21st Century Health Care Consultants sold a full startup package for roughly $8,000 to $21,000, paid upfront, then appears to have closed in mid-2026 with client work unfinished. If you are searching for an alternative, you are probably in one of two situations: you paid them and need someone to finish, or you were about to hire them and now need a different plan. This page is for both. It is written by BridgeCare OS, so read our own entry with that in mind; the rest is as even-handed as we can make it.
The four options, side by side
| Option | Typical cost | When you pay | Who carries the risk | Best for |
|---|---|---|---|---|
| Startup consultant | $5,000 to $21,000 | Upfront or a large deposit, balance on milestones at best | You. Your deposit funds their pipeline. | Medicare home health and hospice, where clinical and accreditation expertise is genuinely scarce |
| Franchise | $40,000 to $200,000 plus 3% to 7% of revenue | Upfront fee, then royalties forever | Shared. The franchisor has a stake in you opening. | Owners who want a brand, a playbook, and a territory, and accept the royalty |
| Do it yourself | State fees and your time | As you go | You, in time rather than money | Non-medical agencies in states with clear rules, if you can read a regulation and follow a checklist |
| Milestone-priced launch (ours) | $8,950 for all seven milestones, or per milestone | When each milestone is delivered, nothing upfront | The provider. If they stop delivering, you stop paying. | Non-medical home care in any state, and anyone finishing after a consultant stopped |
All four exclude the same pass-through costs: the state license fee, liability insurance, workers' compensation, and background checks. Any quote that hides those inside a package price is making comparison harder on purpose.
Option 1: another startup consultant
There are reputable consultants in this space, and some of them are very good at the parts that genuinely need experience: Medicare home health certification, hospice, CHAP or ACHC accreditation, and clinical policy. Names that come up when owners search include Certified Homecare Consulting, Waiver Consulting Group, SimiTree, GPiCare, Kenyon HomeCare Consulting, and MB Healthcare Consultants. We have no relationship with any of them and cannot vouch for them; check their current reviews, and ask the questions below.
What to ask before paying any consultant in 2026:
- How and when do I pay? "50% deposit" means you are funding their next six months. Ask for payment on delivery of named milestones.
- What is delivered at each milestone, in writing? "Licensing support" is not a deliverable. "License application submitted and acknowledged by the state" is.
- What happens to my file if you stop? Do you get your documents, your application status, and your logins?
- Who does the work? The person on the sales call, or a "licensing specialist" you will meet later?
- Can I see the BBB profile and the last twelve months of complaints? 21st Century had an F rating and a refund-refusal complaint on record before it closed. The signal was public.
Option 2: a franchise
Home care franchises cost far more upfront and take a share of revenue for the life of the agreement, but they solve a different problem: they hand you a brand, a marketing engine, an operating playbook, and a territory. If you want to be told what to do and are willing to pay for it every month, a franchise is a legitimate choice, and the franchisor is motivated to get you open. Read the Franchise Disclosure Document, especially the item on outlets that closed or transferred in the last three years.
Option 3: do it yourself
For a non-medical agency this is more realistic than consultants like to admit. State licensing offices publish the application, the rule, and often an FAQ. What you are buying from anyone else is time, sequencing, and the policy manual. If you are good at reading regulations and stubborn about checklists, start with your state's health department page and our Illinois guide as an example of what the full list looks like. The trap is the policy manual: a generic template downloaded from a marketplace will not match your state's code section by section, and that is what the surveyor checks.
Option 4: milestone-priced launch, which is ours
BridgeCare Launch is the service we built after 21st Century's former clients started contacting us. It covers the same ground as a startup package for non-medical home care: entity and accounts, a state-specific policy manual, the license application, staff onboarding and training systems, client contracts and service plans, survey readiness, and Medicaid and EVV enrollment. Every milestone has a published price and is billed only when delivered. The full set is $8,950.
What makes it cheaper is not corner-cutting. Most of the work is documents written to your state's actual code, which we draft with software and have reviewed by a person who knows the rules. What makes it safer is the billing shape: you never fund our pipeline, so we cannot fail you the way an upfront model can.
What it is not: a Medicare home health or hospice consultancy. Those need clinical expertise and accreditation support. Tell us what you are building and we will say honestly whether we can help or who can.
How to decide in ten minutes
- Medicare home health or hospice? A specialist consultant with accreditation experience, paid per milestone if they will agree to it.
- Want a brand and a playbook, and accept royalties? A franchise.
- Non-medical, comfortable with regulations, more time than money? Do it yourself, and buy only the policy manual.
- Non-medical, want it done, refuse to pay upfront again? Milestone-priced launch.