How to Start a Home Health Agency in Louisiana

Starting a home health agency in Louisiana is not currently possible through the traditional licensing route. This guide explains why, what barriers exist, and what your realistic options are if you want to enter the home health care business in Louisiana.

The Reality: Louisiana's Home Health Agency Licensing Moratorium

Louisiana has a state-level licensing moratorium on new home health agencies. Here is what you need to know:

State Licensing Barrier: R.S. 40:2116.32(F)(1)

Louisiana Revised Statute 40:2116.32(F)(1) prohibits the Louisiana Department of Health (LDH) from issuing new home health agency licenses until the state publishes a rule certifying that funding is available for initial surveys. There is a narrow exception for federal-priority cases, but this rule effectively stops new agency licensing.

As of October 2026, it is unclear whether LDH has published the required rule certifying that funding is available. Before pursuing any home health agency licensing path, contact the Louisiana Department of Health, Health Standards section, to confirm the current status of this rule and whether new licenses are being issued.

Federal Medicare Enrollment Freeze

Even if you obtained a state license, the Centers for Medicare and Medicaid Services (CMS) imposed a nationwide moratorium on new Medicare enrollment of home health agencies and hospices, effective May 13, 2026. This moratorium is for six months and is extendable, which means new agencies cannot bill Medicare (the largest payer for home health services) during this period.

Your Realistic Options

If you want to enter the home health care business in Louisiana, you have two practical paths:

Option 1: Buy an Existing Licensed Home Health Agency

The most direct path to operating a home health agency in Louisiana is to purchase an existing, licensed agency. This is called a change of ownership and does not require LDH to issue a new license. You acquire the agency's existing license, which you can operate under your ownership.

Steps for buying an existing home health agency:

1. Search for available agencies. Contact commercial real estate brokers and business brokers in Louisiana who specialize in health care services. Agencies may be listed on general business marketplaces (BizBuySell, Flippa) or industry-specific brokers. Ask brokers directly about agencies for sale in your market.
2. Conduct due diligence. Review the agency's licensing status with LDH, review CMS survey history if the agency is Medicare-certified, inspect financial records for the past 3 to 5 years, verify employee and contractor status, and check patient census and revenue stability.
3. Verify the license is in good standing. Confirm with the Louisiana Department of Health that the agency's license is current and that there are no pending violations or decertifications.
4. Negotiate and purchase. Work with a business attorney to negotiate the purchase price and terms. The sale price depends heavily on patient census, contracts, revenue, and profit margins. Expect to pay a multiple of annual earnings (typically 1x to 3x EBITDA, depending on the market and agency stability).
5. File a change of ownership notice. Notify LDH of the change of ownership. Procedures and required forms should be confirmed with the LDH Home Health Services section. Some changes of ownership may trigger a partial survey, so budget for that possibility.
6. Update business registrations. If you are operating under a new entity (LLC, corporation), register that entity with the Louisiana Secretary of State via the geauxBIZ portal at https://geauxbiz.sos.la.gov/. File a trade name registration if you plan to operate under a name different from the legal entity name.
7. Obtain an Employer Identification Number (EIN) from the IRS. File Form SS-4 with the IRS, or apply online at irs.gov. You will need this for payroll, tax reporting, and Medicare/Medicaid billing.
8. Register for sales tax and other state permits. Register with the Louisiana Department of Revenue at https://revenue.louisiana.gov/businesses/general-resources/business-registration/. Confirm any occupational license requirements with your city or parish.
9. Set up Medicare and Medicaid billing. If the agency is Medicare-certified, enroll as the new authorized official with CMS. Note that you cannot enroll in new Medicare coverage during the current moratorium, but you can continue billing under the existing agency's certification. Work with a Medicare billing specialist or your state's Home Health Quality Reporting System (HHQRS) contacts at CMS to verify current enrollment procedures.
10. Obtain surety bonding if required. Some states require home health agencies to carry a surety bond. Confirm with LDH whether Louisiana requires a bond and, if so, the minimum amount. Surety bonds typically cost 1 to 3 percent of the bond amount annually.

Option 2: Start a Non-Medical Home Care or Home Sitter Business

If you do not want to acquire an existing agency, consider starting a non-medical home care or home sitter service. These businesses do not require state home health licensing and operate outside the Medicare/Medicaid regulatory framework. They provide companionship, personal care assistance, light housekeeping, and transportation services, but do not provide skilled nursing or medical care.

Steps for starting a non-medical home care business:

1. Choose your business structure. Decide whether to operate as a sole proprietorship, LLC, or corporation. An LLC is the most common choice for small home care businesses because it offers liability protection and tax flexibility. An LLC is also simple to set up in Louisiana.
2. Register your business entity with the Louisiana Secretary of State. File Articles of Organization using the geauxBIZ online filing portal at https://geauxbiz.sos.la.gov/. The filing fee is $100, and processing time varies; you can pay $30 for expedited processing (24 hours) or $50 for priority processing (while you wait at the Baton Rouge office). You will need a registered agent with a Louisiana street address.
3. Obtain an Employer Identification Number (EIN). File Form SS-4 with the IRS online or by mail. This takes a few days to a few weeks.
4. Register for sales tax with the Louisiana Department of Revenue. Visit https://revenue.louisiana.gov/businesses/general-resources/business-registration/ or contact the department directly. Louisiana's state sales tax rate is 5 percent, but parishes and municipalities may levy additional sales tax. Confirm any local requirements in your area.
5. Obtain local occupational licenses. Louisiana does not issue a single statewide business license. Most parishes and municipalities require an occupational license or business permit. Contact your city hall or parish clerk of court to determine what licenses and fees are required in your jurisdiction. Fees vary widely by location.
6. Verify background check and caregiver requirements. While non-medical home care does not require state licensure, many clients (particularly Medicaid waiver programs or private clients) require caregivers to pass background checks. Confirm what checks are required by your target clients. Some states require fingerprinting; verify with your parish Clerk of Court whether Louisiana requires this.
7. Get general liability and workers compensation insurance. If you hire employees, Louisiana requires workers compensation insurance. General liability insurance is optional but strongly recommended to protect against slip-and-fall claims or other incidents. Costs vary; expect $300 to $1,000 per year for a small operation.
8. Set up payroll and bookkeeping. If you hire employees, enroll in Louisiana unemployment insurance (LAUS) through the Louisiana Workforce Commission. Set up payroll processing (either in-house or through a payroll service). Keep records of all business income and expenses for tax purposes.
9. Develop client intake and care documentation processes. Create simple forms for client intake, service agreements, emergency contacts, and daily care logs. This protects you legally and ensures quality care.
10. Market your business. Build a simple website, register on Google Business, ask for referrals from local doctors and social workers, and advertise in community newsletters or on Nextdoor and Facebook.

Key Regulations and Licensing for Each Path

Licensed Home Health Agency (Change of Ownership)

Regulatory authority: Louisiana Department of Health, Health Standards section.

License requirements: Home health agencies must comply with Louisiana Administrative Code Title 51, Part I, Chapter 603 (home health services). Requirements include:

• A licensed physician as medical director
• A registered nurse as administrator or clinical director
• Written policies and procedures for patient care, infection control, and employee qualifications
• A Conditions of Participation (CoP) survey by LDH if Medicare-certified
• An annual report to LDH

Insurance requirements: Verify with LDH whether a surety bond is required in Louisiana.

Medicare billing: Contact the CMS Regional Home Health Intermediary (your state's Medicare Administrative Contractor, or MAC) to enroll as a provider. Note the Medicare enrollment moratorium mentioned earlier.

Non-Medical Home Care Business

Regulatory authority: No state licensing. Local authorities (parish/municipality) for occupational licenses only.

Key requirements:

• Business registration with the Secretary of State (LLC, corporation, or sole proprietorship)
• EIN from the IRS
• Sales tax registration with the Louisiana Department of Revenue
• Local occupational license (varies by parish/city)
• Workers compensation insurance (required if you have employees)
• General liability insurance (recommended)
• Background checks for caregivers (may be required by clients)

Costs and Timeline

Buying an Existing Home Health Agency

Purchase price: $100,000 to $500,000 or more, depending on patient census, revenue, and profit. Smaller agencies or those with declining patient loads cost less.

Due diligence and legal fees: $3,000 to $10,000 for business attorney and accountant review.

Working capital: Budget 2 to 3 months of operating expenses (payroll, supplies) after purchase. This is typically $20,000 to $50,000 for a small to medium agency.

Timeline: 2 to 4 months from identifying a target agency to closing and taking over operations. Longer if the agency requires an LDH survey post-acquisition.

Starting a Non-Medical Home Care Business

LLC formation: $100 filing fee with the Secretary of State (or $130 with expedite).

EIN: Free from the IRS.

Sales tax and occupational licenses: Typically $50 to $300, depending on your parish and municipality.

Insurance: $300 to $1,000 per year for general liability and workers comp (if you have employees).

Initial marketing and website: $200 to $1,000 (DIY) or $1,000 to $5,000 (professional design).

Total startup cost: $1,000 to $8,000.

Timeline: 2 to 4 weeks from registration to operational. You can start taking clients as soon as you have your EIN, business entity, and insurance in place.

Tips and Common Mistakes to Avoid

For the Change-of-Ownership Path

• Verify the license status in writing before signing. Do not rely on the seller's word. Request a letter from LDH confirming the agency's license is current and in good standing.
• Have an attorney review the purchase agreement. Home health agencies are heavily regulated, and the purchase agreement must address liability, regulatory compliance, and indemnification. Do not skip this step.
• Review patient contracts and insurance carefully. Understand which patients are on Medicaid, Medicare, or private pay. Confirm that insurance arrangements transfer with the change of ownership.
• Interview key staff before closing. Ask nurses, billing staff, and schedulers whether they plan to stay. High turnover post-acquisition is a major risk.
• Confirm CMS enrollment status with the MAC. If the agency is Medicare-certified, verify with the Medicare Administrative Contractor that the agency is in good standing and that the change of ownership will not trigger a survey or delisting.

For the Non-Medical Home Care Path

• Get insurance before taking your first client. A slip-and-fall injury, allegation of theft, or other incident can shut down a business fast. General liability and workers comp insurance protect you and your employees.
• Define the scope of services in writing. A clear service agreement that specifies what you do (companionship, light housekeeping, personal care assistance) and what you don't do (medical care, medication administration, wound care) prevents misunderstandings and liability disputes.
• Do background checks on caregivers. Even though it is not legally required in Louisiana for non-medical home care, clients expect it. A simple background check from a service like Checkr or GoodHire costs $20 to $50 and protects both you and your clients.
• Keep detailed care records. Document the dates, times, and nature of services provided to each client. This protects you if there is ever a dispute and helps you track client needs and preferences.
• Do not attempt medical care or medication administration. If a client asks you to help with medications or wound care, refer them to a licensed home health agency or a nurse. Providing medical services without a license is illegal in Louisiana.

Resources and Next Steps

Use these official resources to confirm current regulations and requirements:

• Louisiana Department of Health, Health Standards: Confirm the current status of the state licensing moratorium and the requirements for home health agency licensing and change of ownership.
• Louisiana Secretary of State, geauxBIZ: Register your business entity online at https://geauxbiz.sos.la.gov/.
• Louisiana Department of Revenue: Register for sales tax and confirm state tax requirements at https://revenue.louisiana.gov/.
• Louisiana Small Business Development Center (SBDC): Free business planning and financing guidance at https://louisianasbdc.org/.
• U.S. Small Business Administration (SBA), Louisiana District: Guides on business registration, funding, and mentorship at https://www.sba.gov/district/louisiana.
• Centers for Medicare and Medicaid Services (CMS): For agencies seeking Medicare certification or billing, visit cms.gov or contact your state's Medicare Administrative Contractor.
• Your parish Clerk of Court: Confirm local occupational license and permit requirements for your specific parish and city.

Important Disclaimer

This article is informational and does not constitute legal or tax advice. Home health agency licensing and operation are complex, regulated activities with significant liability exposure. Before you purchase an existing agency or start a new business, consult with a qualified Louisiana business attorney and a certified public accountant (CPA) who has experience in health care services. The laws, regulations, and requirements described in this article are current as of October 2026 but are subject to change. Always verify current requirements directly with the Louisiana Department of Health, the Louisiana Secretary of State, and your local authorities before making business decisions or investments.

Summary

Starting a new licensed home health agency in Louisiana is not currently feasible due to state and federal licensing moratoria. Your realistic options are to buy an existing licensed agency through a change of ownership, or to start a non-medical home care business outside the regulated home health framework. Both paths require business registration with the Secretary of State, an EIN, and sales tax registration. A change of ownership is more complex, more expensive, and more heavily regulated, but offers access to Medicaid and potential Medicare billing. A non-medical home care business is simpler, cheaper, and faster to launch, but operates in a less regulated niche. Consider your target market, capital, and regulatory tolerance when choosing which path is right for you.