North Carolina licenses home care agencies through the Division of Health Service Regulation (DHSR), and since a 2023 law, businesses that mainly offer companion, sitter or respite care need a state license too. Medicaid pays for personal care through NC Medicaid Direct and through its health plans (Standard Plans and Tailored Plans). Medicaid dropped its yearly limits on home health nursing and aide visits on July 1, 2026, and every home care license expires on December 31.
Red means act now, amber means read it this month, grey is for the record.
NC Medicaid's home health policy no longer limits skilled nursing to 75 visits a year or home health aide services to 100 visits a year. The amendment also moved the quality assessment and performance improvement (QAPI) and infection control requirements into a note in Section 7.0.
NC Medicaid changed the adult age for State Plan personal care from 21 to 18. It also added a note: an annual reassessment may be done by telephone if the beneficiary agrees; if it doesn't lead to a denial, reduction or termination, a face-to-face assessment must follow within six to eight months.
The N.C. Medical Care Commission proposed readopting five rules on the Health Care Personnel Registry, medication aides and Nurse Aide I training (10A NCAC 13O). DHSR's June 1 notice said no substantive changes were proposed. The rules were filed with the Rules Review Commission, which lists them for its September 29, 2026 meeting; its filing log marks the definitions rule (.0101) as "readopt with changes" and the other four as without changes.
Dates taken from the rules and notices as we read them.
10A NCAC 13O. The date is only proposed; the Rules Review Commission lists the filing for its September 29, 2026 meeting.
Renewals received by December 31 take effect January 1.
Upload in QiRePort for each site.
Every state follows the same outline, so you always know where to look. Open a section for the detail.
Sometimes two official documents say different things. Here is what we went with, why, and what each document says, so you can judge for yourself.
A 2023 law created the home assistance services provider license. The law still counts companion, sitter and respite care as home care when it is given along with other home care services. But DHSR's FAQ (revised May 2025) and its license application still offer a companion, sitter and respite-only home care license. The law wins, but ask DHSR which application to use.
The current law names the State Bureau of Investigation. DHSR's FAQ still quotes an older version that names the Department of Public Safety.
The two NC Medicaid documents give different 2023 start dates. Both are in the past, so this does not change what you do today.
Every answer was written and checked ahead of time, with the official document next to it. Nothing is made up on the spot.
Yes.
Agencies that give in-home aide services involving hands-on care need a home care agency license from DHSR. Since a 2023 law, businesses that mainly give companion, sitter or respite care (with or without homemaker services) need a home assistance services provider license. An individual who provides only his or her own services is excluded.
No hands-on care and no insurance billing.
A home assistance services provider must carry liability insurance, tell new clients it does not give health care or hands-on care, run a criminal check in every state where a worker lived in the past seven years, document each worker's driver's license, vehicle registration, insurance and NC driving record, and attest each year that it complies. It may not bill any insurer, managed care organization or health plan, and it may not employ anyone convicted of a relevant offense or listed on the National Sex Offender Public Website.
$510 a year; it expires December 31.
The fee is $510 for an initial license, a change of ownership and each yearly renewal, and it is not refundable. Every license expires at midnight on December 31. If DHSR gets your renewal and fee by December 31, the new license starts January 1; if later, it starts the day DHSR gets it.
Within five business days of the offer.
For jobs that go into clients' homes, the offer depends on the applicant's consent to a criminal history check. People who have lived in North Carolina less than five years need a state and national fingerprint check. You may employ someone conditionally, but you must submit the request no later than five business days after they start.
Allegations within 24 hours; results within five working days.
Report allegations of abuse, neglect, misappropriation of property, drug diversion or fraud by staff, and injuries of unknown source. Use the 24-hour initial report, then send the results of your investigation within five working days of the first report. Protect clients while the investigation is going on.
Up to 80 a month for adults, plus up to 50 more.
Policy 3L allows up to 80 hours a month for beneficiaries 18 and older, and up to 50 more for those who meet all the extra criteria, such as needing caregivers trained in memory care. Beneficiaries under 21 can be approved for up to 60 hours a month; the policy doesn't say which limit applies at ages 18 to 20. An independent assessment decides the hours.
Every 90 days.
An RN supervisor must visit each client's home every 90 calendar days, with a seven-day grace period. At least two visits a year must happen while the aide is scheduled to be there. DHSR also says an RN must be available whenever in-home aide services are given, and an LPN may not do these visits.
Personal care, CAP in-home services and home health.
EVV has been required for State Plan personal care and CAP in-home aide, respite and personal care codes since January 1, 2021, and for home health visits since 2023. You can use the state's Sandata system or an alternate system that sends visits to the Sandata Aggregator. In NC Medicaid Direct, a claim line with no verified EVV visit pends in NCTracks until it is fixed.
Next-door counties or 90 minutes' drive.
For in-home aide services only, a licensed agency may serve counties next to the county where it is located, or places within 90 minutes' driving time of its site. Tell DHSR 30 days before expanding your service area. You can also open another site, which needs its own license.
The 3136 quality attestation by December 31.
Policy 3L says personal care agencies must send an attestation by December 31 each year that their quality improvement program meets the policy. NC Medicaid says to upload the 3136 form in QiRePort for each site. The 3085 memory care training attestation is uploaded once, if it applies.
The official link for each document. Our own dated copies will sit next to them, so a document is still here when a state moves its website.
69 documents — showing the newest 25