The short answer Massachusetts licenses neither home health nor non-medical home care — but change is pending: the House passed 'An Act to Improve Massachusetts Home Care' (H.4706) in November 2025, and as of mid-2026 the companion measure was still awaiting Senate action, so no license is yet required.
What Massachusetts requires
Massachusetts
Historic status. Massachusetts has been one of the only states with no license for private-pay non-medical home care agencies and no state home health agency license — Medicare certification (DPH as survey agency) was the only survey regime for skilled agencies.
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2025 licensure legislation. The Massachusetts House passed An Act to Improve Massachusetts Home Care (H.4706) on November 5, 2025, which would establish licensure for non-medical home care agencies; the companion Senate measure (S.2555, building on earlier S.3170) remained pending in the Senate as of mid-2026.
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What the bill would require. The framework would task the Executive Office of Health and Human Services with issuing licenses, surveying and investigating agencies, and imposing fines; agencies would have to disclose 5%+ owners, carry workers' comp and liability insurance, and meet training standards, with provisional licenses during transition.
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Timeline. The bill had not been enacted as of July 2026 — EOHHS licensure would begin only after passage and rulemaking, so agencies operating in Massachusetts should track the bill's status and prepare licensure and survey-readiness documentation in advance.
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Existing overlays. Until the new regime is fully live, oversight comes via contracts (ASAPs/Aging Services Access Points for state-funded home care) and Medicare certification for skilled agencies; MA also enforces strong wage-hour rules (domestic workers, earned sick time) on home care employers.
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The federal baseline (applies in every state)
Federal
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.
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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.
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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.
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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.
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Primary sources for this page
- https://www.mass.gov/orgs/department-of-public-health
- https://malegislature.gov/PressRoom/Detail?pressReleaseId=277
- https://malegislature.gov/PressRoom/Detail?pressReleaseId=277
- https://www.mass.gov/orgs/executive-office-of-health-and-human-services
- https://www.mass.gov/orgs/executive-office-of-health-and-human-services
More Massachusetts guides