There is no federal license for residential care homes. Small homes that care for elderly or disabled adults outside of a nursing home are regulated entirely at the state level, and no two states do it quite the same way. A home that would be called a Residential Care Facility for the Elderly in California is an Adult Family Home in Washington, an Adult Foster Home in Oregon, and a Personal Care Home in Pennsylvania.
This guide is a practical reference for operators, aspiring operators, and referral professionals who need to know how each state categorizes and regulates small residential care. It is not legal advice. Always read the full regulations and contact the state agency before you apply.
Why there is no federal license
Nursing homes that accept Medicare or Medicaid are regulated under federal law through the Centers for Medicare and Medicaid Services. Residential care homes, board and care homes, and assisted living homes are not. Congress has never passed a federal statute creating a national residential care license, and the authority to regulate them falls to state governments under general police powers.
This means category names, capacity limits, staffing ratios, training requirements, medication administration rules, physical plant standards, and inspection schedules all vary by state. An operator who moves from one state to another cannot transfer a license. They must apply fresh.
How states categorize small care homes
Most states use one of a few broad patterns.
Single-category states license all residential care homes under one statute regardless of size. Texas is the clearest example. A 4-bed home and a 200-bed community are both licensed as Assisted Living Facilities under Texas Health and Human Services rules, though Type A and Type B subcategories distinguish different care levels.
Tiered-by-size states create a separate smaller category for homes under a capacity threshold, usually 5 to 8 beds. Washington Adult Family Homes (up to 8 beds), Oregon Adult Foster Homes (up to 5 beds), and Florida Adult Family Care Homes (up to 5 beds) are examples. These categories exist specifically to allow family-operated homes inside single-family residences.
Population-specific states license separate categories for the elderly, the developmentally disabled, the mentally ill, and other populations, often with similar physical plant rules but different training and care planning requirements. California is the clearest example, with RCFE (elderly), ARF (adult residential for developmentally disabled), and STRTP (short-term residential therapeutic program for youth) as separate license types.
State-by-state reference
What follows is a reference for 20 of the largest and most commonly searched states. For each, we list the license category name most relevant to small elderly care homes, the licensing agency, the typical capacity range, and notable features.
California
- Category: Residential Care Facility for the Elderly (RCFE)
- Also commonly called: Board and care home
- Agency: California Department of Social Services, Community Care Licensing Division
- Capacity: 6 beds is the typical small home. Licenses issued up to 15 beds under the small facility category. Larger licenses available.
- Notable: Administrator certification required. Strong dementia care addendum rules. See the California board and care guide.
Washington
- Category: Adult Family Home (AFH)
- Agency: Washington Department of Social and Health Services, Residential Care Services
- Capacity: Up to 6 residents, with a possible expansion to 7 or 8 under specific conditions
- Notable: Extensive caregiver training requirements (75 hour basic, plus specialty training in dementia and mental health). See the Washington adult family homes guide.
Oregon
- Category: Adult Foster Home (AFH)
- Agency: Oregon Department of Human Services, Aging and People with Disabilities. See the Oregon Office of Licensing and Regulatory Oversight.
- Capacity: Up to 5 residents
- Notable: Classified into three care levels based on resident acuity. The operator typically lives in the home.
Arizona
- Category: Assisted Living Home
- Agency: Arizona Department of Health Services, Division of Licensing
- Capacity: Up to 10 residents
- Notable: Managers and caregivers must complete state-approved training.
Florida
- Category: Adult Family Care Home (AFCH) for 5 or fewer, Assisted Living Facility (ALF) for larger
- Agency: Florida Agency for Health Care Administration
- Capacity: AFCH up to 5, ALF no upper limit
- Notable: Extended Congregate Care and Limited Mental Health licenses allow higher acuity.
Texas
- Category: Assisted Living Facility, Type A and Type B
- Agency: Texas Health and Human Services Commission
- Capacity: No separate small home category
- Notable: Type A residents must be physically and mentally capable of evacuating unassisted. Type B allows higher dependency.
Georgia
- Category: Personal Care Home
- Agency: Georgia Department of Community Health, Healthcare Facility Regulation
- Capacity: Ranges from family (2-3) to group (4-15) to congregate (16+)
- Notable: Memory care endorsement required for dementia care. See the Georgia personal care homes guide.
Pennsylvania
- Category: Personal Care Home
- Agency: Pennsylvania Department of Human Services, Bureau of Human Services Licensing
- Capacity: 4 or more residents (homes with 3 or fewer are unregulated family situations)
- Notable: Separate Assisted Living Residence category for higher acuity.
North Carolina
- Category: Family Care Home (2-6 beds), Adult Care Home (7+ beds)
- Agency: North Carolina Department of Health and Human Services, Division of Health Service Regulation
- Capacity: Family Care Home up to 6
- Notable: Different training and staffing rules apply to the two categories.
Michigan
- Category: Adult Foster Care Family Home (1-6 beds), Small Group Home (1-12 beds), Medium Group Home, Large Group Home
- Agency: Michigan Department of Licensing and Regulatory Affairs, Bureau of Community and Health Systems
- Capacity: Family home up to 6
- Notable: Homes for the Aged is a separate category with different rules.
Minnesota
- Category: Assisted Living Facility (current statute since 2021) and Adult Foster Care (historical small home category)
- Agency: Minnesota Department of Health
- Capacity: Adult Foster Care historically up to 5
- Notable: Minnesota reformed its residential care licensing in 2021, consolidating most categories under the new Assisted Living Facility license.
Wisconsin
- Category: Adult Family Home (AFH, up to 4 beds), Community-Based Residential Facility (CBRF, 5+ beds)
- Agency: Wisconsin Department of Health Services, Division of Quality Assurance
- Capacity: AFH up to 4, CBRF varies
- Notable: CBRFs are further classified by client category and level of care.
Ohio
- Category: Residential Care Facility
- Agency: Ohio Department of Health
- Capacity: 17 or more for RCF. Smaller homes fall under Adult Care Facility licensing through the Ohio Department of Mental Health and Addiction Services or county-level adult protective services.
Illinois
- Category: Assisted Living Establishment, Shared Housing Establishment (smaller)
- Agency: Illinois Department of Public Health
- Capacity: Shared Housing up to 16, with lower regulatory intensity
New York
- Category: Adult Care Facility, further divided into Adult Home, Enriched Housing, and Assisted Living Residence
- Agency: New York State Department of Health, Division of Adult Care Facility and Assisted Living Surveillance
- Capacity: Varies by subcategory
- Notable: The smallest meaningful category is Family Type Home for Adults, licensed for up to 4 residents.
Virginia
- Category: Assisted Living Facility
- Agency: Virginia Department of Social Services, Division of Licensing Programs
- Capacity: No separate small home category. Small homes are licensed under the general ALF rules.
Colorado
- Category: Assisted Living Residence
- Agency: Colorado Department of Public Health and Environment, Health Facilities and Emergency Medical Services Division
- Capacity: Varies
Nevada
- Category: Residential Facility for Groups
- Agency: Nevada Division of Public and Behavioral Health, Bureau of Health Care Quality and Compliance
- Capacity: 3 or more unrelated residents, with different rules by size and population.
Maryland
- Category: Assisted Living Program, Level 1 through Level 3 based on acuity
- Agency: Maryland Department of Health, Office of Health Care Quality
- Capacity: 4 or more residents
Tennessee
- Category: Assisted Care Living Facility, Residential Homes for the Aged
- Agency: Tennessee Department of Health, Health Care Facilities Division
- Capacity: Varies
What this means for operators
If you are starting a home, the single most important step is reading your state’s full regulations before you buy property or sign a lease. The category name alone does not tell you whether you need an administrator certification, how much training your staff needs, whether you can admit bedridden residents, or what fire marshal approval will require.
For market context on how families search for homes in your state, see our full state directory and the main guides index. For operators, pair this with how to start a board and care home and understanding care home inspections.
Your next step
Pick your state above, click through to the licensing agency URL, and download the full regulations as a PDF. Read them cover to cover before you spend another dollar on your project. Then call the agency’s pre-licensing line and ask to be connected with a licensor in your county. Every successful operator we know took this one step before they took any others.