Home health license: the skilled-care license and the certification behind it. This page explains what the license asserts and what it does not, the three doors owners confuse (licensure, certification, accreditation), and the calendar that keeps an agency licensed after opening day, with the federal clocks cited where they bind.
License, certification, accreditation: three different doors
State licensure lets you operate. Medicare certification (skilled care) lets you bill federal programs and brings the conditions of participation and the survey cycle. Accreditation is a private stamp some payers and referrers want. Owners conflate them and budget for one; the sequence and the money differ for each, and only the first is universally mandatory.
The manual is most of the application
Every licensing packet demands written policies and procedures matched to your services. Surveyors then read that manual against reality for the life of the agency, so writing it borrowed is a debt, not a shortcut. The free builder on this site sizes the manual from your own services and roster before you write or buy a word of it.
Staying licensed is a calendar, not a certificate
Each certified home health agency must be surveyed not later than 36 months after the last day of its previous standard survey (42 CFR 488.730). Renewal cycles, complaint surveys and payer audits arrive in between. Agencies that stay clean run their own audit on a cadence they control; the free compliance checklist turns that audit into items and hours from your own figures.
State variation is the rule
Some states license non-medical care lightly or not at all; others (New York's LHCSA regime among the strictest) run application queues, fixed windows and public need tests. Nothing generic substitutes for the licensing authority's own current page, which is why this page links primary sources and quotes no fees.
Questions people ask about home health license
Can a license be transferred if I buy an agency?
States treat changes of ownership as regulated events: some re-license, some notify-and-review. Buying an agency for its license alone is buying a process, not a certainty; confirm the state's change-of-ownership rules before valuing it.
What gets licenses pulled?
Divergence between the manual and the practice: unqualified staffing, missing records, unworked complaints. The pattern behind enforcement actions is rarely exotic; it is paperwork that stopped being true.
Is a license required for non-medical home care?
In most states yes, with real variation in depth; a few regulate lightly. The state licensing authority's page is the only current answer, and it is where every requirements list on the wider internet was copied from, accurately or not.