How to Start a Home Health Agency in Kentucky: Certificate of Need Batch Reviews, the $500 License and Why Most Founders Hire a Lawyer First

If you are researching how to start a home health agency business in Kentucky, expect a longer road than most small business formations. Kentucky is a Certificate of Need (CON) state, so you cannot open a home health agency simply by filing paperwork with the Secretary of State. You first need state approval through the CON process, then a license from the Cabinet for Health and Family Services. This guide walks through the order of operations, the fees we can confirm, and the points you need to verify with the agency directly.

This article is informational content, not legal or tax advice. Health care regulation is complex and changes over time. Before you sign a lease, hire staff, or file a CON application, consult a qualified Kentucky health care attorney and a certified public accountant (CPA).

What You Need Before You Start

Gather these items before you begin, because several steps depend on them:

• A proposed legal name for your entity that is distinguishable from names already on record
• A Kentucky street address for your registered office (post office boxes are not accepted)
• A registered agent who is either a Kentucky resident or a qualified entity with a business address matching the registered office
• A written business plan covering your service area, clinical staffing, startup budget, and projected patient volume
• A federal Employer Identification Number (EIN) from the IRS
• Accounts on the Kentucky One Stop Business Portal and on MyTaxes.ky.gov
• Written fee estimates from a health care attorney and a CPA
• A realistic timeline, since CON review timing depends on the state batch calendar, not on your schedule

Step 1: Confirm That You Need a Certificate of Need

KRS 216B.020 exempts certain facilities from the CON requirement. The exemptions include assisted living residences, family care homes, primary care centers, residential hospice facilities established by licensed hospice programs, and private duty nursing operating as health care services agencies under KRS 216.718, along with several others. Home health agencies are not on that list, and neither are non-residential hospices. The exemption list was amended effective June 27, 2025, so confirm the current text before you rely on it.

That means a new home health agency needs a CON from the Division of Certificate of Need within the Cabinet for Health and Family Services (CHFS). Do not plan around a personal services agency model. The fast, filing-only path that some small service businesses use does not apply to home health in Kentucky.

Step 2: Choose Your Entity and File Formation Documents

Most home health founders in Kentucky organize as a limited liability company (LLC) or a corporation. Both file with the Secretary of State through the Kentucky One Stop Business Portal at onestop.ky.gov. The current figures are:

Entity	Formation document	Filing fee
LLC	Articles of Organization (Form KLC)	$40
Corporation	Articles of Incorporation (Form PAI)	$50

An LLC name must include "limited liability company," "limited company," the abbreviation "LLC," or "LC." If you abbreviate "limited company," you must use "LTD CO." The name must be distinguishable from any name on record, under KRS 275.100 and KRS 14A.3-010. Search the Secretary of State database at sosbes.sos.ky.gov before you file.

If you need time to secure the name while you prepare the CON application, you can reserve it for 120 days for a $15 fee. Online filings take effect on the date and time they are filed. Processing is usually the same day but can take up to three business days. The Secretary of State publishes no expedited tier, so online filing is the fastest route.

Filing your entity is not a license. Kentucky has no statewide general business license, and registering an entity or an assumed name is a filing, not permission to operate a home health agency.

Step 3: Appoint a Registered Agent and Registered Office

Under KRS 14A.4-010, every entity must maintain a registered office in Kentucky and a registered agent at all times. The registered office must be a Kentucky street address. The agent must be a Kentucky resident whose business address matches the registered office, or a qualified entity with the same address. Unless the agent signs the formation document, the appointment does not take effect until the agent delivers a written statement of acceptance to the Secretary of State. Changing the registered agent or office later costs $10.

If your agency will operate from more than one location, confirm with the CON Division how it treats proposed sites before you commit to a lease.

Step 4: Register Your Tax Accounts and Map Your Obligations

Kentucky has no franchise tax, but several taxes and fees apply depending on your structure:

• Tax account registration: Register with the Kentucky Department of Revenue using Form 10A100 through MyTaxes.ky.gov.
• Limited Liability Entity Tax (LLET): LLCs and corporations owe the LLET, with a $175 minimum if Kentucky gross receipts or gross profits are $3 million or less. The tax rises on a sliding scale between $3 million and $6 million. Above $6 million, it is the lesser of 0.095% of Kentucky gross receipts or 0.75% of Kentucky gross profits.
• Income tax: LLC income passes through to members and is taxed at the 3.5% flat individual rate for 2026, with a $3,360 standard deduction. Corporations pay a 5% flat corporate income tax.
• Sales tax: Kentucky's 6% sales tax has no local add-ons, but it reaches about 50 services. Ask a CPA and the Department of Revenue whether any service you bill is subject to it.
• Occupational license taxes: Cities, counties, and school districts may levy taxes on payroll, net profits, or gross receipts. Kentucky has 120 counties and about 420 cities, and each jurisdiction runs its own forms. Check the district where the agency will operate.

If you plan to use a trade name, file a Certificate of Assumed Name (Form ASN) with the Secretary of State. The fee is $20, and the registration lasts five years and is renewable. A copy of an entity filing is also recorded with the county clerk in the registered office county. Sole proprietors file with the county clerk instead.

Step 5: Prepare and File the CON Application

This is the step that determines your timeline. The CON Division reviews home health, hospice, and residential hospice proposals in batches, which means your application competes for review within a set window. Filing a complete application close to a batch deadline is different from filing one just after a deadline closes.

Before you plan around any date, check the Division's current batch calendar and its application requirements. Confirm:

• The application fee and how it is paid
• Whether your legal entity must already exist when you file
• Required disclosures on owners, managers, and ownership percentages
• Financial projections, staffing plans, and service area documentation the Division expects
• What happens if the application is incomplete when a batch closes

Your application must show need, which is where a clear market analysis and a realistic service plan matter. Keep the business plan consistent with the numbers in the CON filing. Reviewers compare them, and inconsistencies slow everything down.

Step 6: Apply for the $500 CHFS Home Health Agency License

After the CON is approved, the agency is licensed by the CHFS Office of Inspector General (OIG). The initial license fee is $500, and the annual license fee is also $500, set under 902 KAR 20:008. That regulation applies the same fee to non-residential hospice. Your license is not a formality: relicensure requires you to respond to the annual utilization survey, so build survey response time into your operating calendar.

Confirm the current licensing application, inspection process, and survey requirements with CHFS OIG before you schedule your opening date. Do not hire clinical staff or sign a patient service contract until you know what the license requires you to have in place.

Step 7: Plan Medicare and Medicaid Enrollment Separately

Medicare and Medicaid enrollment are separate federal and state steps. Neither happens automatically when you receive your CON or state license. Check the enrollment requirements with CHFS OIG and the CON Division, and confirm the federal steps with the appropriate federal program requirements. Many agencies prepare enrollment documents while the CON review is underway, but timing and documentation depend on the programs, so do not assume that a state approval is enough to start billing.

Step 8: Set Up Your Annual Compliance Calendar

Kentucky's annual deadlines are strict. Put these on your calendar from day one:

• Annual report: $15, due June 30 every year. The filing window opens January 1. Domestic entities that miss June 30 are administratively dissolved.
• LLET: Calculate and pay based on your gross receipts or gross profits.
• CHFS OIG license: $500 annual fee, plus the annual utilization survey.
• Occupational license taxes: File with each local jurisdiction on its own schedule.
• Assumed name renewal: Renew every five years if you use a trade name.

Common Mistakes to Avoid

• Treating the LLC filing as the start of operations. A filed LLC has no authority to deliver home health services without the CON and the license.
• Assuming a personal services model applies. Home health agencies face CON review that many other service businesses never see.
• Missing a batch deadline. An incomplete application can cost you a full review cycle.
• Using a post office box for the registered office. Kentucky requires a street address.
• Skipping the local occupational tax check. Local jurisdictions can levy taxes that a state-level review will not reveal.
• Signing a lease before the CON decision. Your office costs can run for months before you can serve a single patient.
• Assuming Medicare and Medicaid follow the license. They are separate enrollments with separate requirements.

What to Realistically Expect

Many founders find that the filing steps are the simplest part. The Secretary of State can process formation documents within a few business days, and the state fees for the entity are modest. The longer timeline comes from the CON review, the batch calendar, and the time needed to build a compliant operation. Plan for the CON process to set your opening date, and treat any date you see in this article as something to verify with the agency, since regulatory timing can shift.

A carefully prepared application and a clean compliance calendar can help you avoid avoidable delays. They cannot guarantee approval, because the review turns on the state's assessment of need and the completeness of your filing.

Why Many Founders Hire a Health Care Attorney First

A home health agency mixes entity law, health care regulation, and tax obligations, and an error in one area can delay the others. A health care attorney can help you choose the entity, prepare ownership disclosures that match your CON filing, and check that your registered agent and office arrangements meet Kentucky requirements. Many founders also ask the attorney to review the batch calendar against their budget before they commit to a lease or payroll. Attorney fees vary, so request a written estimate before you engage one. A CPA can then model the LLET, income tax, and sales tax exposure for your specific revenue mix.

Official Kentucky Resources

• Kentucky One Stop Business Portal for new formations and online filings
• Kentucky Secretary of State, Division of Business Filings
• Secretary of State business name search
• Secretary of State fee schedule
• Kentucky Department of Revenue for tax registration and questions
• Kentucky Small Business Development Center (KSBDC) for free planning help
• SBA Kentucky district office for federal small business resources

For the CON Division and CHFS OIG, search the Cabinet for Health and Family Services website directly, and confirm the current batch calendar, application forms, and licensing requirements before you plan your opening date.

Reminder: this article is informational content, not legal or tax advice. Confirm every fee, deadline, and requirement with the named agency, and consult a qualified attorney and CPA before you file.