How to Start a Home Care Business in Georgia: HFRD Licensing Steps

To start a home care business in Georgia, you register a business entity with the Secretary of State, choose one or more service classifications, run fingerprint background checks on your key people, write a policy and procedure manual, then file a Private Home Care Provider application with the Healthcare Facility Regulation Division (HFRD) inside the Department of Community Health. Fees run $550 to $1,050 depending on how many services you offer, and the license only issues after an on-site inspection. On top of that, you’ll carry liability insurance, follow federal rules on privacy, wages, and workplace safety, and pick up a local occupational tax certificate before you open.

Decide Which Services You’ll Offer

Georgia Rules and Regulations Chapter 111-8-65 splits private home care into three service classifications, and this choice shapes your staffing, your fees, and the rest of your application.¹ You can pick one, two, or all three.

Nursing services: clinical care such as wound care, medication administration, and vital sign monitoring under a physician’s order. This classification requires a Georgia-licensed RN to supervise all nursing services.
Personal care services: hands-on help with bathing, dressing, grooming, and eating. Staff must complete at least 40 hours of training or hold an equivalent credential, such as a certified nurse aide certificate.
Companion or sitter services: non-medical support like meal preparation, light housekeeping, and shopping. No physical assistance with hygiene, no clinical tasks. Staffing requirements are the lightest, which is why many new agencies start here.

Get the classification right the first time. Operating outside your license (say, licensed as companion-only but helping clients bathe) is a compliance problem, and adding a classification later costs another application fee and possibly another inspection.²

Register the Business and Get Your Federal IDs

The DCH won’t accept your license application without a registered legal entity. File with the Georgia Secretary of State’s Corporations Division as an LLC (articles of organization) or a corporation (articles of incorporation). The filing fee is $110 either way, which is the $100 filing fee plus a $10 service charge.³ Standard processing runs about seven business days, with expedited options at added cost.⁴

Once the entity is formed, apply to the IRS for an Employer Identification Number (EIN). It’s free, done online, and usually issued immediately. You’ll need it to open a business bank account, hire staff, and file payroll taxes.

Then apply for a National Provider Identifier through the National Plan and Provider Enumeration System (NPPES), operated by the Centers for Medicare and Medicaid Services.⁵ Agencies apply for an Organization NPI (Type 2) and select at least one healthcare taxonomy code describing the services offered.⁶ Even a private-pay-only agency needs an NPI for the Georgia licensing packet.

Start Background Checks Through GCHEXS Early

Georgia requires fingerprint-based state and federal criminal background checks for every owner, administrator, manager, and employee with direct access to clients or their finances.⁷ The system also cross-references the federal OIG List of Excluded Individuals and Georgia’s professional license databases.

Begin by submitting a GCHEXS Facility Account Registration form to the DCH Office of Inspector General. Once your account is active, you can enter applications for yourself and anyone you hire. Each person completes a Criminal Records Check Authorization Form and submits fingerprints.⁸ Fees typically range from $15 to $75 per person depending on the level of check.

Results can take several weeks. Start this before you file the license application, because HFRD will not move your file forward without clearance on key personnel.

Write Your Policy and Procedure Manual

Every private home care provider must maintain written policies and procedures that define the scope of services and how the agency operates.¹ The manual has to be finished before you apply, because HFRD reviews it during the approval process, and inspectors use it as the benchmark during the initial visit and every unannounced check afterward.

At a minimum the manual has to cover:

Client rights and complaint handling.
Written service agreements that spell out services, costs, and any authorization to access a client’s personal funds.
Emergency procedures for medical crises, natural disasters, and other urgent situations in a client’s home.
Staff training and competency verification, with specific protocols for each service classification you offer.
Record keeping, including signed and dated clinical and progress notes for nursing services.
Infection control procedures for preventing spread of illness and handling contaminated materials.

A vague or incomplete manual is one of the most common reasons applications get delayed. Treat it as the operational backbone of the agency, not a paperwork exercise.

File the HFRD Application, Pay Fees, and Pass Inspection

Download the Private Home Care Provider Application Packet from the DCH website.⁹ The form asks you to name a qualified administrator with full authority and responsibility for daily operations, reachable during business hours and meeting the educational and experience standards in Chapter 111-8-65.¹ A solo owner-operator can serve as their own administrator if they meet the qualifications. If you plan to offer nursing services, you also designate a Supervisor of Nurses who holds a current Georgia RN license and submit that person’s license number and background.

You’ll disclose everyone with a financial interest in the business, including parent companies and individual investors, so HFRD can vet them.¹⁰

What You’ll Pay

Fees are set by the Board of Community Health under Rule 111-8-25-.03:

Application processing fee: $300, due at submission.
License fee: $250 per service classification. All three (nursing, personal care, companion/sitter) is $750.

Total initial fees run $550 to $1,050 depending on classifications.² These are separate from your entity filing, background check costs, and any local permits.

Submit the complete package (application form, policy manual, proof of entity registration, records check documentation) to the HFRD office in Atlanta or through the DCH secure online portal.¹⁰

The On-Site Inspection

A staff reviewer first checks your materials for completeness. Respond quickly to any requests for clarification, because delays on your end extend the timeline directly. Once the paperwork clears, HFRD schedules a mandatory on-site inspection of your business location. The inspector confirms you can maintain client records securely, that personnel files contain completed background checks and training documentation, and that office operations match your policy manual. If there are deficiencies, you submit a plan of correction with specific dates before the license issues.

Once you pass, HFRD issues the Private Home Care Provider license. Display it prominently. Renewal is annual at $250 per classification, and unannounced inspections happen throughout the year.²

Carry the Required Insurance

Georgia law makes liability insurance (or a self-insurance trust) a condition of obtaining and keeping a healthcare facility permit.¹¹ Without proof, HFRD won’t issue or renew the license. Most home care agencies carry general liability and professional liability; talk to a broker who knows healthcare businesses about appropriate limits.

If you have three or more employees, Georgia also requires workers’ compensation insurance.¹² Home care involves lifting, transfers, and driving between homes, so injury risk is real. Skipping coverage when it’s required exposes you to personal liability for employee injuries and possible criminal penalties.

Federal Rules Every Home Care Employer Has to Follow

The state license lets you operate. Federal rules govern how you handle information, pay caregivers, and protect them on the job.

HIPAA

If your agency transmits health information electronically (billing insurance, coordinating with physicians), you’re a covered entity under HIPAA. That means written privacy procedures, employee training on those procedures, and a designated privacy officer.¹³ The Security Rule adds a duty to analyze security risks for electronic protected health information, put appropriate safeguards in place, and revisit them as technology and operations change. Paper-based agencies still need to secure records against unauthorized staff or visitors.

Wages, Overtime, and Travel Time

The Fair Labor Standards Act requires non-exempt home care workers to be paid at least the federal minimum wage for all hours worked, with overtime at one and a half times the regular rate over 40 hours in a workweek.¹⁴ Two things trip up new agencies.

Travel between two client homes during the same workday is paid time. The ordinary commute from home to the first client and from the last client home is not. Travel with a client to appointments or the grocery store is work time.¹⁴

The companionship exemption is narrow. If a worker spends more than 20 percent of the workweek on activities of daily living, or does any medically related tasks, the exemption is gone and full minimum wage and overtime apply. Misclassifying employees as exempt companions is one of the fastest routes to a Department of Labor investigation.

OSHA

Nursing services and any personal care that risks contact with blood or bodily fluids trigger the OSHA Bloodborne Pathogens Standard. You need a written Exposure Control Plan, personal protective equipment provided at no cost, and training at initial assignment and at least yearly after that.¹⁵ Contaminated sharps go into puncture-resistant, labeled containers immediately. Gloves are mandatory when hand contact with blood or non-intact skin is reasonably anticipated. OSHA’s general PPE rule also requires you to assess workplace hazards and supply appropriate equipment at your cost.¹⁶ In home care, “the workplace” is wherever your employees are working, which makes hazard assessment less straightforward than a traditional office.

Payroll Taxes

You’ll withhold and remit Social Security tax (6.2% of wages up to $184,500 in 2026) and Medicare tax (1.45% of all wages) on both the employer and employee side, plus withhold an additional 0.9% Medicare tax on individual wages over $200,000 in a year.¹⁷ FUTA is employer-only, on the first $7,000 of each employee’s annual wages. File Form 941 quarterly and issue W-2s by the end of January. A payroll service or accountant pays for itself quickly here.

Local Permits and Zoning

The state license doesn’t replace local requirements. Most Georgia counties and cities require an Occupational Tax Certificate, which is the local business license. Fees vary and are usually tied to employee count or projected gross receipts.

Before you sign an office lease, confirm the property is zoned for commercial or healthcare-related use. If you’re thinking of operating from home, check whether your jurisdiction permits it; some prohibit commercial activity in residential zones or require a special use permit. Discovering a zoning conflict after you’ve leased space and filed the state application is expensive to unwind.

If You Want to Serve Medicaid Clients

The HFRD license is only step one for Medicaid work. Georgia Medicaid runs a separate provider enrollment through the state’s Medicaid Management Information System. Home health agencies are classified as high risk, so expect an unannounced site visit during enrollment review, and be ready to submit detailed ownership and managing employee information under federal rules. Incomplete information leads to denial.

Many agencies open as private-pay only and add Medicaid once operations are stable. That’s a reasonable path. If Medicaid clients will be a big share of your revenue from the start, begin the enrollment process the moment your state license is in hand, because the timeline can add several months before you can bill.

1
Cornell Law School. Georgia Comp R and Regs R 111-8-65-.09 – Administration and Organization
2
Cornell Law School. Georgia Comp R and Regs R 111-8-25-.03 – General Licensing
3
Georgia Secretary of State. How to Guide – Register a Domestic Entity
4
Georgia.gov. Register an LLC with Georgia Secretary of State
5
Centers for Medicare and Medicaid Services. NPPES
6
Centers for Medicare and Medicaid Services. Apply for an NPI – NPPES
7
Georgia Department of Community Health. Georgia Criminal History Check System (GCHEXS)
8
Georgia Department of Community Health. GCHEXS Criminal Records Check Authorization Form and Instructions
9
Georgia Department of Community Health. Licensure Forms and Applications
10
Cornell Law School. Georgia Comp R and Regs R 111-8-65-.06 – Applications
11
Justia Law. Georgia Code 31-7-3.4 – Carrying of Liability Insurance or Establishment of Self-Insurance Trust as Condition Precedent to Obtaining or Maintaining Permit
12
Georgia State Board of Workers’ Compensation. Workers Compensation Insurance FAQs
13
Centers for Medicare and Medicaid Services. HIPAA Basics for Providers – Privacy, Security, and Breach Notification Rules
14
U.S. Department of Labor. Domestic Service Final Rule Frequently Asked Questions
15
Occupational Safety and Health Administration. 1910.1030 – Bloodborne Pathogens
16
Occupational Safety and Health Administration. 1910.132 – General Requirements
17
Social Security Administration. Contribution and Benefit Base