How to Start a Home Health Agency in South Carolina: Certificate of Need Still Applies

Most South Carolina business formation guides say the state has no general business license and that the Certificate of Need (CON) program was scaled back. That is true for most businesses. It is not true for home health agencies. Under S.C. Code Section 44-69-75, a home health agency still needs a Certificate of Need before the Department of Public Health (DPH) will license it. If you treat the CON as an afterthought, it will hold up your lease, your hiring, your payer contracts, and your opening date.

This guide walks through the full path in order: the CON, the business entity, the registered agent, tax registrations, the local business license, the DPH license, and Medicare certification. It is informational only and is not legal or tax advice. Home health is one of the more heavily regulated small businesses in the state, so plan to work with a healthcare attorney and a CPA before you sign a lease, file formation documents, or submit a license application.

What You Need Before You Start

Gather these materials and decisions before you file anything. Several of them take longer to finish than the paperwork itself.

• A written business plan that lists the services you will offer, such as skilled nursing, home health aide care, therapy, or a combination, along with the counties you will serve and your projected staffing
• A direct answer from DPH on whether your planned services and service area require a CON
• A business name checked against the Secretary of State database at businessfilings.sc.gov
• A registered agent with a South Carolina street address
• An office location that can meet DPH requirements, plus a lease or proof of ownership
• A federal Employer Identification Number (EIN) from the IRS
• Insurance quotes for professional and general liability, and a plan for workers' compensation if you will have employees
• Clinician license copies and credential files for every nurse, therapist, and aide you plan to hire
• Draft policies covering patient rights, infection control, clinical records, emergency preparedness, and complaint handling
• A working capital budget that covers payroll and rent through the months before Medicare and other payer revenue arrives

Step 1: Confirm the Certificate of Need Requirement Before You Commit

Start here. The CON is the longest lead item and the step most likely to change your plan. Since 2023 Act 20 repealed most of South Carolina's CON requirements, many people assume the entire program is gone. It is not. Home health agencies still need a CON before DPH will issue a license under S.C. Code Section 44-69-75.

Contact DPH in writing and ask three specific questions. First, do your planned services and each county you want to serve fall under the CON requirement? Second, what is the current CON application form, and what fee applies? Third, what is the current review timeline? Ask for the answers in writing and keep them in your file. Do not rely on a timeline from a consultant or an online article unless the agency confirms it.

Do not sign a lease, buy equipment, or make offers to staff until you understand the CON outcome. A lease signed before approval is one of the most expensive mistakes a new agency can make.

Step 2: Choose Your Business Entity

Most home health owners form either a limited liability company (LLC) or a corporation. Both are filed with the South Carolina Secretary of State through Business Entities Online at businessfilings.sc.gov. The state filing fee is $110 for an LLC; a corporation pays $110 plus the $25 minimum license fee with Form CL-1 ($135 total), and its articles must be signed by a South Carolina attorney.

• LLC. You file Articles of Organization under S.C. Code Section 33-44-203. A standard LLC is not required to file an annual report or pay the corporate License Fee. An LLC that elects to be taxed as a corporation must file Form CL-1 and pay a one-time $25 initial License Fee within 60 days of commencing business.
• Corporation. You file Articles of Incorporation under S.C. Code Section 33-2-102, along with Form CL-1. The $25 initial License Fee is due within 60 days of doing business or using capital in South Carolina. Corporations file an annual report as part of the SC1120 or SC1120S corporate income tax return, due by the 15th day of the fourth month after the end of the business year. The recurring License Fee is 0.1 percent of capital and paid in surplus plus $15, with a $25 minimum. C corporations pay 5 percent of South Carolina taxable income.

Entity choice affects your tax bill, your liability exposure, and how you bring in investors or partners. Ask a CPA to model both options against your expected first-year revenue and payroll before you decide.

Step 3: Name Your Business and Appoint a Registered Agent

An LLC name must contain the words limited liability company or limited company, or an accepted abbreviation such as LLC, L.L.C., LC, or L.C. Under S.C. Code Section 33-44-105, the name must be distinguishable on the Secretary of State's records from other registered names and from reserved names. Search the database before you file. If you need time to finalize the name, you can reserve it for 120 days for $25. The reservation is nonrenewable, so plan your filing date around it. Check the naming rules for a corporation separately on the Secretary of State site before you file.

Every LLC must designate and continuously maintain a registered agent and office in South Carolina for service of process under S.C. Code Section 33-44-108. The agent must be an individual who resides in South Carolina, a domestic corporation, another limited liability company, or a foreign corporation or company authorized to do business in the state. The agent's name and address must appear on the formation document. If you later change the agent or office, you file a statement of change with the Secretary of State. Missing a registered agent can put your company out of compliance, so calendar a check each year.

Step 4: File the Formation Documents Online

File through Business Entities Online at businessfilings.sc.gov. The state's business one stop states that online filings are returned within 24 to 48 business hours. The Secretary of State does not publish a separate expedite tier or expedite fee for business entity filings, so online filing is the fastest route. Mailed and in-person filings take longer, and the state does not publish a mail turnaround window.

Keep the filed documents and the confirmation. You will need them for your bank account, your EIN application, your DPH application, and your CON packet. Reviewers at each agency will ask for proof that the entity exists, so do not rely on a screenshot of a pending filing.

Step 5: Get Your EIN and State Tax Registrations

Apply for an EIN with the IRS. Use the trade name you plan to operate under on that application if you use one. Next, register with the South Carolina Department of Revenue (SCDOR) through the Business Tax Application on MyDORWAY at dor.sc.gov. Agencies that hire staff need withholding registration with the SCDOR. Confirm with your CPA which other state payroll registrations apply, including unemployment insurance registration with the state agency that administers that program.

If you sell any tangible goods, such as durable medical equipment or supplies, you may need an SCDOR Retail License. It is a one-time, nonrefundable $50 fee per location, applied for through the same Business Tax Application. Most service-only agencies do not sell goods, so confirm with the SCDOR whether this applies to your business model.

Step 6: Get Your Local Business License

South Carolina does not issue a general statewide business license. A Secretary of State filing is not a business license. Cities and counties levy local business license taxes, and most cities do. Only nine counties levy them at the county level: Beaufort, Charleston, Dorchester, Horry, Jasper, Marion, Orangeburg, Richland, and Sumter. The local license year runs May 1 to April 30, and the license is due April 30. Renewals are handled at localblrenewal.com.

Contact the city or county where your office will sit to confirm the rate, the application steps, and the documents they require. Rates vary by jurisdiction, so do not budget from another city's numbers.

Step 7: Apply for Your DPH License

After your CON is approved, apply to DPH for the home health agency license. The current fee schedule in DPH's FY2026 fee report lists a $100 license fee plus $50 for each county served. Inspection is $250 every two years, plus $25 for each county. Confirm these figures with DPH before you finalize your budget, because fee schedules change.

Ask DPH for its complete application checklist. Expect the application to ask for your approved CON, your entity documents, your office information, your administrator and governing body, your clinical policies, your staffing plan, and proof of insurance. Plan for an on-site inspection before the license is issued. Assemble your policy binders, personnel files, and clinical record templates before the inspector arrives. If the inspector identifies deficiencies, correct them quickly and keep written proof of each correction.

Step 8: Pursue Medicare Certification

If you plan to serve Medicare beneficiaries, you need Medicare certification in addition to your state license. Medicare certification is a separate enrollment process through the Medicare contractor serving South Carolina, and it typically includes a survey. Medicare visits are not reimbursed until certification is final, so start enrollment early and build that gap into your working capital plan.

Medicaid and private payer contracts follow their own enrollment and credentialing steps. Confirm the current process, documents, and timeline with DPH and with each payer. Do not assume that a state license opens the door to every payer automatically.

Step 9: Hire, Credential, and Prepare to Open

Before opening, verify every clinician license, collect professional references, complete background checks as your policies require, and train staff on your written procedures. Keep a credential file for each person that includes license copies, expiration dates, and training records. Surveyors commonly review personnel files, so keep them complete and current from the first day. Set a calendar reminder for each license renewal.

Common Mistakes to Avoid

• Assuming the CON program is gone. Home health agencies still need a CON under S.C. Code Section 44-69-75 before DPH licensure.
• Signing a lease or hiring staff before the CON decision. Both are sunk costs if the CON is denied or delayed.
• Confusing DPH with the former DHEC. The former DHEC was split in 2024, and home health licensing runs through DPH.
• Filing a state DBA. South Carolina has no state-level DBA registration. List your trade name on your local business license on your IRS EIN application and your SCDOR Business Tax Application.
• Filing an annual report for a standard LLC. A standard LLC does not file one. A corporation does, and an LLC taxed as a corporation does too.
• Treating the Secretary of State filing as the local license. Your city or county license is a separate requirement.
• Assuming Medicare certification follows automatically. It requires its own enrollment and survey.
• Underfunding working capital. Certification, credentialing, and first payer approvals can take longer than your bank balance will comfortably allow.

Fee Summary

The table below lists the fees referenced in this guide. Where a figure is not published here, confirm it with the named agency before you budget.

Item	Amount	Confirm with
LLC Articles of Organization or corporation Articles of Incorporation	$110	SC Secretary of State
Form CL-1 initial License Fee (corporations, and LLCs taxed as corporations)	$25, due within 60 days of doing business	SC Secretary of State and SCDOR
Name reservation (120 days, nonrenewable)	$25	SC Secretary of State
SCDOR Retail License (only if selling tangible goods)	$50 per location, one-time	SCDOR
DPH home health agency license	$100 plus $50 per county served	DPH
DPH inspection	$250 every two years plus $25 per county	DPH
Certificate of Need application	Confirm with DPH	DPH
Local business license	Varies by city or county	Your city or county
Medicare enrollment and survey	Confirm with the Medicare contractor	Medicare contractor and DPH

Expected Results

Formation can move quickly. Filed online, the Secretary of State's documents are returned within 24 to 48 business hours, so the entity itself is often the fastest step in this process. The longer stages are the CON, the DPH license, and Medicare certification. Those timelines depend on the agency's current workload and on how complete your application is when it is filed, so plan conservatively and ask each agency for a current estimate.

A well-organized agency may be able to reduce delays by submitting complete applications, keeping personnel and policy files current, and responding quickly to agency questions. Once licensed and certified, an agency may be able to serve Medicare and other payer patients, subject to each payer's enrollment and contract terms. Outcomes vary by local market, staffing, referral relationships, and payer mix. Nothing in this guide is a promise of approval, a timeline, or revenue.

Official Resources

• South Carolina Secretary of State: sos.sc.gov/online-filings/business-entities
• Business Entities Online and name search: businessfilings.sc.gov
• South Carolina Department of Revenue: dor.sc.gov
• South Carolina Small Business Development Centers, which can review your plan: scsbdc.com
• U.S. Small Business Administration, South Carolina district: sba.gov/district/south-carolina

Disclaimer

This article is informational content only. It is not legal, tax, or healthcare regulatory advice, and it does not create an attorney-client or accountant-client relationship. Certificate of Need, licensing, and Medicare rules change, and fees and timelines may differ from what is printed here. Confirm every requirement with the agency that administers it. Consult a qualified South Carolina healthcare attorney and a CPA before you form the business or file any application.