States where the guide found no home care agency license
Published by Home Care Agency Blueprint. Written under the direction of founder Scott McKenzie. · Updated
In some states the reference guide found no state license for non-medical home care agencies. That is not the same as “no rules”: many of these entries say whether a license is needed is not confirmed in official sources, and most list a Medicaid provider pathway instead. Read the state entry and confirm with the state before you rely on it.
Read the exact wording. The guide uses several different labels below. “No state license identified” means the research did not find one on official sources; it is not a statement that a license is never required. The last column quotes what each entry says under “License required?”.
No state license identified
| State | License / pathway | Flag | What the entry says under “License required?” |
|---|---|---|---|
| Alabama | None found; Medicaid waiver personal care via Alabama Medicaid-approved agencies | — | Not confirmed in official sources — check with the state agency — the sources reviewed do not establish whether a non-medical home care agency needs a state license. The January 2026 manual’s licensure/certification language concerns Medicaid home-health providers, and the cited home-health rules describe skilled services. [1][2] |
| Arizona | DES/DDD HCBS certification (Medicaid-funded services) | — | Not confirmed in official sources — check with the state agency |
| Idaho | Medicaid Personal Assistance Agency (PAA) provider enrollment | — | Not required / N/A — The 2016 Idaho Department of Insurance publication states that non-medical in-home care agencies are not required to be licensed in Idaho. The HHA rules separately say a personal assistance agency requires HHA licensure only if it primarily provides nursing services. [1][2] |
| Iowa | Iowa Medicaid HCBS provider enrollment (IAC 441-77) | — | Not confirmed in official sources — check with the state agency — the sources reviewed do not establish whether Iowa requires a standalone license for non-medical home-care agencies. They describe Medicaid/HCBS provider requirements, including that attendant-care community businesses have necessary licenses and permits under otherwise-applicable law. [1][2] |
| Michigan | MDHHS Home Help agency provider approval + CHAMPS enrollment (Medicaid) | — | Not required / N/A — The Michigan Attorney General checklist describes non-medical home care as an unregulated industry. This does not remove the separate MDHHS approval and CHAMPS enrollment requirements for agencies participating in the Home Help program. [1][2][3] |
| Montana | Medicaid provider enrollment (DPHHS programs) | — | Not confirmed in official sources — check with the state agency |
| Nebraska | Nebraska Medicaid provider enrollment (PAS/HCBS) | — | Not confirmed in official sources — check with the state agency — the sources reviewed do not establish whether a separate state license is required for a non-medical personal-care, companion, or homemaker agency. The cited home-health rules exclude these services, but do not resolve whether another separate license applies. [1][2][3] |
| North Dakota | HHS Qualified Service Provider (QSP) agency enrollment | — | Not confirmed in official sources — check with the state agency — the sources reviewed do not establish whether an ordinary non-medical home-care agency needs a separate state license. The statement that QSPs do not need a special certificate or license does not resolve agency licensing. [1][2] |
| Vermont | None found (home health designation applies to home health only) | — | Not confirmed in official sources — check with the state agency — Vermont's home health rules require designation for home health agencies. Under the rule effective July 1, 2026, designated services are limited to skilled home health and hospice; Choices for Care personal-care, companion and homemaker services are no longer designated services. The rules do not establish a separate license for standalone non-medical agencies. (Updated after the October 15, 2026 guide.) [1] |
No general license identified
| State | License / pathway | Flag | What the entry says under “License required?” |
|---|---|---|---|
| New Mexico | Medicaid (Mi Via) certification or HHA license | — | Not confirmed in official sources — check with the state agency — the sources reviewed do not establish whether New Mexico requires a general state license for non-medical-only companion, homemaker, or personal-care agencies. The home health agency definition excludes providers offering only non-medically directed services; specified Medicaid programs have their own provider requirements. [1][2][3] |
| Wisconsin | DHS/DQA Personal Care Agency certification (Medicaid) | — | Not confirmed in official sources — check with the state agency |
Medicaid certification only
| State | License / pathway | Flag | What the entry says under “License required?” |
|---|---|---|---|
| Alaska | SDS Personal Care Services / CFC-PCS provider certification | — | Not confirmed in official sources — check with the state agency — For Medicaid PCS or Community First Choice PCS, provider certification is required. The sources reviewed do not establish whether a separate state license is required for a non-Medicaid, non-medical home-care agency. [1][2] |
No state license
| State | License / pathway | Flag | What the entry says under “License required?” |
|---|---|---|---|
| Mississippi | MS Division of Medicaid E&D Waiver provider enrollment | Changed | Not confirmed in official sources — check with the state agency |
No (private pay)
| State | License / pathway | Flag | What the entry says under “License required?” |
|---|---|---|---|
| Missouri | No license; Medicaid in-home services via MMAC contract + enrollment | Watch | For private-duty/private-pay companies, Missouri does not issue a state license. Agencies serving Medicaid clients use the state-contract pathway rather than a stated separate home-care-agency license. [1] |
No
| State | License / pathway | Flag | What the entry says under “License required?” |
|---|---|---|---|
| South Dakota | No license (HB 1138 vetoed 2026); Medicaid via DHS LTSS | Watch | Not required / N/A — No. The SD Department of Health states that non-medical providers of in-home care (bathing, light housekeeping, meal preparation) are not regulated by the Department. HB 1138 (2026), which would have created a non-medical home care agency license starting Jan 1, 2027, passed both chambers but was vetoed; the House veto-override vote failed on Mar 30, 2026. [1][2][3] |
No non-medical license confirmed
| State | License / pathway | Flag | What the entry says under “License required?” |
|---|---|---|---|
| Wyoming | HHA license applies to health services; Medicaid HCBS certification | Watch | Not confirmed in official sources — check with the state agency — the sources reviewed do not establish whether a non-medical-only companion, homemaker, or personal-care agency must obtain a state license. The stated license requirement applies to health care facilities, including a home health agency as defined in the cited facts. [1][2][3] |
Close calls to check
- Massachusetts: Yes – new law, not yet implemented. Chapter 180 of 2026 (approved Aug 6, 2026) creates a home care agency license that will become mandatory on a date EOHHS has not yet set; regulations pending. As of October 15, 2026, no license was being issued.
- West Virginia: the guide lists OHFLAC home care service provider registration (§15-2C-7), so it is not in the lists above.
- States marked WATCH above may change; see changes since March 2026.
Frequently asked questions
Can I open a non-medical agency without any approval in these states?
Do not assume so. The entries often say whether a license is needed is not confirmed in official sources, and other rules, such as Medicaid enrollment, business registration, employment law and local rules, can still apply. Confirm with the state before serving clients.
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