How to Start a Home Health Agency in Florida

Florida licenses home health agencies through its Agency for Health Care Administration, AHCA. The law is Part III of Chapter 400 of the Florida Statutes, with the general licensing rules in Part II of Chapter 408. Medicare is a second, separate step. As of October 26, 2026, that step is closed.

A note on labels. A CMS rule is a federal regulation or CMS's notice in the Federal Register, and I cite the paragraph. A Florida rule is the Florida Statutes or the Florida Administrative Code, and I quote the state's own page with the day I read it: October 26, 2026. County counts are Medicare's own files, as our markets pages show them. Florida also licenses agencies that send only aides, homemakers and companions, and registers companion and homemaker services. This page covers skilled, Medicare-certified home health only. For the steps every state shares, see how to start a home health agency in 2026.

The Short Answer

Medicare is closed to new agencies. As of October 26, 2026, CMS's nationwide moratorium, effective May 13, 2026, stops new home health agencies from enrolling in Medicare unless the Medicare contractor received their application before that date.
The Florida license is open. You apply to AHCA on the Health Care Licensing Application for home health agencies, AHCA Form 3110-1011.
A skilled agency must be accredited. Proof of accreditation and an accreditation survey are due within 120 days after AHCA receives the application.
The money test is in the statute. Two years of projected financial statements signed by a CPA, at least three months of average projected expenses covered, and no month in the first year projected at an operating margin of 15% or more.
The fee. AHCA's checklist lists a $1,705 biennial licensure fee and a $300 biennial assessment fee.
No certificate of need. Florida's certificate of need law does not list home health agencies.

The 2026 Medicare Moratorium, in Florida

On May 15, 2026, CMS published a notice in the Federal Register announcing a nationwide moratorium on enrolling home health agencies in Medicare. It says: "This moratorium is effective May 13, 2026." Its scope:

no new HHAs or HHA branches or practice locations will be enrolled into Medicare unless the HHA's enrollment application was received by the applicable Medicare contractor prior to this notice's effective date.

It applies to HHAs "seeking to enroll anywhere in the United States, including all States, territories, and the District of Columbia." On length, the notice says "a temporary enrollment moratorium imposed by CMS remains in effect for 6 months. If CMS deems it necessary, the moratorium may be extended in 6-month increments."

Six months from May 13, 2026 is November 13, 2026. That date is our arithmetic, not a date CMS published. As of October 26, 2026, CMS had published no extension.

Buying an agency is outside the moratorium unless the sale counts as a new enrollment. The notice (section I.A.2.c, under 42 CFR §424.570(a)(1)(iii)) says the moratorium does not apply to "Changes in ownership (except changes in ownership of HHAs, hospices, and suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that would require an initial enrollment)." One sale that does count: buying a majority of an agency within 36 months of its first enrollment counts as a new enrollment, unless an exception applies (42 CFR §424.550(b)). CMS's notice says that rule "requires an HHA undergoing a non-exempt CIMO within 36 months of its initial enrollment (or within 36 months of its most recent CIMO) to enroll in Medicare as a brand new HHA". CIMO is a change in majority ownership. CMS says the moratorium would prohibit such an agency from reenrolling, because "it would constitute an initial enrollment." Medicaid is left to each state: CMS chose to "allow each State to decide whether some form of a home health provider moratorium is appropriate for their respective Medicaid and CHIP programs".

Florida has been here before. CMS's notice lists the earlier moratoria: new agencies in Miami-Dade County and the counties around it from July 31, 2013, Broward County from February 4, 2014, and the whole state from August 3, 2016, until CMS let the moratoria expire on January 30, 2019. Medicare's count of new Florida agencies by year is on the Florida markets page.

Step 1: The Florida License

Who licenses

AHCA's Laboratory and In-Home Services Unit, in the Bureau of Health Facility Regulation. Section 400.464(1), Florida Statutes: "A license or registration issued by the agency is required in order to operate a home health agency in this state." A license issued since July 1, 2018 "must specify the home health services the licensee or registrant is authorized to perform and indicate whether such specified services are considered skilled care."

AHCA's State Laws and Rules page lists the law and rules, read October 26, 2026:

Source	What AHCA calls it
Florida Statutes, Chapter 400, Part III	Home health agency laws
Florida Statutes, Chapter 408, Part II	Licensing procedure laws
Florida Administrative Code, Chapter 59A-8	State rules
Florida Administrative Code, Chapter 59A-35	State rules

What the application must prove

Section 400.471(2) says the initial applicant "must file with the application satisfactory proof that the home health agency is in compliance with this part and applicable rules, including":

A list of services, provided directly or by contract.
The number and discipline of the professional staff.
"A business plan, signed by the applicant, which details the home health agency's methods to obtain patients and its plan to recruit and maintain staff."
Evidence of contingency funding under section 408.8065.
A balance sheet, income and expense statement, and statement of cash flows for the first 2 years of operation.
The other ownership interests in health care entities of each controlling interest.
Accreditation documentation, for an agency that provides skilled care.

The money test has numbers in it. Section 400.471(2)(e): "An applicant may not project an operating margin of 15 percent or greater for any month in the first year of operation." The financial documents must be "compiled and signed by a certified public accountant." Section 408.8065(1)(c): "The statement must show that the applicant has at a minimum 3 months of average projected expenses to cover startup costs, working capital costs, and contingency financing requirements. The minimum amount for contingency funding may not be less than 1 month of average projected expenses."

Three more requirements from the same statutes and AHCA's checklist:

Insurance. Malpractice and liability coverage "in an amount of not less than $250,000 per claim," with proof at the initial application and each renewal (section 400.471(3)).
Zoning and the office. AHCA's checklist asks for "Documentation from the appropriate local government official, which states that the applicant has met local zoning requirements" and proof of the legal right to occupy the property.
A bond for some owners. Applicants and controlling interests who are nonimmigrant aliens "must file a surety bond of at least $500,000" (section 408.8065(2)).

Accreditation within 120 days

For an agency that provides skilled care, section 400.471(2)(g) says "the applicant must provide proof of accreditation that is not conditional or provisional and a survey demonstrating compliance" from a recognized accrediting organization "within 120 days after the date of the agency's receipt of the application for licensure." In that sentence "the agency" is AHCA (section 400.462(4)). The accreditation "must be continuously maintained by the home health agency to maintain licensure."

The survey before the license

Florida surveys before it licenses. Rule 59A-8.003(2)(a), Florida Administrative Code: "Home health agencies will be surveyed prior to initial licensure, and at least every 36.9 months on an unannounced basis thereafter." The survey is done by AHCA or an accrediting organization. For the initial license, a skilled agency's accreditation survey is due within 120 days after AHCA receives the application (section 400.471(2)(g)), and the agency asks AHCA for exemption from state licensure surveys by sending its accreditation and the accrediting organization's most recent survey report (Rule 59A-8.003(2)(b)). After that, AHCA accepts the accrediting organization's survey in place of its own periodic licensure survey when the accreditation is not provisional and AHCA receives the report (section 400.471(4)).

The application and the fee

The application is AHCA Form 3110-1011, the Health Care Licensing Application for home health agencies. AHCA's applications page says renewals must go through its Online Licensing System, and "Initial applications and change during licensure period applications may also be submitted online through the Agency's Online Licensing System".

AHCA's Home Health Agency application checklist, read October 26, 2026:

Due with the application	Amount
Biennial licensure fee	$1,705
Biennial assessment fee	$300

The statute says the license fee is set by rule, "not to exceed $2,000 per biennium" (section 400.471(5)). The rule says "Licensure fees, as defined by authorizing statute or rule, are non-refundable once submitted to the Agency" (Rule 59A-35.050(1)).

The timeline

Section 408.806(3), Florida Statutes:

"Upon receipt of an application for a license, the agency shall examine the application and, within 30 days after receipt, notify the applicant in writing of any apparent errors or omissions and request any additional information required."
Omitted information "must be filed with the agency within 21 days after the agency's request for omitted information or the application shall be deemed incomplete and shall be withdrawn from further consideration and the fees shall be forfeited."
"Within 60 days after the receipt of a complete application, the agency shall approve or deny the application."

Licenses are biennial (section 408.806(4)(a)).

No certificate of need

Florida still has a certificate of need law, but home health agencies are not on its list. Section 408.036(1) covers added beds in community nursing homes or intermediate care facilities for the developmentally disabled, "The new construction or establishment of additional health care facilities," conversions from one type of facility to another, and "The establishment of a hospice or hospice inpatient facility". Section 408.032(8) defines a health care facility as "a skilled nursing facility, hospice, or intermediate care facility for the developmentally disabled." A home health agency is none of those.

Step 2: Medicare Certification

As of October 26, 2026, this is the step the moratorium closes. AHCA's order of steps: "Home health agencies may apply for enrollment in the federal Medicare and/or Medicaid program after the state license has been issued. To avoid delay or denial of the Medicare or Medicaid enrollment application, the information provided on the application must match the information provided on the state license application."

The federal steps are the same in every state:

Enroll on Form CMS-855A.
Show initial reserve operating funds. A new agency "must have available sufficient funds, which we term 'initial reserve operating funds,' at the time of application submission and at all times during the enrollment process" up to three months after billing privileges start, "exclusive of actual or projected accounts receivable from Medicare" (42 CFR 489.28(a)). The amount is the average cost per visit of three or more comparable agencies in their first year, times whichever is greater: the visits you project for your first three months, or 22.5% of those agencies' average visit count (42 CFR 489.28(b)).
Pass a certification survey by the state survey agency or an approved accrediting organization.

Accreditation Options

AHCA lists three accrediting organizations for skilled home health agencies, read October 26, 2026:

Accrediting organization	Accredited for state licensure	Deemed option for Medicare certification
Accreditation Commission for Health Care (ACHC)	Yes	Yes
Community Health Accreditation Partner (CHAP)	Yes	Yes
The Joint Commission (TJC)	Yes	Yes

Where Florida's Agencies Are

Medicare's 2025 county file counts 775 home health agencies billing for 243,697 Original Medicare users across Florida. Those are agencies with Medicare volume, not every licensed agency. An agency that serves several counties counts in each. The eight counties with the most users:

County	Agencies	Home health users	Users per agency
Palm Beach	126	23,527	187
Miami-Dade	172	16,694	97
Broward	108	14,049	130
Lee	41	12,814	313
Pinellas	52	11,778	227
Hillsborough	76	11,210	148
Sarasota	39	11,187	287
Duval	41	9,472	231

Medicare fee-for-service only. CMS does not publish counts under 11. All 67 Florida counties are on the Florida markets page.

Every county in Florida, free

Agencies, Medicare home health users and users per agency for each Florida county. The Florida state report reads every county as crowded, balanced or room to grow: $199, one time.

See Florida by county

Frequently Asked Questions

Can I start a home health agency in Florida right now?

You can apply for the Florida license. Medicare enrollment is the step that is closed. CMS put a nationwide moratorium on Medicare enrollment of new home health agencies, effective May 13, 2026, and it applies "anywhere in the United States, including all States, territories, and the District of Columbia." Six months from May 13, 2026 is November 13, 2026. That date is our arithmetic, not a date CMS published. As of October 26, 2026, CMS had published no extension. AHCA says home health agencies "may apply for enrollment in the federal Medicare and/or Medicaid program after the state license has been issued."

How much does a Florida home health agency license cost?

AHCA's application checklist for home health agencies, read October 26, 2026, says "The biennial licensure fee is $1,705" and "The biennial assessment fee is $300." The statute says the license fee is set by rule and may not exceed $2,000 per biennium (section 400.471(5), Florida Statutes). A Florida license runs two years.

Do I need a certificate of need for a home health agency in Florida?

No. Florida's certificate of need law does not list home health agencies today. Section 408.036(1), Florida Statutes, lists added nursing home and intermediate care beds, new health care facilities, conversions from one facility type to another, and hospices. Section 408.032(8) defines a health care facility as "a skilled nursing facility, hospice, or intermediate care facility for the developmentally disabled." A home health agency is none of those. Both read October 26, 2026, in the 2026 Florida Statutes.

Do I need Medicare certification to open in Florida?

Not for the Florida license. AHCA says home health agencies "may apply for enrollment in the federal Medicare and/or Medicaid program after the state license has been issued." You need Medicare certification to bill Medicare, and as of October 26, 2026, CMS's moratorium means a new agency applying now cannot enroll. An agency that provides skilled care still has to be accredited to hold a Florida license (section 400.471(2)(g), Florida Statutes).

How long does it take to get a home health license in Florida?

The statute sets the clocks. AHCA has 30 days after it receives an application to point out errors or omissions. You have 21 days to send what is missing, or the application is withdrawn and the fee is forfeited. AHCA has 60 days after a complete application to approve or deny it (section 408.806(3), Florida Statutes). A skilled agency must also show accreditation and an accreditation survey within 120 days after AHCA receives the application (section 400.471(2)(g)).

Sources

Florida pages, read October 26, 2026:

CMS:

Medicare data:

Home health by county in Florida: CMS Market Saturation & Utilization, Home Health, 2025

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How to Start a Home Health Agency in Florida (2026)