Home Care Agency Licensure in California

Two licensing agencies. The California Department of Public Health (CDPH) licenses home health agencies (Health & Safety Code § 1725 et seq.), while the California Department of Social Services (CDSS) Home Care Services Bureau licenses non-medical Home Care Organizations (HCOs). Source ↗

Home Care Organization license. Under the Home Care Services Consumer Protection Act (Health & Safety Code § 1796.10 et seq.), any entity arranging non-medical home care must hold an HCO license, renewed every two years, with per-location fees set by the CDSS fee schedule. Source ↗

Home Care Aide Registry. All affiliated caregivers must be listed on the public Home Care Aide Registry, which requires DOJ/FBI background clearance, TB screening, and five hours of entry-level training before working independently with clients. Source ↗

Home health surveys. CDPH's Center for Health Care Quality conducts home health licensure and Medicare certification surveys; California has no CON, but agencies face initial licensing surveys, complaint investigations, and plan-of-correction enforcement. Source ↗

Compliance exposure. Operating an HCO without a license is subject to civil penalties, and CDSS can deny, suspend, or revoke licenses for background check or staffing violations — worth noting given California's aggressive wage-hour and PAGA enforcement climate for home care employers. Source ↗

No federal home care license. There is no federal license for home care or home health agencies. Licensure is a state function: each state (and DC) decides whether and how to license home health agencies and non-medical personal care/companion agencies, so requirements vary dramatically by jurisdiction. Source ↗

Medicare certification (42 CFR Part 484). Agencies that bill Medicare for skilled home health must be certified as meeting the Medicare Conditions of Participation at 42 CFR Part 484 (patient rights, comprehensive assessment, QAPI, skilled professional services, home health aide standards, and more), on top of any state license. Source ↗

Accreditation with deemed status. Most new Medicare home health agencies obtain certification through a CMS-approved accrediting organization with deeming authority — ACHC, CHAP, or The Joint Commission — whose surveys substitute for the state agency's Medicare certification survey. Source ↗

State survey agencies enforce both. State survey agencies (usually the state health department) operate under agreements with CMS to survey Medicare-certified agencies, and most also run the state licensure survey program — initial surveys, renewal/recertification surveys, complaint investigations, and plan-of-correction enforcement per the CMS State Operations Manual. Source ↗