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Run the Payroll Fee Auditor →Blog · Payroll Management · Home Health
Home Health Agencies: Multi-Location Payroll Guide (2026)
Multi-location payroll for home health agencies means one payroll with per-location cost centers, a state account wherever a location or a remote employee sits, headcount thresholds counted across the whole company, and the home health agency rules cited here applied at every site. BEG: $45 per employee per month inside the payroll software you already use, live in 3 to 5 days.
Rules that change with a second home health agency location
A live-in domestic worker is one who resides on the premises permanently or for extended periods, meaning 5 days a week or 120 hours or more. Since January 1, 2015, agencies may not claim the live-in overtime exemption and must pay overtime after 40 hours; workers on 24-hour shifts who do not reside on the premises are not live-in workers.
An agency may rely on a caregiver's written statement signed under penalties of perjury that the care recipient lives in the caregiver's home under the plan of care, and should not file Form 1099-NEC for payments it knows are excludable. Payments from the care recipient's private funds are not excludable.
What is counted company-wide
OSHA recordkeeping, the ADA and Title VII, COBRA, FMLA and the ACA employer mandate all count employees across every location, so a second site can trip a threshold no single site reaches. FMLA eligibility is the exception: the 50-employee test is measured within 75 miles of the employee's own worksite. A location in a new state adds a withholding account (unless the state has no wage tax), an unemployment account, that state's minimum wage and overtime rule for registered nurses and LPNs, and its new hire and final pay deadlines.
How the payroll is structured
One EIN, one payroll, one set of pay codes for visit-based aide pay, travel time reimbursement and Medicaid billing vs payroll, with location as a cost center on every employee record so labor cost, tax registrations and required postings resolve by site. Separate EINs per location are a legal-entity decision, not a payroll one, and each EIN files its own 941s and W-2s.
The rules behind this page, with sources
General information, not legal advice. Every rule below was read on the agency page linked next to it.
- A live-in domestic worker is one who resides on the premises permanently or for extended periods, meaning 5 days a week or 120 hours or more. Since January 1, 2015, agencies may not claim the live-in overtime exemption and must pay overtime after 40 hours; workers on 24-hour shifts who do not reside on the premises are not live-in workers. [DOL Fact Sheet #79B]
- An agency may rely on a caregiver's written statement signed under penalties of perjury that the care recipient lives in the caregiver's home under the plan of care, and should not file Form 1099-NEC for payments it knows are excludable. Payments from the care recipient's private funds are not excludable. [IRS Notice 2014-7 Q&A (Q7, Q15, Q20)]
Read the full guide to how to manage payroll in multiple states, and the rest of the home health agency payroll library.
Managed Payroll, Handled.
BEG manages payroll at $45 per employee per month, all-inclusive. Get an instant cost comparison for your business.
Frequently Asked Questions
Does a second home health agency location need its own payroll?
No. One payroll with location cost centers is the norm under a single EIN. A second EIN, if the entity structure requires one, files its own returns and W-2s.
Which thresholds count employees across all home health agency locations?
OSHA logs, Title VII and the ADA, COBRA, FMLA coverage and the ACA employer mandate. FMLA eligibility for an individual is measured within 75 miles of that employee's worksite.
Home health agency multi-site rule: DOL Fact Sheet #79B
A live-in domestic worker is one who resides on the premises permanently or for extended periods, meaning 5 days a week or 120 hours or more. Since January 1, 2015, agencies may not claim the live-in overtime exemption and must pay overtime after 40 hours; workers on 24-hour shifts who do not reside on the premises are not live-in workers.
What does managed payroll cost for a home health agency?
$45 per employee per month, all-inclusive, inside the payroll software you already use, with no monthly minimum. Visit-based aide pay, travel time reimbursement and Medicaid billing vs payroll are configured at setup, not billed as add-ons.
Related Resources
Anthony leads payroll solutions at Business Executive Group, a national managed payroll firm serving businesses across industries including Home Health Agencies. BEG manages payroll at $45 PEPM, all-inclusive, with deep expertise in compliance, multi-state filing, and industry-specific payroll requirements. Get instant pricing at beghr.com.
Authoritative source: U.S. Department of Labor: Wage and Hour Division
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