Tennessee presents a compelling opportunity for home care entrepreneurs, with a population of approximately 7,153,758 (2025 est.) and an estimated 1,348,336 (2025 est.) adults aged 65 and older. Starting a home care agency in The Volunteer State requires obtaining a Home Health Agency License through the Health Facilities Commission, Division of Licensure and Regulation. With growing senior demand and the right regulatory preparation, Tennessee is an attractive market for new home care agencies.
Tennessee Home Care Market Overview
Tennessee has a population of approximately 7,153,758 (2025 est.), with an estimated 1,348,336 (2025 est.) adults aged 65 and older. The state’s senior population continues to grow as the Baby Boomer generation ages, creating increasing demand for home and community-based care services throughout The Volunteer State.
The major metro areas — Nashville, Memphis, Knoxville, and Chattanooga — represent the largest concentration of home care demand, but significant opportunities also exist in smaller communities and rural areas where provider shortages create underserved markets for entrepreneurs willing to serve these populations.
Tennessee Medicaid home and community-based services are delivered through the CHOICES program. Enrollment as a Medicaid provider is essential for agencies planning to serve Medicaid-eligible clients. The combination of a growing senior population, diverse market opportunities, and strong Medicaid infrastructure makes Tennessee an attractive state for launching a home care agency.
Licensing & Regulatory Requirements
Non-Medical Home Care: Home Health Agency License
To provide personal assistance services or home care in Tennessee, you must obtain a Home Health Agency License from the Health Facilities Commission, Division of Licensure and Regulation. The governing regulations are found in Tenn. Comp. R. & Regs. 0720-27; TCA § 68-11-201 et seq..
Key requirements include:
- Application submitted through the No fully online portal; applications via forms from HFC Licensure Applications; CON via e-portal
- $1,404 initial application fee
- Criminal background checks for all owners, administrators, and direct care staff
- Written policies and procedures covering client care, emergency protocols, and personnel management
- Proof of professional and general liability insurance
- Compliance with Tenn. Comp. R. & Regs. 0720-27; TCA § 68-11-201 et seq.
Home Health: Licensed and Certified Home Health
Starting a licensed and certified home health agency requires obtaining the appropriate state license and then pursuing Medicare certification. The clinical director must be a registered nurse or physician, and the agency must maintain comprehensive clinical documentation in compliance with federal Conditions of Participation.
Hospice
Hospice agencies must be licensed through the Health Facilities Commission, Division of Licensure and Regulation and Medicare-certified. Minimum staffing requirements include a registered nurse, social worker, and chaplain. The Medicare certification process requires substantial clinical infrastructure and preparation.
Tennessee requires a Certificate of Need (CON) for certain healthcare services. This additional regulatory step may extend your timeline and requires demonstrating community need. Working with an experienced consulting partner like TBOSC can help you navigate the CON process successfully.
Step-by-Step Startup Timeline
Form Your Business Entity
Register your LLC or corporation with the Tennessee Secretary of State. Obtain your EIN, open a business bank account, and register for any required state tax accounts. Budget 1–2 weeks.
Develop Policies, Procedures & Compliance Framework
Draft comprehensive policies covering client rights, HIPAA compliance, emergency preparedness, personnel management, and quality assurance. These must align with all applicable state regulations. Budget 2–4 weeks with expert guidance from TBOSC.
Submit Your License Application
Submit your complete application through the No fully online portal; applications via forms from HFC Licensure Applications; CON via e-portal, including the $1,404 application fee. Include all required documentation, background check authorizations, insurance certificates, and policies and procedures. Budget 1–2 weeks to compile and submit everything accurately.
Agency Review & Approval
The Health Facilities Commission, Division of Licensure and Regulation will review your application, process background checks, and may schedule an on-site survey. Processing typically takes 30-45 days pre-opening for survey request; processing + board ratification + 7-10 business days for license. Respond promptly to any correspondence to avoid delays.
Recruit, Hire & Train Staff
While awaiting licensure, begin recruiting caregivers and administrative staff. Develop orientation and training programs that align with your policies and industry best practices. All direct care workers should undergo background checks and receive proper training.
Launch Operations & Secure Contracts
Once licensed, begin marketing to referral sources across your target service area. Enroll as a Medicaid provider through the CHOICES program if serving Medicaid clients. Build relationships with hospitals, physicians, and discharge planners in your market and explore partnerships with senior living communities.
Estimated Startup Costs in Tennessee
| Category | Estimated Range |
|---|---|
| Business Formation & Legal | $2,000 – $5,000 |
| License Application & Fees | $1,404 – $2,000 |
| Insurance (GL, PL, Workers’ Comp) | $5,000 – $12,000 |
| Office Space & Setup | $3,000 – $10,000 |
| Policies & Procedures Development | $2,500 – $6,000 |
| Technology & Software | $2,000 – $5,000 |
| Recruitment & Training | $2,000 – $6,000 |
| Marketing & Branding | $2,000 – $8,000 |
| Working Capital (3–6 months) | $15,000 – $40,000 |
| Total Estimated Range | $33,500 – $94,000 |
Tennessee offers growing opportunities for home care entrepreneurs. Research your local market carefully, understand your target demographics, and budget appropriately based on your service area and operational plans. Entrepreneurs targeting larger metro areas should budget toward the higher end due to increased competition and cost of living.
Planning to Start a Home Care Agency in Tennessee?
TBOSC has helped entrepreneurs across The Volunteer State navigate the licensing process with the Health Facilities Commission, Division of Licensure and Regulation. Book a free strategy call to discuss your Tennessee home care startup.
Book a Free Strategy Call Call 888-818-8426Key Tennessee Regulations to Know
Tennessee’s regulatory framework for home care is administered by the Health Facilities Commission, Division of Licensure and Regulation. Here are the key regulatory frameworks you should understand:
- Tenn. Comp. R. & Regs. 0720-27; TCA § 68-11-201 et seq.: Governs home care agency requirements, covering licensure, client care standards, staffing, documentation, and administrative requirements
- No fully online portal; applications via forms from HFC Licensure Applications; CON via e-portal: The required platform for submitting applications, renewals, and reporting changes
- Criminal History Check Requirements: All owners, administrators, and direct care workers should undergo criminal background checks
- CHOICES: Tennessee’s Medicaid home and community-based services program. Provider enrollment is essential for agencies serving Medicaid clients
- HIPAA Compliance: All home care agencies must maintain strict compliance with federal health information privacy regulations
- Employment Law: Compliance with state and federal employment laws, including wage and hour regulations, is required for all agency staff
Why TBOSC for Tennessee
The Business of Senior Care has extensive experience helping entrepreneurs launch home care agencies across Tennessee. Our team understands the Health Facilities Commission, Division of Licensure and Regulation’s specific documentation expectations and can guide you through every step of the licensing process. Whether you’re targeting the Nashville, Memphis, Knoxville, or Chattanooga markets, TBOSC provides the consulting, policy development, and strategic business planning you need to launch successfully in The Volunteer State. Find your state or visit the Tennessee page to explore our state-specific services.
Frequently Asked Questions
How long does it take to get a home care license in Tennessee?
For non-medical home care, processing typically takes 30-45 days pre-opening for survey request; processing + board ratification + 7-10 business days for license from the time the Health Facilities Commission, Division of Licensure and Regulation receives your complete application. For home health with Medicare certification, the timeline extends significantly. Working with TBOSC helps ensure your application is complete and error-free, minimizing delays.
Do I need a Certificate of Need to start a home care agency in Tennessee?
Yes. Tennessee requires a Certificate of Need for certain healthcare services. This adds an additional step to the licensing process, requiring you to demonstrate community need for your services. The CON process can extend timelines, so working with an experienced partner like TBOSC is especially valuable in CON states.
What are the biggest challenges of starting a home care agency in Tennessee?
Key challenges include navigating the licensing application process accurately, meeting administrator and staffing requirements, recruiting quality caregivers in a competitive market, and understanding Medicaid enrollment processes. Despite these challenges, Tennessee’s growing senior population and favorable market conditions make it one of the best states for new home care agencies.
Can I operate a home care agency in Tennessee without a license?
No. Tennessee requires all agencies providing home care services to hold a valid license from the Health Facilities Commission, Division of Licensure and Regulation. Operating without proper licensure is a violation of state law and can result in enforcement actions, fines, and injunctions.
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