How to Start a Home Care Agency in Florida: Licenses and Steps

To start a home care agency in Florida, you apply to the Agency for Health Care Administration (AHCA) under one of three license categories, and the rest of the process follows from that choice: forming a business entity, clearing Level 2 background screening, submitting CPA-signed financial projections, lining up insurance and staffing, paying the fee, and passing an on-site survey. Most first-time applicants take three to six months from filing to license in hand.

Pick the Right License Category First

Florida Statutes Chapter 400, Part III creates three separate pathways, and choosing the wrong one is the most common early mistake. Each has a different scope, a different fee, and different staffing rules.

Home Health Agency (HHA). The broadest license. Covers skilled nursing, physical and speech therapy, home health aide services, and medical social work. If you plan to perform any clinical tasks or bill Medicare or Medicaid, this is the license you need.¹
Nurse Registry. A referral-only model. The registry verifies credentials and matches clients with independent contractor nurses, nursing assistants, or home health aides who then deliver care on their own. Florida law expressly classifies these workers as independent contractors, not employees of the registry.²
Homemaker and Companion Service Provider. A registration rather than a full license. Covers housekeeping, meal preparation, errands, and social companionship. It excludes hands-on personal care such as bathing or dressing, and it prohibits medication administration. The registration fee is $50 per two-year period.³

Working outside your scope can trigger administrative penalties and loss of licensure. A companion provider that starts helping clients bathe is performing hands-on personal care that requires an HHA license. Under the companion registration, permissible tasks are limited to things like casual cosmetic assistance, light household duties, and social engagement.⁴

Form the Business Entity and Get Federal Numbers

Register your corporation or LLC with the Florida Department of State’s Division of Corporations (Sunbiz) before you touch the AHCA application. The resulting Articles of Incorporation or Organization go into your application packet.⁵

Apply for a federal Employer Identification Number (EIN) with the IRS. The online application is free, is issued immediately, and is limited to one EIN per responsible party per day.⁶

If you intend to bill any insurer, Medicare, or Medicaid, get a National Provider Identifier (NPI) through the NPPES online portal. The NPI is a 10-digit number issued at no cost.⁷

Complete Level 2 Background Screening

Florida requires Level 2 background screening for the licensee (if an individual), the administrator or equivalent, the financial officer, and every controlling interest holder.⁸ A controlling interest generally means anyone who owns five percent or more of the business or has a comparable level of influence over its operations.⁹

Fingerprints are collected through an approved livescan vendor. Results go to the Florida Department of Law Enforcement and the FBI, then into the AHCA Background Screening Clearinghouse. If any screened person has a disqualifying offense under Chapter 435, the application will not move forward until that person is removed from ownership or management.

Any agency that will accept federal health care dollars should also check every employee and contractor against the Office of Inspector General’s List of Excluded Individuals and Entities (LEIE). Hiring an excluded person exposes the agency to civil monetary penalties, and services furnished by that person are not eligible for Medicare, Medicaid, or other federal reimbursement.¹⁰

Prepare the Proof of Financial Ability to Operate

Florida will not take your word that you can afford to run a health care agency. Home health agencies, home medical equipment providers, and health care clinics must all demonstrate financial viability before a license is issued.¹¹

The Proof of Financial Ability to Operate (POFA) is a set of projected financial statements covering your first two years: a balance sheet, an income and expense statement, and a statement of cash flows showing that assets, credit, and projected revenue can cover liabilities and expenses.¹¹ The statements must be signed by a certified public accountant.¹²

Projections need to be realistic and internally consistent. If you assume 50 clients in month one but your staffing plan only covers 15, AHCA will catch it. CPA fees for this work commonly fall between roughly $600 and $2,500. Back the projections up with current bank statements showing enough liquidity to cover the plan.

Line Up Staff for Your License Type

Who you need to hire before filing depends on which license you chose.

Home Health Agency

Every HHA must have a designated administrator meeting the qualifications in Florida law.¹³ If the agency provides skilled care, it must also have a director of nursing: a registered nurse who is a direct employee of the agency, a graduate of an approved nursing school, licensed in Florida, and with at least one year of RN supervisory experience.¹⁴

A useful shortcut for smaller agencies: if the administrator is a licensed physician, physician assistant, or registered nurse, that person can also serve as director of nursing, but only if the agency has 10 or fewer full-time equivalent employees and contractors.¹³ Agencies that do not provide skilled care are not required to have a director of nursing at all.¹⁵

Nurse Registry

Nurse registries must adopt written procedures for selecting, documenting, screening, and verifying the credentials of every independent contractor referred, and must confirm each contractor’s identity before making a referral.¹⁶ Because the registry does not employ the caregivers, its staffing obligations are administrative and credentialing rather than clinical.

Homemaker and Companion Provider

Homemaker and companion providers must collect the employment or contract history of anyone who will have client contact and make diligent efforts to verify it.³

Regardless of license type, have copies of professional licenses, resumes, and signed compliance affidavits assembled before you submit. AHCA reviews these during processing and again during the initial on-site survey.

Get Insurance and, for Medicare Applicants, a Surety Bond

Your application must include proof of professional liability insurance. Florida does not publish a single minimum coverage amount that applies across all home care license types, so confirm the current requirement with AHCA when you file. Industry practice for home health agencies generally starts at $1 million per occurrence with a $2 million aggregate; actual needs depend on services and staff size.

If you plan to participate in Medicare, a separate federal surety bond applies. Every Medicare-participating home health agency must obtain a surety bond of at least $50,000 or such amount as CMS specifies, whichever is greater. The bond names CMS as the obligee and guarantees payment of any Medicare overpayments or civil monetary penalties the agency incurs.¹⁷ Government-operated agencies may qualify for a waiver based on a clean five-year track record.

File the AHCA Application and Pay the Fee

The application form for a home health agency is AHCA Form 3110-1011.¹⁸ The business name on the form must match your Sunbiz registration exactly. Even minor differences, such as a missing comma or “LLC” versus “L.L.C.,” can trigger delays.

The application requires:

Registered agent information for legal service of process.
Ownership and management details for every controlling interest holder, administrator, and financial officer, with their Background Screening ID numbers from the Clearinghouse.
POFA schedules, internally consistent with your narrative about capital and service volume.
A service description covering the services you will provide, the geographic area you will serve, and the populations you intend to reach. It must align precisely with your license type. A companion registration application that describes skilled nursing tasks will be flagged immediately.

Submit through the AHCA online portal, which requires a user account and PDF uploads of all supporting documents.¹⁹

Pay the applicable fee at submission. The fees differ substantially by license type:

Home Health Agency: approximately $1,705.
Nurse Registry: approximately $2,000.
Homemaker and Companion Service Provider: $50 per biennium.³

The HHA and nurse registry fees are set by Florida Administrative Code and may be adjusted, so verify current amounts before submitting. Fees are non-refundable even if the application is denied.

Respond to the Omission Letter and Pass the On-Site Survey

Expect an omission letter. Most first-time applicants get one, and it is not a sign that the application is in trouble. The letter identifies missing documents, clerical errors, or inconsistencies. You have 21 days to respond with the fixes.²⁰ Miss that window and AHCA can close your file, forcing you to start over with a new application and new fees. Treat the 21-day deadline as immovable.

Once the paperwork is clean, an AHCA inspector visits your office. The inspector verifies that the physical location is equipped and ready to accept clients, reviews your policies and procedures manual for compliance with Rule 59A-8, checks that communication systems work, and confirms the personnel files match what you submitted.

The office must look like a functioning agency, not an empty room with a desk. Have your policy manual printed and organized, employee and contractor files complete, supplies stocked, and phones working. The inspector wants to see that you could accept a client the day the license is granted. From submission to final approval, the whole process typically runs three to six months, depending on how complete your initial filing is and how quickly you cure deficiencies.

What You Need in Place Before You Start Serving Clients

HIPAA Compliance

Any home care agency that transmits health information electronically for billing, referrals, or eligibility checks is a covered entity under HIPAA. That captures most home health agencies and nurse registries. Homemaker and companion providers that never handle medical information may be exempt, though the safer assumption is that you are covered.

The Privacy Rule requires you to protect individually identifiable health information in any form, give clients a notice of privacy practices, limit staff access to the minimum necessary, and enforce that in written policies.²¹ The Security Rule adds administrative, physical, and technical safeguards for electronic protected health information: a risk analysis, a designated security officer, workforce training, access controls, and audit trails. Retain HIPAA documentation for at least six years.²² Designate a privacy official and train every workforce member before they handle patient information.

Medicare and Medicaid Certification

A Florida HHA license lets you operate. It does not let you bill Medicare or Medicaid. Federal certification is a separate process through CMS, with Conditions of Participation for home health agencies set out primarily in 42 CFR Part 484.²³ Expect an additional survey (typically by AHCA acting on behalf of CMS) to verify you meet those conditions, plus enrollment through the Provider Enrollment, Chain, and Ownership System (PECOS). The Medicare surety bond is required as part of this process.

To bill Medicaid, Florida requires Electronic Visit Verification (EVV) for personal care and home health care services. The EVV system must electronically capture the type of service, the client and caregiver identities, the date and location, and the start and end times of each visit. Agencies that bill Medicaid without a compliant EVV system face reductions in the federal matching rate for Medicaid payments.

Worker Classification

Getting worker classification wrong is one of the most expensive mistakes in home care, with consequences ranging from back taxes and penalties to losing your license. Nurse registries have the clearest ground: Florida law expressly classifies caregivers referred by a nurse registry as independent contractors.²

Home health agencies that try to classify caregivers as independent contractors face intense federal scrutiny. The Department of Labor uses an “economic reality” test that asks whether the worker is genuinely in business for themselves or economically dependent on the agency. Two factors carry the most weight: how much control the agency exercises over the work, and whether the worker has a real opportunity for profit or loss based on their own initiative. In the HHA model, most caregivers will be employees: you set schedules, assign clients, supervise, and provide equipment. If they are employees, you must withhold federal income tax, pay the employer share of Social Security and Medicare, file quarterly payroll returns, and carry workers’ compensation as required by Florida law.

Required Employee Training

All home health agency employees must complete training on Alzheimer’s disease and related disorders under Section 430.5025. Agencies whose client base is at least 90 percent individuals aged 21 or younger are exempt.²⁴

Every HHA employee must also complete a one-time HIV and AIDS education course within 30 days of hire, with limited exceptions for employees already subject to separate requirements under other statutes.¹⁵ Build these deadlines into onboarding. Inspectors check personnel files for proof that training was completed on time.

Renewal

Florida home care licenses run on a two-year cycle. Renewal requires a new application, the renewal fee, current background screenings, and continued compliance with staffing and operational requirements. Letting the license lapse means you cannot legally operate until the renewal clears, so mark the expiration date the day your initial license arrives and start the renewal process well ahead of the deadline.

1
The Florida Legislature. Florida Code 400 Part III – Home Health Services
2
Florida Senate. Florida Code 400-506 – Licensure of Nurse Registries
3
The Florida Legislature. Florida Code 400-509 – Registration of Particular Service Providers
4
Cornell Law School. Florida Administrative Code 59A-18.009 – Homemakers or Companions
5
Division of Corporations – Florida Department of State. Start a Business
6
Internal Revenue Service. Instructions for Form SS-4 Application for Employer Identification Number
7
CMS. How to Apply for a National Provider Identifier
8
The Florida Legislature. Florida Code 408-809 – Background Screening
9
Florida Senate. Final Bill Analysis CS/CS/HB 1543
10
U.S. Department of Health and Human Services, Office of Inspector General. Background Information – Exclusions
11
Florida Senate. Florida Code 408-8065 – Additional Licensure Requirements
12
The Florida Legislature. Florida Code 408-8065 – Additional Licensure Requirements
13
Florida Senate. Florida Code 400-476 – Staffing Requirements
14
The Florida Legislature. Florida Code 400-462 – Definitions
15
Florida Administrative Code. 59A-8.0095 – Personnel
16
Cornell Law School. Florida Administrative Code 59A-18.005 – Registration Policies
17
eCFR. Title 42 Part 489 Subpart F – Surety Bond Requirements for HHAs
18
eLaws. Ref-07060 Health Care Licensing Application, Home Health Agency, AHCA Form 3110-1011
19
Florida Agency for Health Care Administration. AHCA Single Sign On Portal
20
Florida Agency for Health Care Administration. Homemaker Companion Services Provider – General Information
21
U.S. Department of Health and Human Services. Summary of the HIPAA Privacy Rule
22
U.S. Department of Health and Human Services. Summary of the HIPAA Security Rule
23
CMS. Home Health Agency Center
24
Florida Senate. Florida Code 400-4785 – Patients With Alzheimers Disease or Other Related Disorders