Maintained dataset · Checked October 22, 2026
Most "how to start" guides never mention that some doors are closed. Moratoria freeze new licenses. Need tests presume your county has enough agencies already. Certificate-of-need states make you prove the market wants you before you may open. This tracker lists every gate in our dataset — dated, sourced, and re-checked on the quarterly sweep.
| State | Gate type | What it means for a new founder | Source |
|---|---|---|---|
| Alabama | Con | Certificate of Need (SHPDA) gates the skilled home health lane; it does not apply to non-medical personal care agencies. | Source |
| Alaska | Con | CON was NOT repealed — verify any claim otherwise. Alaska's Certificate of Need Program, AS 18.07, remains in the 2025 Alaska Statutes (Ch. 18.07, §§18.07.021 administration, 18.07.031 CON required, 18.07.035 application and fees, 18.07.041/043 standards of review). HB 77 in the 32nd Legislature was a bill 'repealing the certificate of need program' — a proposal, not an enactment. As codified, §18.07.031(a) requires a CON only for an expenditure of $1,000,000 or more for construction of a health care facility, alteration of bed capacity, or addition of a category of health services, plus any conversion of a building to a nursing home — so a typical asset-light home care / home health start-up below the $1M threshold does not trigger CON, but the program itself is alive and Alaska was reported in October 2026 as among states considering CON repeal for federal rural-health funds, i.e. still to repeal, not repealed. | Source |
| Arkansas | Con | Skilled lane gate: a Permit of Approval (CON-equivalent) from the Arkansas Health Services Permit Agency has been required before a new home health agency license; not re-verified in primary text this pass — confirm before launch. | Source |
| Arkansas | Rule Change | 2025 legislation rewrote the private care agency scheme: Act 853 removed DHS DPSQA certification from licensure, Act 643 exempted previously trained home caregivers from repeating training, and Act 674 changed criminal-history check rules; ADH's amended Rules for Private Care Agencies (20 CAR Part 49) were proposed with an October 1, 2026 effective date. Separately, 2025 SB 120 proposed extending licensure, training and background checks to purely private-pay home care agencies, after testimony that the existing standards applied only to Medicaid-accepting agencies — the private-pay reach of the license was actively contested in 2025. | Source |
| California | Moratorium | SB 164 moratorium on NEW home health agency licenses from June 29, 2026 until no later than 90 days after CDPH's revised HHA regulations take effect (unmet-need exception possible). Applies to the skilled HHA lane only — it does NOT block the non-medical Home Care Organization license. | Source |
| Colorado | Rule Change | Statutory fee escalators in CRS 25-27.5-104(1)(g)(II): home care agency licensure fees must increase 8% in FY2025-26, 6% in each of FY2026-27, FY2027-28 and FY2028-29, then by Denver-Aurora-Lakewood CPI from FY2029-30. CDPHE publishes the updated schedule by March 1 each year, effective July 1. | Source |
| Georgia | Con | Certificate of Need applies to the skilled Home Health Agency lane in Georgia — a new home health agency needs CON approval in addition to DCH licensure. The non-medical Private Home Care Provider license itself has no CON or need test. | Source |
| Idaho | Rule Change | 2025 Streamlined Facilities Licensing Act (Idaho Code § 39-1303(8)) exempts Medicare-certified home health agencies from licensure/certification under the new facilities chapter while Chapter 24 (§ 39-2403) licensure language remains on the Legislature's site — the interaction of the two chapters should be rechecked at launch. | Source |
| Louisiana | Need Test | Initial HCBS licensing is 'subject to any facility need review approval' per LAC 48:I Ch. 50 application-closure text reviewed. | Source |
| Maine | Rule Change | Registration became licensure: PL 2023 c.309 (22 MRSA §1717 sub-§2-A) provides that beginning 1 July 2024 an entity may not provide home care services without a Personal Care Agency license; 10-144 CMR Ch. 129 repealed and replaced the 1999 registration rule and took effect in August 2024. Operating without a license is a civil violation of $500/day up to $10,000. | Source |
| Minnesota | Moratorium | VERIFIED on mn.gov (DHS): temporary moratorium on NEW 245D Home and Community-Based Services (HCBS) licenses administered by the Minnesota DEPARTMENT OF HUMAN SERVICES — effective January 1, 2026, anticipated 24 months, ending December 31, 2027. DHS will stop accepting new 245D applications, stop adding new service lines to existing 245D licenses, and cancel pending applications. Authority: Minn. Stat. 245A.03 subd. 7a and Executive Order 25-10. IMPORTANT SCOPE LIMIT: this is the DHS 245D HCBS license, NOT the MDH 144A home care license above — the MDH basic/comprehensive home care license is a different license and this moratorium announcement does not close it. A founder who needs 245D HCBS waiver services is blocked until 2028; a private-pay / MDH-licensed home care launch is a different lane. | Source |
| Mississippi | Con | Certificate of Need required to establish a home health agency or offer home health services (Miss. Code § 41-7-191(1)(d)(ix)); MSDH CON criteria require documented unmet need of 50+ patients in each county proposed to be served (15 Miss. Code R. 8-90-07-703.02). | Source |
| Mississippi | Moratorium | Mississippi's State Health Plan imposed a moratorium on new home health agencies dating to the 1980s — the CON standards text itself opens 'If the present moratorium were removed or partially lifted, MSDH would review applications…' In 2025 a federal district judge (Slaughter litigation) struck the decades-old moratorium down as violating due process and equal protection, because the plaintiff 'cannot offer home health services without a Certificate (of Need), and he cannot receive a Certificate because of the four-decades-long moratorium.' Post-judgment MSDH CON practice for new home health agencies was unsettled when checked — verify with MSDH before launch and do not present the skilled lane as simply open or simply closed. | Source |
| Montana | Rule Change | Certificate of Need: DPHHS's older prospective-provider letter required CON review for home health agencies through October 1, 2021; the current DPHHS letter states a CON is NOT required for home health agencies. Montana's CON statute (MCA 50-5-301) still lists home health among regulated categories in secondary summaries — verify current CON status with DPHHS Health Planning before relying on either statement at launch. | Source |
| New Jersey | Rule Change | Accreditation gate at renewal: under N.J.A.C. 13:45B-13.5(b), starting with the first renewal after the rule amendment, a health care service firm must show it is accredited by a Department of Human Services-recognized accrediting body — in practice, accreditation must be obtained within 12 months of initial registration; a firm registered less than 12 months before its first renewal is excused at that first renewal. Loss of accreditation must be reported to the Division within 10 days. | Source |
| New Jersey | Rule Change | Financial-reporting change in 2026: P.L. 2026, c.45 (signed July 22, 2026) modified Health Care Service Firm financial reporting, and the Division has suspended the audit/enhanced reporting duties in N.J.A.C. 13:45B-13.5A(b)-(e) while it updates its regulations. (Reported by law-firm analyses of the Division's action; flagged for re-verification on the Division site before launch.) | Source |
| New York | Need Test | Public-need test for new LHCSAs: under DOH's public need methodology (applications on/after April 1, 2020), if 5 or more LHCSAs are actively serving patients in a county, there is a presumption of NO need, and the applicant must submit evidence-based data to overcome it for each such county. DOH's FAQ applies this presumption today. NOTE: some current codified printings of PHL §3605 show the public-need criterion removed from subdivision 4 — the statute text and DOH's operating methodology conflict in the sources checked on 2026-10-22, so treat the need test as live DOH practice but flag it for re-verification before launch. | Source |
| North Carolina | Con | Certificate of Need gates the home health (skilled/Medicare-certified) lane by county in North Carolina. No CON is required for the home care license used for in-home aide / personal care services. | Source |
| North Dakota | Moratorium | Check before enrolment: the HHS QSP page carries a standing 'Provider Enrollment Moratoria' notice/link. Any active moratorium by service/county would pause new QSP enrolment for that service; the page retrieved lists the moratoria resource but no service-specific moratorium text was extracted in this pass, so verify current moratoria in the QSP portal at enrolment. | Source |
| Rhode Island | Con | As written in the current licensure regulation, 216-RICR-40-10-17 §17.4.1(B): 'A certificate of need is required as a precondition to the establishment and initial licensure of any home nursing care provider or home care provider', with prior Health Services Council review and licensing-agency approval also required for changes in owner, operator or lessee (§17.4.1(B)(1)). | Source |
| Rhode Island | Rule Change | June 2026 removal: the FY2027 budget legislation signed 12 June 2026 amended R.I. Gen. Laws Chapter 23-15 so CON review for new health care facilities is limited to hospitals (other than behavioural-health-only), nursing facilities, hospice, inpatient rehabilitation and free-standing emergency care — CON review is stated to be no longer required for home nursing care providers or home care providers. The licensure regulation Part 17 had not been conformed in the text retrieved for this pass, so a launch-eve check of the amended §23-15 and Part 17 is essential: the gate appears legislatively removed but the regulation on its face still imposes it. | Source |
| South Carolina | Con | Certificate of Need gate applies to the skilled home health lane only (§44-69-75), not to the In-Home Care Provider license. | Source |
| South Dakota | Rule Change | Watch item, not a current gate: HB 1138 (2026), which would have created state licensing, training standards and criminal-history background-check procedures for non-medical home care agencies, was vetoed and did not take effect. South Dakota therefore remains unlicensed for non-medical home care as of this pass, but the vetoed bill signals the direction of travel — build to licensed standards anyway. | Source |
| Tennessee | Con | Certificate of Need required BEFORE licensure for a new home health agency: HFC's 'Home Health Services — Procedures for Applying for Licensure of a New Facility' states 'You must first apply for a Certificate of Need (CON) from the Health Facilities Commission prior to applying for licensure of this type of facility' (exceptions in TCA 68-11-1607 for agencies providing only pediatric services and/or EEOICPA federal program services, which must instead obtain accreditation within 2 years). The CON gate applies to the SKILLED home health lane, not to a personal support services agency. | Source |
| Vermont | Con | Skilled lane only: 13-010 Code Vt. R. §4.1 — any person seeking to become a home health agency in Vermont shall apply for and obtain a Certificate of Need from the Green Mountain Care Board prior to filing an application for designation, and must obtain and maintain federal CMS certification before designation (§4.2-4.3). Geographic franchise areas under 33 V.S.A. §6304 further limit entry. | Source |
| Vermont | Rule Change | Revised Regulations for the Designation and Operation of Home Health Agencies were trained on 29 June 2026 and took effect 1 July 2026; new §2.2(ii) defines unskilled (non-medical) services and §2.2 states unskilled services are not designated services, confirming the non-medical lane stays outside designation. | Source |
| Washington | Rule Change | Fee rule change effective June 1, 2026 (WSR 26-04-110, filed 2/3/26): initial fee rose from $3,283 to $5,000 per service category, renewal tables were raised, a county surcharge was added ($500 per additional urban county, $100 per additional rural county; first county free), and the minimum assumed FTEs rose from 1 to 2. | Source |
| West Virginia | Con | Skilled lane only: Certificate of Need under W. Va. Code Ch. 16-2D is required before establishing/expanding home health services; CON is administered by the West Virginia Health Care Authority, requires determination of need, consistency with the State Health Plan and financial feasibility, and licensure cannot issue until final CON conformance. Non-medical registration under §15-2C-7 has no CON gate. | Source |
A gate on one lane does not close the other: a home health moratorium does not stop a non-medical agency, and a need test on one license type does not ban the business outright. The verdict checker applies the gates to your exact service mix — run it before you conclude a state is closed to you.
The state has stopped issuing a license type for a set period. There is no application clever enough to beat a moratorium; the moves are waiting, asking for a published exception, or opening the other lane.
You must prove the area needs another agency. New York's version presumes the answer is no in counties already served by five or more agencies — the presumption is rebuttable, but it is the state starting from "no".
A planning gate used by a minority of states for health facilities and, in a few, home care or home health. Expect a longer, evidence-based application — and a timeline measured in seasons, not weeks.
The free checkers give you the verdict and the number. The Kit gives you the working papers: your state's application packet walked through in filing order, the policies-and-procedures binder spec (what your binder must contain — never a boilerplate binder), the administrator self-audit, the insurance & bond spec sheet, the Medicaid gate map, the franchise-vs-independent 10-year worksheets, and the payroll-runway planner.
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Included in the $49 HomeCareLicenseCheck Kit
