1. Two Ways People Start a Home Care Agency in New York
Option 1 — Start From Zero (Apply for License)
You apply for a LHCSA (Licensed Home Care Services Agency) license from the New York State Department of Health.
Pros
Cheap to start
Full ownership
Cons
Takes 1–2 years for approval
Hard paperwork
Startup cost:
$30,000 – $100,000
Option 2 — Buy an Existing Licensed Agency (Most Common)
Many entrepreneurs buy an already licensed agency.
Pros
Start immediately
Already approved by the state
Existing patients possible
Cons
Expensive
Cost:
$150,000 – $500,000+
In Queens, Brooklyn, and Bronx, this is very common.
2. The 3 Most Profitable Home Care Services
Your agency can offer:
1️⃣ Personal Care Assistance (PCA)
Help clients with:
Bathing
Dressing
Cooking
Medication reminders
Medicaid pays roughly:
$22–$30 per hour
2️⃣ Home Health Aide (HHA)
Caregivers help with:
Personal care
Mobility
Monitoring health
Requires certified aides.
3️⃣ Companion Care (Private Pay)
Services include:
Elderly companionship
Grocery shopping
Transportation
Rates:
$25 – $40 per hour
3. Medicaid Programs That Bring Most Patients
Most agencies make money through Medicaid programs.
In New York the biggest one is:
MLTC (Managed Long Term Care)
Examples include:
Fidelis Care
Healthfirst
Centers Plan for Healthy Living
These companies send patients to home care agencies.
If you contract with them, you can receive dozens of patients every month.
4. Staff You Must Hire
Even a small agency needs these roles:
Administrator
Runs the business operations.
Salary:
$70k – $120k per year.
Director of Nursing (RN)
Responsible for:
Patient care plans
Nurse supervision
Compliance
Salary:
$90k – $150k.
Home Health Aides (HHA)
They are the caregivers.
Typical pay in NYC:
$17 – $20 per hour.
Scheduler / Coordinator
Manages:
caregiver schedules
patient assignments
Salary:
$40k – $60k.
5. Software You Must Use
Home care agencies must track:
visits
caregiver schedules
billing
Popular software:
AxisCare
AlayaCare
WellSky
Cost:
$200 – $800 per month.
6. Insurance You Need
Your agency must have:
1️⃣ General Liability Insurance
2️⃣ Professional Liability
3️⃣ Workers Compensation
4️⃣ Disability Insurance
Cost yearly:
$5,000 – $15,000
7. How Agencies Get Their First Patients
This is the most important part of the business.
Hospital referrals
Hospitals discharge patients and refer them to home care agencies.
Nursing homes
Many elderly people need home care after leaving nursing homes.
MLTC referrals
Insurance companies send clients to agencies.
Community marketing
Agencies promote services at:
mosques
churches
senior centers
Online marketing
Agencies run:
Google Ads
Facebook ads
Local SEO
8. Real Profit Example
Example agency with 50 patients.
Each patient receives:
6 hours care daily.
Medicaid pays:
$25/hour.
Daily revenue:
50 × 6 × $25 = $7,500
Monthly revenue:
$225,000
After paying staff and expenses:
Profit:
$40k – $70k per month
9. Biggest Problems in This Business
Caregiver shortage
Hard to find reliable aides.
Medicaid paperwork
Billing can be complex.
Competition
New York has many agencies.
10. Growth Strategy (How Agencies Reach $1M+)
Successful agencies:
1️⃣ Contract with multiple MLTC insurance companies
2️⃣ Hire 100+ caregivers
3️⃣ Expand to Brooklyn and Bronx
4️⃣ Use strong hospital referral networks
Large agencies often reach:
$5M – $20M yearly revenue.
11. Smart Strategy Most New Owners Use
Instead of starting big:
They begin with:
1 small office
20 patients
15 caregivers
Then grow gradually.
💡 Since you live in Jamaica, Queens, that area is actually one of the biggest home care markets in New York because many seniors rely on Medicaid.
✅ If you want, I can also explain:
How to start a home care agency in New York WITHOUT a license first (legal workaround)
How people buy a home care agency for $50k instead of $500k
How to get your first 10 patients in 30 days
Exact paperwork required for LHCSA application
These strategies are what most new agency owners in NYC don’t know.