How North Carolina licenses home care
DHSR's Acute and Home Care Licensure and Certification Section issues the Home Care Agency License under G.S. 131E-135 through 142 and rule 10A NCAC 13J. The same license type covers companion and personal care agencies and agencies providing skilled services. Each site is licensed separately and renews annually. A 'home health agency' in North Carolina is a licensed home care agency that has additionally been certified for Medicare and Medicaid reimbursement of skilled nursing and therapy.
Certificate of Need is the gate for Medicare-certified home health
North Carolina still applies Certificate of Need review to Medicare-certified home health agencies. A separate CON and license is required per site, and approval depends on the State Medical Facilities Plan showing unmet need in that county. Non-medical home care licensure is not subject to CON. Practically, this means most new entrants in North Carolina start as non-medical or private-pay personal care agencies, and their insurance program should be priced for that model rather than a skilled one.
Workers' compensation at three employees
Under G.S. Chapter 97, a North Carolina employer with three or more employees must carry workers' compensation or be approved to self-insure, and corporate officers count toward the three. Home care agencies hit that threshold almost immediately. Caregiver payroll classified correctly — rather than dumped into a clerical or generic service code — is the single biggest lever on the premium, and it is also what the auditor will re-classify at year end if you get it wrong.
Liability limits your contracts will require
The DHSR rules do not publish a fixed general liability dollar figure. The limits come from who pays you. The table below reflects what North Carolina agencies are most often asked to produce.
| Payer or partner | Typical requirement | Notes |
|---|---|---|
| Private pay clients | $1M / $2M general liability | Families increasingly ask for the certificate |
| CAP/DA and CAP/C waiver contracts | $1M / $2M GL plus $1M professional liability | Additional insured usually required |
| NC Innovations (I/DD) providers | $1M / $2M GL plus abuse & molestation | Abuse limits often specified separately |
| Hospital discharge partners | $1M / $3M professional liability plus umbrella | Primary and non-contributory, waiver of subrogation |
Background checks are a licensure condition and an underwriting question
G.S. 131E-265 requires a licensed home care agency to run a criminal history record check before employing anyone in a position that enters a patient's home — a state check for residents of five years or more, and a state plus national fingerprint check for anyone with less. Underwriters treat a documented, consistently applied screening program as the strongest single argument for better abuse and molestation pricing, so keep the files.
Caregiver driving in North Carolina
North Carolina rules do not set an agency-specific auto requirement, but the exposure does not care. When a caregiver drives a personal vehicle between clients and causes an injury, the agency is named. Hired and non-owned auto liability is the coverage that responds on the agency's behalf, and it costs a fraction of the claim it prevents.
Note on the NC start-up surety bond
Several third-party start-up guides state that North Carolina requires a $50,000 surety bond for initial home care agency licensure. We could not confirm that figure in the DHSR rule text, and requirements change. Before you budget for it, confirm the current bond and training conditions directly with DHSR — and if your application packet does call for a bond, we can place it alongside the liability program.
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