How do you start a non-medical senior home care agency in 2027?

First, find out what your state requires

Non-medical means personal care, companionship and homemaker help without skilled nursing, and the license category depends on which of those you offer. Three examples show how far states differ.

California: the Department of Social Services (CDSS) Home Care Services page says the law requires Home Care Organizations to be licensed, and that licensing began in January 2016. Its fee page lists $5,603 for the license, valid for 2 years, and $35 to register a home care aide, also valid for 2 years. The application process lists six Section A forms, including an employee dishonesty bond form (HCS 402), and six Section B documents: organizing papers, job descriptions, personnel policies, a training plan, a program description and insurance information.

Texas: the Health and Human Services Commission HCSSA page says home and community support services agencies must be licensed, defines personal assistance services as routine ongoing care required by a person in a residence or independent-living environment, and lists an initial three-year license fee of $2,625 for a parent agency or branch. Processing generally takes up to 45 days once a thoroughly complete application is received. The agency must also be in good standing with the Comptroller and Secretary of State.

Florida: the Agency for Health Care Administration's homemaker and companion page says any individual or organization providing those services must register, at $50.75 for a 2-year registration plus screening fees. The registration "does not allow hands on personal care," and Florida law does not require insurance for registration. Level 2 fingerprint screening is required for managing employees and financial officers, and for new homemakers and companions before hiring.

Other states may differ again, so confirm yours with the state licensing agency, and ask a health care or employment attorney about caregiver classification and scope of services.

Second, plan the business and budget the startup costs

ZenBusiness's guide estimates total startup capital for a non-medical agency at about $40,000 to $80,000 and says to overestimate early expenses. HomeCareAtlas, an informational platform, repeats that most sources quote $40,000 to $80,000, says working capital of three to six months of runway is the largest line, and puts home health agencies with skilled nursing at $150,000 to $350,000 (all vendor-stated). Those two are guides, not audited figures.

• Licensing and application fees: $500 to $5,000 (ZenBusiness).
• Liability insurance (general and professional): $2,000 to $6,000 (ZenBusiness).
• Business formation and registration: $300 to $1,000 (ZenBusiness).
• Scheduling software: $1,000 to $3,500 (ZenBusiness).
• Initial payroll and workers' compensation reserves: $10,000 to $30,000 (ZenBusiness).
• Marketing and website: $1,500 to $7,000 (ZenBusiness).
• Background checks and staff training: $500 to $2,000 (ZenBusiness).

ZenBusiness also says owners need a local business license and an EIN from the IRS, and that staff entering client homes must pass criminal history screening.

Third, insure and bond the agency

Insureon, an online small-business insurance marketplace, recommends general liability, professional liability, workers' compensation, commercial auto, cyber insurance and fidelity bonds for non-medical home care on its home care page. It lists average monthly premiums of $29 for general liability, $48 for medical malpractice and $136 for workers' compensation, and says its typical customer has fewer than five employees (vendor-stated; actual prices depend on services and coverage).

California requires an employee dishonesty bond as part of licensing. SuretyBonds.com, run by the insurance agency Brooklyn Ventures LLC, says on its California page that the bond is $10,000 in coverage, that premiums are $125 for one year or $281 for three years, and that it is renewed annually while the license is active (vendor-stated). Florida, by contrast, does not require insurance for its homemaker and companion registration, but you may still want it.

Fourth, hire, screen and train caregivers

The Bureau of Labor Statistics Occupational Outlook Handbook lists a median pay of $35,800 per year ($17.21 per hour) for home health and personal care aides in May 2025, about 4,677,100 jobs, and projected growth of 18 percent from 2025 to 2035. It says a high school diploma or equivalent is typical, short-term on-the-job training is typical, some states require a license or certification that may include training, a background check and a competency exam, and some employers require first aid and CPR.

State rules add specifics. In California, aides apply through CDSS with Live Scan fingerprints, per the aide application page, and registered aides appear in a public Home Care Aide Registry. In Florida, you must complete Level 2 screening before hiring a homemaker or companion. Budget for screening and training at about $500 to $2,000 per ZenBusiness, and for payroll reserves, since wages are your largest recurring cost.

Fifth, line up who pays: private pay, insurance, Medicaid and VA

The federal Administration for Community Living's who pays for long-term care page says Medicare pays for long-term care only when skilled or rehabilitative services are needed and does not pay for non-skilled assistance with activities of daily living. It says Medicaid pays the largest share of long-term care services, with eligibility based on income and state requirements, that the VA and Older Americans Act pay only for specific populations and in certain circumstances, and that people pay out of pocket for what is not covered. It lists long-term care insurance among private options.

• Private pay: families paying out of pocket, the starting point for most new agencies since it needs no payer enrollment. This page found no sourced national payer-mix percentages, so none are given.
• Long-term care insurance: an option the ACL lists; policyholders typically need an agency that can document care and bill according to the policy, so ask each insurer what it requires.
• Medicaid home and community-based services waivers: Medicaid.gov's 1915(c) page says states can target waivers to areas of greatest need, limit them to groups such as older adults, and choose the maximum number of people served. It reports about 257 active HCBS waiver programs, with nearly all states and DC offering them. Each state runs its own provider enrollment.
• VA Homemaker and Home Health Aide: VA's program page says aides work for an organization under contract with VA, not as VA employees, are supervised by a registered nurse, and that a copay may apply depending on service-connected disability status.
• VA Veteran-Directed Care: VA's program page says veterans receive a flexible budget and choose and hire their own workers, including family, friends or neighbors, with a VA provider sending electronic payments. Because veterans can hire directly, this route does not by itself bring clients to agencies.

Sixth, choose software and plan for visit verification

Medicaid.gov's EVV page says states had to require electronic visit verification for Medicaid-funded personal care services by January 1, 2020 and for home health care services by January 1, 2023, with FMAP reductions of up to 1% for states that miss it. If you plan to accept Medicaid waiver clients, choose software that supports your state's EVV system.

AlayaCare describes itself on its site as an operating system for home care, listing scheduling, authorization tracking, EVV compliance, billing, care plans, a mobile app and a family portal, and cites 1,000+ global clients and 10M+ visits per month (vendor-stated). WellSky Personal Care states on its page that it is a software suite for non-medical agencies with recruiting, applicant tracking, screening, training, a family portal and a mobile app, and that it has transitioned over 4,000 agencies to its personal care software (vendor-stated). CareTime says on its site that new sales now run through Alora, which handles scheduling, clinical documentation, billing, EVV and compliance, while existing CareTime customers keep their software (vendor-stated). Request demos from at least two and ask each how it connects to your state's EVV aggregator.

Seventh, decide between independent and franchise

Franchising trades a larger budget for a brand, training and systems. ComForCare states on its startup costs page a total initial investment of $102,475 to $163,925 and an initial franchise fee of $29,500 to $59,000 that rises with territory size, covering three to six months of operating expenses, insurance, licensing and accreditation fees and recruiting (franchisor-stated). It says the franchise disclosure document must be given at least 14 days before you sign.

Visiting Angels, per Franchise Chatter's review of its 2024 FDD, lists total estimated franchise costs of $125,460 to $171,150, an initial fee of $51,950 for up to 100K population, $64,950 for up to 200K and $89,950 for up to 325K, a royalty of 3.5% of gross revenues stepping down to 3.25% and 3.0% at higher revenue, and 542 franchised units at the end of 2023. Franchise Chatter is an independent blog summarizing the FDD, so request the current FDD from any brand you consider.

Compared with the $40,000 to $80,000 independent estimates, these franchise ranges are higher and add royalties. An independent agency keeps full control and lower cost but builds its own brand, hiring and compliance systems.

What the evidence does and does not show

• Licensing varies sharply. A $5,603 California license, a $2,625 Texas initial fee and a $50.75 Florida registration that bars hands-on care show there is no single national answer.
• Startup figures are estimates. The $40,000 to $80,000 range comes from vendor and guide pages, and franchise ranges come from the franchisors or an FDD summary, none independently audited.
• Public payers are limited. Medicare does not pay for non-skilled daily help, and Medicaid waivers vary by state and can cap enrollment.
• No payer-mix figures were found. This page did not find a sourced national split of private pay, insurance and Medicaid, so it does not give one.
• Vendor pages sell something. Software, insurance and bond facts are the companies' own statements, and no company is adjusted for.

Questions people ask

Sources

• California Department of Social Services: Home Care Services · Licensing requirement and aide registry
• CDSS application fees · HCO and aide registration fees
• CDSS Home Care Organization application process · Forms and documents
• CDSS home care aide application process · Live Scan and aide fee
• Texas HHSC: HCSSA licensing · Personal assistance licensing and fees
• Florida AHCA: homemaker and companion services · Registration, fee, limits
• ZenBusiness: non-medical senior home care agency · Startup cost ledger
• HomeCareAtlas startup cost calculator · Cost ranges and working capital
• Insureon: non-medical home care insurance · Coverages and average premiums
• SuretyBonds.com: California home care bond · Bond amount and premium
• BLS: home health and personal care aides · Pay, jobs, growth, training
• ACL: who pays for long-term care · Medicare, Medicaid, VA, private pay
• Medicaid.gov: 1915(c) HCBS waivers · Waiver rules and counts
• Medicaid.gov: electronic visit verification · EVV deadlines and penalty
• VA: Homemaker and Home Health Aide care · Contracted aides, eligibility
• VA: Veteran-Directed Care · Budget and hiring workers
• ComForCare franchising: startup costs · Investment and fee range
• Franchise Chatter: Visiting Angels 2024 FDD · Investment, fees, royalty, units
• AlayaCare · Software features and scale
• WellSky Personal Care · Software features and agencies
• CareTime · Sales moved to Alora

Facts were read from the linked pages on November 2, 2026. This page is general information, not legal advice; talk to a health care attorney and your state licensing agency. If a page here is out of date, tell us and we will correct it from a source.

Top photo: Lifecirclehealthservices / CC BY-SA 4.0 via Wikimedia Commons