence forms. Mail the $2,000 fee (PHL Section 3605(13)). DOH must get it within 30 days. The fee is not refunded once DOH acknowledges your application (DOH LHCSA FAQ). Do not send your policy manual yet. DOH asks for it after PHHPC approval.
4-12 Months
PHHPC Review, Policy Manual, and Pre-Opening Survey
DOH reviews your file, then puts it on a PHHPC agenda. PHHPC meets six times a year. If you get contingent approval, you send your Policy and Procedure Manual to your DOH Home Care regional office. Once the manual is accepted, the regional office schedules a pre-opening survey. DOH says it cannot give an exact timeframe.
1-2 Weeks
License Issuance
After you pass the survey, the Bureau of Home Care Licensure and Certification issues your LHCSA license. Then you must register with DOH every year (PHL Section 3605-b).
We can do all of them for you in New York.
New 2026 Legal Mandates
10 NYCRR Parts 765 and 766 Compliance
Ongoing - Part 765 covers how you get a LHCSA license, including public need. Part 766 sets the minimum standards for running one: patient care, staffing, records, and quality assurance. These are the main rules for LHCSAs, under Article 36 of the Public Health Law.
LHCSA Public Need and Financial Review (10 NYCRR 765-1.16)
April 1, 2020 - Since April 1, 2020, every new LHCSA must show public need. It must also show it can pay its bills. You file through NYSE-CON (DOH LHCSA FAQ). If a county has 5 or more LHCSAs actively serving patients, the state presumes no need. You must rebut that with data. PHHPC reviews public need, character and competence, and money. This is the biggest barrier to a new LHCSA.
Home Care Aide Minimum Wage (PHL 3614-f) and Wage Parity Law (PHL 3614-c)
January 1, 2026 - The home care aide minimum wage for 2026 is $19.65/hr in NYC, Nassau, Suffolk, and Westchester. It is $18.65/hr in the rest of the state (PHL 3614-f). From 2027, it changes each January 1 with prices. The Wage Parity Law sets a higher minimum total pay for Medicaid-funded work in NYC, Nassau, Suffolk, and Westchester (PHL 3614-c). DOH posts the current wage parity amounts. These are legal minimums. Market pay may be higher.
Criminal History Record Checks (10 NYCRR Part 402)
Ongoing - You must ask DOH for a fingerprint Criminal History Record Check (CHRC) on each new worker you plan to hire (10 NYCRR 402.6). Fingerprints go to the NYS Division of Criminal Justice Services and the FBI. The law lets DOH charge you a fee for the check (Executive Law 845-b). Ask DOH what it charges. While results are pending, a new hire may work only under supervision (10 NYCRR 402.4).
CDPAP Has One Statewide Fiscal Intermediary
April 1, 2025 - Public Partnerships LLC (PPL) is now the only fiscal intermediary (FI) for CDPAP. DOH says all CDPAP members must use PPL. Under Social Services Law 365-f, as of April 1, 2025, no one else may give FI services except PPL and its subcontractors. So a LHCSA cannot earn money as a CDPAP FI. Plan your business without FI revenue.
Home Care Registry and Annual LHCSA Registration
Ongoing - Check each aide in the NYS Home Care Registry before they start (PHL Section 3613). Post their job with you within 10 business days (10 NYCRR 403.5). You must also register your LHCSA with DOH every year (PHL Section 3605-b). Late annual LHCSA registration: $500 per month. Missing two annual registrations: license revocation proceedings.
Our New York licensing team tracks the law so you do not have to.
Caregiver Mandates
Important Warning
DOH rules let a LHCSA employ or contract for staff (10 NYCRR 766.9). But tax and labor law decide if a worker is an employee. Most agencies hire aides as W-2 employees. Ask an employment lawyer before you pay anyone on a 1099. The 2026 home care minimum wage is $19.65/hr downstate and $18.65/hr elsewhere (PHL 3614-f).
- Home Health Aide Certification: 75 hours of state-approved training. That is 59 hours in class and 16 hours of supervised practice (DOH HHA training FAQ). Aides must also pass a competency check.
- Personal Care Aide Training: Personal care aides need at least 40 hours of DOH-approved training (18 NYCRR 505.14). This is separate from the 75-hour home health aide program.
- Home Care Registry: Check each aide in the NYS Home Care Registry before they start. Post their job with you within 10 business days (10 NYCRR 403.5).
- Annual In-Service Training: Home health aides need 12 hours of in-service training each year. Personal care aides need 6 hours (10 NYCRR 766.11).
- Fingerprint Background Check (CHRC): Fingerprint Criminal History Record Check through DOH (10 NYCRR Part 402). Checked against NYS DCJS and FBI records. New hires work only under supervision until cleared.
Regional Billing Snapshots
*Regional rates vary by specialized care needs (Dementia, Parkinson's) and local competition.*
We launch New York home care agencies start to finish.
Regional Market Opportunities
New York has the 4th most seniors in the U.S. (Census 2025 estimate). Aide minimum wages are $19.65/hr downstate and $18.65/hr elsewhere. Wage parity raises total pay for Medicaid work downstate. Many agencies need managed long-term care (MLTC) contracts. But many MLTC plans have closed networks. The billing rates below are our estimates, not official numbers.
New York City (5 Boroughs)
Largest market in the state with enormous demand. High competition but endless client base. Many people here use CDPAP, which now runs through one statewide fiscal intermediary (PPL).
Key: Multilingual care is essential. Focus on specific boroughs or neighborhoods to build density. NYSE-CON public need review is most competitive here.
Long Island (Nassau & Suffolk)
Affluent suburban market with high private-pay rates. Large senior population, lower competition than NYC.
Key: Special care, like dementia care, can earn top rates. The aide minimum wage is $19.65/hr, plus wage parity for Medicaid work.
Westchester & Rockland Counties
Wealthy suburbs with mix of private pay and Medicaid. Strong referral networks through hospitals and senior centers.
Key: Hospital discharge partnerships are key to steady client flow. Westchester uses the downstate minimum wage ($19.65/hr). Rockland uses the rest-of-state rate ($18.65/hr).
Hudson Valley (Dutchess, Orange, Ulster)
Growing retirement destination with lower operating costs. Aging-in-place culture creates strong demand.
Key: Rural caregiving routes require efficient scheduling and mileage management. Caregiver minimum is $18.65/hr.
Capital District (Albany, Saratoga)
State government retirees create steady demand. Lower costs than downstate but solid margins.
Key: State employee benefit programs provide referral channels. NYSE-CON may be less competitive here.
Western NY (Buffalo, Rochester)
Lower cost of living and wages ($18.65/hr minimum). Medicaid is a big payer here.
Key: Focus on Medicaid contracts and MLTC plans for volume. NYSE-CON approval may be more achievable in less saturated counties.
Cost of care in New York
What agencies charge clients vs. what caregivers earn in New York. The difference is the agency's gross margin per billable hour — before overhead like insurance, admin, marketing, and compliance costs.
$34
Avg. hourly rate charged to clients
$21.55
Avg. caregiver hourly wage
$12.45
Gross margin per hour
37%
Gross margin %
What this means for agency owners
In New York, agencies keep roughly $12.45 per billable hour after paying the caregiver. That's a 37% gross margin.
This is a typical margin for the industry. You will need to manage overhead carefully, but profitability is achievable with good operations.
Sources: Avg. hourly rate from CareYaya and CareScout 2025 surveys (averaged). Caregiver wage from Care.com. Gross margin is before overhead costs like insurance, admin, marketing, and compliance.
New York Medicaid Programs
Consumer Directed Personal Assistance Program (CDPAP)
NY's program that lets Medicaid members hire, train, and manage their own caregivers, including family. One statewide fiscal intermediary, Public Partnerships LLC (PPL), handles payroll for all members (DOH CDPAP page).
Agency Angle: A LHCSA can no longer be a CDPAP fiscal intermediary. PPL is the only one. Do not plan on FI revenue. CDPAP still matters to you. It competes with agency home care for the same clients and aides.
Managed Long Term Care (MLTC)
Medicaid managed care for people who need more than 120 days of long-term care at home or in the community. Many plans work in different parts of the state.
Agency Angle: Join the networks of MLTC plans. Each plan has its own sign-up process. Rates vary by plan and region. Many plans have closed networks. A LHCSA license does not promise you a contract. Check which plans are open before you plan on Medicaid money.
Medicaid Personal Care Services
Medicaid help at home with personal care and housekeeping. It is paid by Medicaid directly or through a managed care plan.
Agency Angle: Can be steady base business. Mix it with private pay to raise margins.
Becoming a Provider
Essential 2026 Tech Stack for Owners
Tiles outlined in teal are areas HomeCareAtlas covers in our platform.
New York Licensing FAQ
Do I need to demonstrate public need to start in New York?
Yes. Since April 1, 2020, every new LHCSA must prove public need. You file through NYSE-CON. If a county has 5 or more LHCSAs actively serving patients, the state presumes no need (10 NYCRR 765-1.16). DOH counts an agency as actively serving at 25 or more patients (DOH LHCSA FAQ). You must rebut that with data. Examples: a group no one serves, a language gap, or a service no one offers. PHHPC reviews public need, character and competence, and money. This is the biggest barrier.
Can I operate from home in New York?
Maybe, but ask DOH first. The rules say your office must be big enough to run the agency well (10 NYCRR 766.9). They do not set a size. We did not find a rule that bans a home office. Records must be kept safe and private.
What is CDPAP and should I participate?
CDPAP (Consumer Directed Personal Assistance Program) lets Medicaid members hire their own caregivers, including family. One statewide fiscal intermediary, Public Partnerships LLC (PPL), now runs payroll for the whole program. Your LHCSA cannot be a CDPAP fiscal intermediary. Do not build your business plan on CDPAP FI revenue.
How long does the LHCSA application really take?
DOH says it cannot give an exact timeframe. Our estimate is 9 to 18 months, and approval is not sure. The steps are: DOH review, PHHPC agenda (PHHPC meets six times a year), policy manual review, then a pre-opening survey. DOH says a complete application and quick answers make it go faster.
What's the difference between LHCSA and Home Health Agency?
A LHCSA can give aide care, like personal care and homemaking. Some LHCSAs also give nursing. A Certified Home Health Agency (CHHA) is certified for Medicare and Medicaid home health care. The rules are very different. Most new non-medical agencies look at the LHCSA path.
Can I operate a home care agency in New York without a license?
No. Under Article 36 of the Public Health Law, an agency must be licensed or certified by DOH to give or arrange home care services. That includes home health aide, personal care, and homemaker services. Running one without a license breaks state law.
Will getting my LHCSA license guarantee I can take Medicaid patients?
No. Many MLTC plans have closed networks. You need a LHCSA license to contract with them. But the license does not promise a contract. Check which plans are open in your area first.
Should I apply for a new license, buy an agency, or partner with one?
It depends on your budget, time, and how much risk you can take. A new LHCSA costs less up front. But it is slower and less sure. Buying an agency is often faster but costs much more. Partnering can be the quickest way in, but you give up some control. Many New York founders look at all three first.
What are the biggest challenges of starting a home care agency in New York?
Here are the big ones: (1) proving public need in NYSE-CON, mainly in "no need" counties. (2) A long wait with no promise of approval. Our estimate is 9 to 18 months. (3) Paying the $19.65/hr downstate aide minimum wage, plus wage parity. (4) Finding enough aides. (5) Getting MLTC contracts when networks are closed. Still, New York has many seniors who need help at home.
Starting in a Nearby State?
Licensing requirements vary a lot between states. Compare your options:
New Jersey
$500 fee · Varies
Connecticut
$375 fee · 1-3 Months
Pennsylvania
$100 fee · 10-20 Weeks
Massachusetts
No state license required · 4-8 Weeks
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Home care agencies in New York
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Where our numbers come from
We check each fact against New York's own rules. Tap a source to read it yourself.
- License needed?YesN.Y. Public Health Law Art. 36 (§3605)· Oct 2026
- Who oversees itNew York State Department of Health (NYSDOH)N.Y. Public Health Law §3605· Oct 2026
- License nameLicensed Home Care Services Agency (LHCSA)10 NYCRR Part 766· Oct 2026
- The rules10 NYCRR Part 766 (LHCSA)10 NYCRR Parts 765-766· Oct 2026
- First license fee$2,000N.Y. Public Health Law §3605(13)· Oct 2026
- License lasts—N.Y. Public Health Law §§3605, 3605-b· Oct 2026
- BondNoneN.Y. Public Health Law §3605; 10 NYCRR Parts 765-766· Oct 2026
- Owner/manager trainingNo state minimumN.Y. Public Health Law §3605; 10 NYCRR Parts 765-766· Oct 2026
- Caregiver training40 hours10 NYCRR 700.2(b)(14); 18 NYCRR 505.14· Oct 2026
- Background checksDOH Criminal History Record Check (fingerprints to NYS DCJS and FBI) for each prospective employee10 NYCRR 402.6; Exec. Law §845-b· Oct 2026
- How long it takes9-18 MonthsBest guess — not confirmed yet
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This guide is for informational purposes only and does not constitute legal, regulatory, or business advice. Licensing requirements, fees, and regulations change frequently. Always verify current requirements with your state's licensing agency before making business decisions. HomeCareAtlas is not responsible for the accuracy or completeness of this information.
Researched and reviewed by
John Helmy, Founder of HomeCareAtlasBuilding tools and resources to help home care agency owners navigate licensing, compliance, and growth.