Selling a home care agency in North Carolina

Certificate of need and acquisitions

North Carolina uses certificate of need to control new home health agency offices. A buyer cannot simply open a new Medicare-certified agency in a county; it has to win a CON in a competitive review or buy an existing agency.

When a buyer acquires an existing agency, the parties notify the Healthcare Planning and Certificate of Need Section, which issues a determination. DHSR's published decisions include no-review letters for multi-county home health acquisitions, which let the transaction proceed without a full CON review. That pathway is the reason established North Carolina home health agencies attract strong buyer interest.

Change of ownership for a licensed home care agency

DHSR's change of ownership process for home care agencies starts with a letter from the seller 30 days before the effective date of the change. The buyer then completes a licensure application describing changes to ownership, operation, and corporate name.

Medicare-certified agencies also go through federal enrollment change of ownership steps, so a buyer of a home health agency will coordinate the CON determination, the state license, and Medicare enrollment in one timeline.

Payer mix

North Carolina agencies typically blend Medicare home health, Medicaid personal care and waiver services, and private pay. Buyers look at how revenue splits across those sources, at authorization stability, and at how concentrated referrals are among hospital systems and physician groups.

What moves value for a North Carolina agency

The items buyers price most heavily in North Carolina:

CON-protected offices

Home health agency offices in counties where new entry requires a CON.

Referral diversity

Volume spread across hospital systems, physician groups, and community sources.

Caregiver supply

Fill rate, turnover, and complete personnel files.

Survey history

DHSR survey results and how deficiencies were corrected.