How to start a home care agency in Nebraska and reach your first client faster
Nebraska does not license nonmedical home care agencies, so new owners think they can open next week. For private pay families, they nearly can. But the worker statute decides who you may hire and which checks you must keep on file, and Medicaid clients come only after a DHHS referral, Maximus enrollment, owner fingerprints, a policy review and electronic visit verification. Home health and hospice add a DHHS license and Medicare on top. We put all of it in the right order for you.
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Nebraska rulesNeb. Rev. Stat. 71-6501 to 71-6504 and 480 NAC 4
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Nebraska requires.
Nonmedical home care for AD Waiver participants
- State license
- None for nonmedical care; DHHS Medicaid provider enrollment instead
- Who you deal with
- DHHS Division of Medicaid and Long-Term Care, Division of Developmental Disabilities, Maximus, Resource Developers and service coordinators
- Must haves
- Resource Developer referral, Maximus enrollment, APS and CPS registry screening, fingerprint checks for owners of 5% or more, policy and procedure review, staff age 19 or older, EVV
- Realistic time to first client
- Several months
Orientation for Nebraska only. We confirm your exact path on the free call.
Three places new Nebraska agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Reading no license as no rules
Nebraska has no license for nonmedical care, but Neb. Rev. Stat. 71-6503 says an agency may employ or contract only with workers who meet the statute's list, and it must run a criminal history check on each one and keep the records at its place of business for inspection. Owners who hire first and check later end up with caregivers they cannot keep.
What it costs: Caregivers you have trained and scheduled, then have to let go, and clients left without coverage.
Waiting on the Medicaid referral chain
An AD Waiver agency cannot simply apply online. A Resource Developer refers you to Maximus, Maximus screens you, Nebraska Medicaid Provider Relations sends fingerprint packets for every owner of 5% or more and asks for your policies and procedures, and only then do you get a welcome letter and go back to the Resource Developer to finish. Agencies that start this after opening carry staff with no waiver clients.
What it costs: Months of rent, insurance and payroll carried by your operating reserve while enrollment is pending.
Visits that do not get paid
Nebraska Medicaid requires electronic visit verification for personal care and home health visits. Since 2025 DHHS has tightened its checks: visits need GPS or phone (IVR) verification, an active NPI in the Netsmart system and other required data, or the claim is declined. New agencies that set up EVV late, or train caregivers poorly, find out when payments stop.
What it costs: Unpaid claims for care you already delivered and paid your caregivers for.
What does a delay cost your agency?
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Home care vs home health vs hospice in Nebraska
The three sound alike and are regulated differently. The one you choose decides your regulator, staffing, startup capital and timeline.
| Topic | Nonmedical home care | Home health (skilled) | Hospice |
|---|---|---|---|
| What your staff do | Attendant care (hands on help with daily living, bathing, transfers, medication reminders), companion and homemaker services | Skilled nursing or at least one other therapeutic service, such as therapy or home health aide services | Home care, palliative care and supportive services for people who are terminally ill, and their families |
| State license | None; worker rules in Neb. Rev. Stat. 71-6501 to 71-6504 | DHHS home health agency license (Neb. Rev. Stat. 71-417; 175 NAC 14) | DHHS hospice license (Neb. Rev. Stat. 71-418; 175 NAC 16) |
| Certificate of Need | No | No; Nebraska's Certificate of Need Act covers long term care and rehabilitation beds only | No; Nebraska's Certificate of Need Act covers long term care and rehabilitation beds only |
| Main payers | Private pay, AD Waiver and other DHHS waiver services paid outside Heritage Health | Medicare, Heritage Health plans, commercial insurance | Medicare hospice benefit, Nebraska Medicaid |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment | Accreditation or state survey, then Medicare enrollment |
| Key staff | Owner or manager who runs hiring checks; caregivers who meet the statute (age 19 or older for waiver work) | Administrator and backup administrator, RN available or on call, trained and competency tested home health aides | Administrator and backup, physician medical director, RN, social worker, counselor |
| Startup capital | Lowest | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks (private pay) to months (AD Waiver) | Longest: licensure, survey, enrollment | Longest: licensure, survey, enrollment |
Many Nebraska owners start with nonmedical care, build cash flow and a caregiver team, then add home health. The statute allows it: a home health agency may also be an in-home personal services agency. We plan both from day one so your hiring checks, policies and EVV setup grow with you instead of being rebuilt.
Nebraska requirements at a glance
| Nonmedical home care license | None. Neb. Rev. Stat. 71-6501 to 71-6504 set worker qualifications and require criminal history and registry checks. |
|---|---|
| Home health and hospice licensing | DHHS Division of Public Health, Licensure Unit, under the Health Care Facility Licensure Act: 175 NAC 14 (home health) and 175 NAC 16 (hospice) |
| Medicaid agency | DHHS Division of Medicaid and Long-Term Care; enrollment contractor Maximus (Provider Data Management System) |
| Main Medicaid home care route | Aged and Disabled (AD) Waiver, run by the DHHS Division of Developmental Disabilities; renewed by CMS effective July 1, 2026 |
| Managed care | Heritage Health: Nebraska Total Care, UnitedHealthcare Community Plan and Molina Healthcare. Waiver services are paid outside the plans. |
| Caregiver training | No state hour count for nonmedical workers: training sufficient for the services offered. Home health aides need the 75 hour course and an RN competency evaluation. |
| Background screening | Criminal history check; APS, child abuse central registry, Nurse Aide, Medication Aide and sex offender registries; driving record when driving is part of the job |
| Electronic visit verification | Required for personal care (since 2021) and home health (since 2024); state system through Netsmart, or an approved alternate vendor |
| Certificate of Need | Not required for home care, home health or hospice |
| Entity filing | Nebraska Secretary of State, Business Services Division. Nebraska has no general state business license. |
Summary of Nebraska requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Nebraska
The order matters. Steps 5 and 6 should start long before step 8, because the waiver referral chain takes time and every caregiver needs checks on file before their first visit.
Form the business with the Secretary of State
File your LLC or corporation with the Nebraska Secretary of State, appoint a registered agent, get an EIN, and register for state withholding with the Department of Revenue and unemployment insurance with the Department of Labor. Nebraska has no general state business license, but check your city's rules.
You do this; we give you the checklistDecide your payer mix
Private pay, the AD Waiver or both. Waiver work adds enrollment steps and an age 19 minimum for caregivers. Use the path finder above.
Decided on your free consultationSet up insurance and employment basics
Arrange workers' compensation, general and professional liability, and auto coverage for caregivers who drive. Build Nebraska's paid sick time rules into payroll as soon as they apply to your headcount.
You do this; we specify what is requiredWrite policies to Nebraska's rules
Adopt policies for hiring checks, service agreements, client rights, care plans, supervision, incident and abuse reporting, records and EVV, written to Neb. Rev. Stat. 71-6501 to 71-6504 and 480 NAC 4. Waiver agencies must have abuse and neglect procedures, and Nebraska Medicaid asks for your policies and procedures during enrollment.
We write this for youBuild the caregiver pipeline
Before anyone works, confirm age and English (or the client's language), run a criminal history check, search the APS, child abuse, Nurse Aide, Medication Aide and sex offender registries, pull a driving record for anyone who drives clients, and document training. Keep every record at your office.
We set up the system and trackerGet a referral and enroll through Maximus
For the AD Waiver, a DHHS Resource Developer or Area Agency on Aging resource developer refers you to Maximus. Create your account with the referral number and complete the online application in Maximus' Provider Data Management System. Paper applications have not been accepted since June 1, 2025.
We prepare and manage itPass the Provider Relations review
After Maximus screening, Nebraska Medicaid Provider Relations sends a fingerprint background check packet for each owner of 5% or more and asks for your policies and procedures. Once approved, you get a welcome letter and finish with the Resource Developer, who negotiates your rate.
We prepare and manage itSet up electronic visit verification
Register in the state's Netsmart EVV system or connect an approved alternate vendor. Train caregivers to check in and out by GPS or phone, and make sure the NPI numbers DHHS requires are active in Netsmart before your first waiver visit.
We walk you through setup
In-home personal services worker rules and background checks
Neb. Rev. Stat. 71-6502 lists who may work as an in-home personal services worker, and 71-6503 says an agency may employ or contract only with people who meet that list. AD Waiver agencies also follow 480 NAC 4. Section 71-6504 says the worker sections do not apply to people providing aged and disabled services or certain other DHHS program services, which have their own provider standards, so waiver staff are held to 480 NAC 4.
- Age and character: At least 18 years old and of good moral character under the statute. For AD Waiver agencies, caregivers, the director and the administrator must be 19 or older (480 NAC 4-002).
- Criminal history: A criminal history check on every worker. No conviction punishable by more than one year of imprisonment that is rationally related to fitness for the work.
- Registry checks: No adverse findings on the Adult Protective Services Central Registry, the child abuse and neglect central register, the Medication Aide Registry, the Nurse Aide Registry or the Nebraska State Patrol sex offender registry.
- Driving record: A Department of Motor Vehicles driving record check (or the issuing state's) for any worker whose duties include driving.
- Language and training: Able to speak and understand English or the language of the person served, with training sufficient for the services offered. The statute sets no hour count, so write your own curriculum and skills checklist.
- Waiver provider standards: Staff must know how to respond to emergencies and recognize distress. DHHS screens the APS and child protection registries at enrollment and at an annual in person review, and an agency may not employ disqualified people in direct care.
- Home health aides: Licensed home health agencies need aides who completed the 75 hour training course, an RN competency evaluation before the first home visit, and criminal and registry checks before hiring under 175 NAC 14-010.
- Recordkeeping: Keep documentation of every check at your place of business, ready for inspection.
Six mistakes that slow Nebraska agencies down
We look for every one of these in the first week of an engagement.
Hiring before the checks are done
- What it costs
- A caregiver who fails a registry or criminal history check after you have trained and scheduled them.
- How we prevent it
- A hiring checklist that blocks scheduling until every check in 71-6502 and 71-6503 is on file.
Hiring 18 year olds for waiver cases
- What it costs
- The statute allows 18, but 480 NAC 4 requires waiver caregivers to be 19 or older, so those caregivers cannot work AD Waiver cases.
- How we prevent it
- We flag age limits by payer in your caregiver tracker.
Skipping the driving record check
- What it costs
- Workers who drive clients without the required DMV check, which is a gap in the records you must keep.
- How we prevent it
- Driving record checks built into hiring for every role that includes transportation.
Starting Medicaid enrollment after opening
- What it costs
- Months of payroll with no waiver clients while the referral, Maximus screening, fingerprints and policy review run.
- How we prevent it
- We start the referral and prepare your policy packet while the business is still being set up.
Treating EVV as an afterthought
- What it costs
- Declined claims for visits without GPS or phone verification or a linked NPI.
- How we prevent it
- EVV registration, NPI setup and caregiver training before the first waiver visit.
Drifting into skilled care without a license
- What it costs
- Nursing or therapy services make you a home health agency under Neb. Rev. Stat. 71-417, which may not operate without a DHHS license.
- How we prevent it
- Clear service definitions so caregivers give medication reminders, not skilled care.
In a free 30 minute call we confirm your Nebraska path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Nebraska launch packages
Three fixed price packages, matched to the path you choose. Your exact price is quoted in writing after your free call, before any work starts.
Private pay launch
For nonmedical agencies serving families who pay privately.
- Nebraska path and a dated launch plan
- Policy and procedure manual written to Neb. Rev. Stat. 71-6501 to 71-6504 and 480 NAC 4
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
AD Waiver ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to AD Waiver requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for Nebraska Medicaid (DHHS) through a Resource Developer referral and Maximus enrollment
- Survey and audit readiness
- Nebraska city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to DHHS rules and the Medicare Conditions of Participation
- License application and inspection readiness
- Accreditation survey preparation
- Medicare and Medicaid enrollment support
Every package: one fixed price agreed in writing · you own 100% of your agency · no franchise fees or royalties.
On your own vs a franchise vs Lunaria
| Topic | On your own | Home care franchise | With Lunaria |
|---|---|---|---|
| Who owns the business | You | You, under the franchisor's brand and rules | You, 100% |
| Ongoing fees | None | Royalties and brand fees, usually a share of revenue | None. One fixed project fee |
| Knowing what Nebraska requires | Pieced together from manuals and forums | A national playbook, adapted | Confirmed on your first call, then in writing |
| Policy manual | A template, often from another state | The franchisor's standard manual | Written to Neb. Rev. Stat. 71-6501 to 71-6504 and 480 NAC 4 |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for Nebraska Medicaid (DHHS) through a Resource Developer referral and Maximus enrollment prepared together |
| Your brand and marketing | Up to you | The franchisor's brand, with territory limits | Your brand, plus local search set up for you |
The Nebraska home care startup checklist
Every Nebraska step in order: business setup, your payer path, policies, caregiver screening and training, Medicaid enrollment and getting found. The items to start first are starred.
- Choose your care type and payer mix (private pay, AD Waiver, or both)
- Form your LLC or corporation with the Nebraska Secretary of State and appoint a registered agent
- Get an EIN and register with the Department of Revenue and the Department of Labor
- Check your city's business rules
- Buy workers' compensation, general and professional liability, and auto coverage
- and 13 more steps
Christine Ochimas, RN, LMFT, MBA
Christine founded Lunaria Care Consulting to give nurses and caregivers a direct route from "I want my own agency" to a compliant business with clients. She reads state requirements the way a reviewer does and writes policies the way a nurse would actually use them.
- We serve owners in all 50 states and DC, with a plan written for Nebraska
- We help through enrollment and survey readiness, not just the application
- We tell you what we cannot promise: no one can guarantee a state or health plan decision
Have these ready for your consultation
- The care you want to provide and the clients you want to serve
- The Nebraska cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, AD Waiver, Medicare
- Your target opening month and rough budget
No client or patient records. We never need them for a first call.
What it costs to start a home care agency in Nebraska
| Item | Notes |
|---|---|
| State license | None for nonmedical care. A home health license is $650 initially, then $650 to $950 a year by admissions (175 NAC 14-003). A hospice license that is not an inpatient facility is $450 initially, then $450 to $600 a year (175 NAC 16-003). Check current fees with DHHS. |
| Entity formation | Nebraska Secretary of State filing fee for your entity type, plus biennial or annual report fees |
| Criminal history and registry checks | Per worker, plus driving record checks for drivers |
| Owner fingerprints | Fingerprint background checks for each owner of 5% or more during Medicaid enrollment |
| Training | Your own curriculum and trainer time; home health aide training and competency testing for licensed agencies |
| Insurance | Workers' compensation, liability, auto coverage |
| EVV and scheduling software | State Netsmart system or an approved alternate vendor; confirm costs before you choose |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while Medicaid enrollment or Medicare certification is pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Nebraska
Weeks, once the business, insurance and hiring checks are in place.
Several months: Resource Developer referral, Maximus screening, owner fingerprints, policy review, then rate setting and EVV.
Longest: DHHS application and onsite inspection, certification survey and Medicare enrollment, which a CMS moratorium paused for new agencies from May 13, 2026.
Omaha and Lincoln hold most of Nebraska's private pay demand, and agencies near Omaha compete with providers across the river in Council Bluffs. Outside the two metros, in Grand Island, Kearney, North Platte and the many small towns of Greater Nebraska, long drives make reliable staffing your selling point, and service coordinators look for agencies that will cover rural counties. Many families search for care for a parent from another city or state, so a complete Google Business Profile and clear pages for each community you serve help you get found.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Nebraska?
No. Nebraska does not license agencies that provide only attendant, companion and homemaker services. You must still follow Neb. Rev. Stat. 71-6501 to 71-6504, which set worker qualifications and require criminal history, registry and driving record checks kept at your office.
Who licenses home health and hospice agencies in Nebraska?
The DHHS Division of Public Health, Licensure Unit, under the Health Care Facility Licensure Act. Home health rules are in 175 NAC 14 and hospice rules are in 175 NAC 16. Both require a signed application, fees and an onsite inspection before you operate.
What background checks do Nebraska caregivers need?
A criminal history check on each worker; checks of the Adult Protective Services Central Registry, the child abuse and neglect central register, the Nurse Aide and Medication Aide registries and the sex offender registry; and a driving record check when driving is part of the job.
Do Nebraska caregivers need a certificate or set training hours?
Not for nonmedical work. The statute requires training sufficient for the services offered, with no hour count. Home health aides in licensed agencies need the 75 hour training course and an RN competency evaluation.
How do Nebraska home care agencies get AD Waiver clients?
A DHHS or Area Agency on Aging Resource Developer refers you to Maximus for Medicaid enrollment. After screening, owner fingerprints and a policy review, you finish with the Resource Developer. Participants then choose their providers with their service coordinator.
Do Heritage Health plans pay for waiver services?
No. AD Waiver services are arranged by DHHS service coordinators, with rates set by DHHS Resource Developers, and paid by Nebraska Medicaid outside the three Heritage Health plans. Home health and hospice for Medicaid members do involve the plans.
Does Nebraska require a Certificate of Need for home health or hospice?
No. Nebraska's Certificate of Need Act applies to long term care and rehabilitation beds, not to home care, home health or hospice. Licensure, survey and Medicare enrollment still apply.
Can I open a new Medicare home health agency or hospice right now?
CMS put a nationwide moratorium on new Medicare enrollment of home health agencies and hospices from May 13, 2026, for six months. It may have ended or been extended by the time you read this. Nebraska Medicaid also requires hospices to take part in Medicare, so check the status first.
How much does Nebraska home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, AD Waiver or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges.
Is a franchise a better way to start a home care agency in Nebraska?
A franchise gives you a brand and playbook in exchange for fees and ongoing royalties. Starting independently with Lunaria costs one fixed price, and you own 100% of your agency with no franchise fees or royalties. We work in all 50 states and DC.
Sources checked for this guide (43)
- Neb. Rev. Stat. 71-6501, in-home personal services definitions (Nebraska Legislature, Internet Archive copy 2025-03-14)
- Neb. Rev. Stat. 71-6502, worker qualifications (Nebraska Legislature)
- Neb. Rev. Stat. 71-6503, agency duties (Nebraska Legislature; FindLaw copy current as of 1/1/2024)
- Neb. Rev. Stat. 71-6504, applicability (Nebraska Legislature)
- LB824 (2022), amending 71-6501 (slip law)
- Neb. Rev. Stat. 71-417, home health agency defined
- Neb. Rev. Stat. 71-418, hospice defined
- Neb. Rev. Stat. 71-5829.03, activities requiring a certificate of need
- DHHS Licensure Unit, Home Health Agencies page (Internet Archive copy)
- DHHS Licensure Unit, Hospice Services page (Internet Archive copy)
- 175 NAC 14-003, home health licensure and fees (Cornell LII)
- 175 NAC 14-005, home health general requirements (Cornell LII)
- 175 NAC 14-010, home health standards of operation (Cornell LII)
- 175 NAC 16-003, hospice licensure and fees (Cornell LII)
- 175 NAC 16-005, hospice license expiration (Cornell LII)
- 175 NAC 16-010, hospice staffing and checks (Cornell LII)
- 480 NAC 4-002, HCBS waiver general provider requirements (Cornell LII)
- 480 NAC 4-003, HCBS waiver service specific provider requirements (Cornell LII)
- 471 NAC 36-003, hospice Medicaid provider standards (Cornell LII)
- 471 NAC 9-003, home health Medicaid provider requirements (Cornell LII)
- 404 NAC 4-001, developmental disabilities provider certification (Cornell LII)
- DHHS Provider Bulletin 20-04, home health and hospice Medicare enrollment requirement
- DHHS, Services on the Aged and Disabled Waiver (Internet Archive copy, October 2026)
- DHHS, Provider Enrollment for HCBS Providers (Internet Archive copy)
- DHHS HCBS Enrollment Flowchart
- DHHS, Provider Screening and Enrollment (Maximus PDMS, no paper applications from June 1, 2025)
- DHHS AD and TBI Waivers Service Handbook: Personal Care (updated July 2024)
- DHHS news release, Governor Pillen directs changes to AD Waiver (1/27/2026)
- DHHS news release, AD Waiver service coordination moves from LHD to DHHS (April 1, 2026)
- Medicaid.gov, NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00, effective 7/1/2026)
- Medicaid.gov, Nebraska 1915(c) waiver descriptions
- DHHS Electronic Visit Verification page (Internet Archive copy)
- DHHS EVV Home Health Services page (Internet Archive copy)
- DHHS Heritage Health page (Internet Archive copy)
- DHHS Heritage Health Provider FAQ (waiver services fee for service)
- Nebraska Secretary of State, New Business Information
- Federal Register, hospice enrollment moratorium (FR Doc. 2026-09718, 5/15/2026)
- CMS Home Health and Hospice Nationwide Moratorium Q&As (revised 7/09/26)
- CMS provider enrollment moratoria page
- CMS-855A Medicare enrollment application, institutional providers
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- National Law Review and Koley Jessen summaries of LB415 paid sick time amendments (secondary, pointer only)
This guide is general information and reflects Nebraska requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Nebraska Department of Health and Human Services, Nebraska Medicaid and CMS before filing. Lunaria Care Consulting provides professional consulting services and does not provide legal advice.
Other states: see all state guides. What we do: licensing, compliance, Medicaid enrollment and local search marketing.