How to start a home care agency in Nevada and reach your first client faster
Nevada licenses nonmedical home care directly, and the order trips people up. The license needs a Nevada office, insurance, a surety bond and owner fingerprints before you file, and you cannot fingerprint caregivers through the state until the license is issued. Nevada Medicaid enrollment, EVV and attendant training come after that. Home health and hospice face a state licensing pause and a federal Medicare enrollment moratorium in 2026. We put all of it in the right order for you.
- Guides reviewed by Christine Ochimas, RN, LMFT, MBA
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Nevada rulesNAC 449.396 to 449.3982, NRS Chapter 449B and Medicaid Services Manual Chapter 3500
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Nevada requires.
Personal care for Nevada Medicaid members
- State license
- Agency to provide personal care services in the home (NRS 449B.100; NAC 449.396 to 449.3982)
- Who you deal with
- HCQC, Nevada Medicaid and its fiscal agent, ADSD for waiver services
- Must haves
- HCQC license, Nevada Medicaid enrollment as Provider Type 30 (Personal Care Services, Provider Agency), EVV, a 24 hour phone line and backup caregivers, attendants trained to NAC 449.3977
- Realistic time to first client
- Several months after the license
Orientation for Nevada only. We confirm your exact path on the free call.
Three places new Nevada agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Filing under the wrong license type
Nevada has three look alike licenses: a personal care agency, an employment agency that places nonmedical workers, and an intermediary service organization for self directed care. HCQC tells applicants to confirm the type before applying, because fees are not refunded when the wrong type is filed (NAC 449.013).
What it costs: A lost $1,374 application fee and weeks of rework before the real application even starts.
Everything is due before you file, and hiring comes after
HCQC's checklist wants a signed Nevada lease, a liability certificate, a surety bond, a local business license or zoning approval, owner fingerprint waivers and administrator elder abuse training with the application. Yet HCQC says the license must be issued before you can open the state fingerprinting account for employees, who must then be entered in NABS within 10 days of hire.
What it costs: Rent, insurance and bond premiums paid for months before you can staff a single client.
Clinical licenses on pause
On June 5, 2026 the Nevada Health Authority announced a pause on new state home health and hospice licenses and a moratorium on new Nevada Medicaid enrollments, for at least six months, while it reviews existing providers for fraud. CMS separately stopped new Medicare enrollment of home health agencies and hospices nationwide from May 13, 2026.
What it costs: A clinical business plan that cannot open on schedule, with leadership and rent already committed.
What does a delay cost your agency?
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Home care vs home health vs hospice in Nevada
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 | Help with bathing, dressing, toileting, grooming, meals, laundry, shopping, cleaning and transportation for elderly people and people with disabilities | Skilled nursing in the home, with therapy and home health aide services, under physician, PA or APRN orders | Palliative and supportive care for people who are terminally ill, and bereavement support for families |
| State license | Agency to provide personal care services in the home (NRS 449B; NAC 449.396 to 449.3982) | Agency to provide nursing in the home (NRS 449.0015; NAC 449.749 to 449.800) | Program of hospice care (NRS 449.0115; NAC 449.017 to 449.0188) |
| Certificate of Need | No | No Certificate of Need step; new licenses paused from June 2026 | No Certificate of Need step; new licenses paused from June 2026 |
| Main payers | Private pay, Nevada Medicaid Personal Care Services, Frail Elderly and Physical Disabilities waiver services | Medicare, Nevada Medicaid and its managed care plans, commercial insurance | Medicare hospice benefit, Nevada Medicaid |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment (paused nationwide from May 13, 2026) | Accreditation or state survey, then Medicare enrollment (paused nationwide from May 13, 2026) |
| Key staff | Administrator (18 or older, high school diploma or equivalent) and a designee; trained attendants | Administrator with an MD or RN license, a health care degree or a year of health care management experience; RNs; certified nursing assistants as aides | Governing body, administrator, physician directed interdisciplinary team, RN, social worker |
| Startup capital | Lowest, but a surety bond and Nevada office are required from day one | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Months: license, then hiring and Medicaid | Longest: licensure, survey, enrollment, and the 2026 pauses | Longest: licensure, survey, enrollment, and the 2026 pauses |
Most Nevada owners start with a personal care agency, build cash flow and a caregiver team, then add home health once licenses reopen. Nevada already holds licensed home health agencies to most of the federal home health rules in 42 CFR Part 484 (NAC 449.7935), so we write your clinical policies to that standard from day one instead of rewriting them later.
Nevada requirements at a glance
| Nonmedical home care license | Agency to provide personal care services in the home, under NRS Chapter 449B (moved from NRS 449 by AB 519 in 2025) and NAC 449.396 to 449.3982 |
|---|---|
| Licensing agency | Health Care Quality and Compliance (HCQC), Health Care Purchasing and Compliance Division of the Nevada Health Authority |
| Fees | $1,374 initial and $687 yearly renewal for a personal care agency, plus 6% of the renewal fee at issuance and renewal (NAC 449.013); not refundable |
| Surety bond | $5,000 for fewer than 7 employees, $25,000 for 7 to 25, $50,000 for more than 25, payable to the Aging and Disability Services Division (NRS 449B.185) |
| Home health and hospice | Licensed by HCQC under NRS 449 and NAC 449; new state licenses and Nevada Medicaid enrollments paused from June 2026 for at least six months, with an exemption process |
| Medicaid | Nevada Medicaid Personal Care Services (MSM Chapter 3500), enrolling as Provider Type 30; Frail Elderly (MSM 2200) and Physical Disabilities (MSM 2300) waivers with ADSD |
| Attendant training | NAC 449.3977 topics and a competency evaluation before working alone, first aid and CPR within 6 months, 8 hours of training a year, elder abuse training before care and yearly |
| Background checks | Fingerprints through the Nevada Automated Background Check System (NABS) within 10 days of hire, repeated at least every 5 years (NRS 449B.310) |
| Electronic visit verification | Required for Medicaid personal care, home health and certain waiver services; the state system is Sandata, or you can use your own compliant system |
| Entity filing | Nevada Secretary of State, a state business license, DETR registration, and your city or county business license |
Summary of Nevada requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Nevada
The order matters. Steps 3 and 5 must be finished before you file in step 6, and caregiver fingerprinting in step 7 cannot start until HCQC issues the license.
Choose the right license and payer mix
Decide between a personal care agency, an employment agency that places nonmedical workers, or an intermediary service organization, and whether you will serve private pay families, Nevada Medicaid or both. Use the path finder above.
Decided on your free consultationForm the business
File your LLC or corporation with the Nevada Secretary of State, get your state business license and EIN, and register with DETR for unemployment insurance, which also registers you for the Modified Business Tax. HCQC wants a copy of the state business license itself, not a receipt or screenshot.
You do this; we give you the checklistLock in the office, insurance and bond
Sign a lease for a physical Nevada location, get a city or county business license or zoning approval, a liability certificate naming the Health Care Purchasing and Compliance Division as holder, and a surety bond sized to your headcount under NRS 449B.185.
You do this; we specify what is requiredWrite policies to NAC 449
Adopt policies covering attendant duties and prohibited tasks, client rights, confidentiality, infection control, service plans, emergencies, the client disclosure statement and abuse reporting, written to NAC 449.396 to 449.3982 and NRS Chapter 449B, plus a yearly infection control plan.
We write this for youPrepare owners and the administrator
Each owner with 10% or more signs the fingerprint waiver, the administrator completes elder abuse training (NRS 449B.225), and the applicant completes HCQC's NABS training and emails the certificate before licensing.
You do this; we give you the checklistApply to HCQC
File the application and fee in the state health facility licensing portal with every checklist document, then prepare for the inspection, which follows HCQC's personal care agency survey workbook.
We prepare the applicationBuild the caregiver pipeline
Once licensed, open your fingerprinting account, enter each new hire in NABS and send them for fingerprints within 10 days, check references and TB screening, and complete training and a documented competency evaluation before anyone works alone.
We set up the system and trackerEnroll in Nevada Medicaid and set up EVV
Enroll with Nevada Medicaid's fiscal agent as Provider Type 30 (Personal Care Services, Provider Agency) with your license, then set up the state Sandata EVV system or your own compliant system before your first Medicaid visit.
We prepare and manage it
Attendant training and background checks
Nevada sets topics and a competency standard for personal care attendants rather than a fixed initial hour count. NAC 449.3973 to 449.3977 and NRS Chapter 449B set the rules, and HCQC surveyors check each personnel file against its survey workbook. Since AB 519 (2025), Medicaid personal care assistants must complete the same training.
- Training before working alone: A training program with supervised on the job instruction, covering documentation and time records, client rights and confidentiality, aging and disability, communication, first aid and CPR, and task skills such as transfers, toileting, skin care, fall prevention, nutrition and infection control (NAC 449.3977). It must be completed within the 12 months before the attendant's first client.
- Competency evaluation: The agency must evaluate and document each attendant as competent in every required area. Proof of earlier training can shorten what you repeat, but the evaluation is still yours to do.
- First aid and CPR: Certification within 6 months of starting work (NAC 449.3976). Online courses count only if the hands on skills check is live, not prerecorded.
- Yearly training: At least 8 hours a year related to client needs (NAC 449.3975), elder abuse training before providing care and every year (NRS 449B.225), and yearly infection control training from a nationally recognized source.
- Medication assistance: HCQC's 2026 survey workbook requires attendants who help with medication to complete 16 hours of approved medication management training first and 8 hours every year, with a medication record kept for each client.
- Cultural competency: NRS 449B.280 requires approved cultural competency training for staff with regular client contact; HCQC's workbook checks for it within 90 days of hire and every two years.
- Fingerprints and NABS: Within 10 days of hire, the employee signs the waiver and self disclosure form in NABS, is entered in NABS and is fingerprinted. Rechecks are due at least every 5 years. Disqualifying crimes are listed in NRS 449B.440.
- TB screening and references: Personnel files must show the TB tests or certificates required by NAC 441A.375, checked references, proof of age 18 and auto insurance for any attendant who drives clients.
Six mistakes that slow Nevada agencies down
We look for every one of these in the first week of an engagement.
Applying under the wrong license type
- What it costs
- A nonrefundable fee lost and a new application under the right type.
- How we prevent it
- Your first call ends with the right Nevada license and the order to do it in.
Filing with gaps in the checklist
- What it costs
- Receipts instead of licenses, an unsigned lease or the wrong certificate holder send the packet back.
- How we prevent it
- We assemble every checklist item to HCQC's stated format before you file.
Missing the 10 day NABS deadline
- What it costs
- A survey finding under NRS 449B.310, and a caregiver you may have to pull from a client.
- How we prevent it
- A tracker that flags fingerprint, TB, CPR, elder abuse and yearly training dates for every caregiver.
Letting attendants work alone too early
- What it costs
- Care by an untrained attendant is a deficiency, and a risk to the client and your license.
- How we prevent it
- Training and competency forms written to NAC 449.3977, signed before the first solo visit.
Outgrowing the surety bond
- What it costs
- Your license is suspended by law if the bond lapses, and the bond must rise as you pass 7 and 25 employees.
- How we prevent it
- We flag bond tiers at renewal and as your headcount grows.
Building a clinical plan on a paused license
- What it costs
- Leadership hired and rent signed for a home health or hospice that cannot be licensed or enrolled yet.
- How we prevent it
- We check the current state and CMS status on your first call and plan around it.
In a free 30 minute call we confirm your Nevada path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Nevada 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.
- Nevada path and a dated launch plan
- Policy and procedure manual written to NAC 449.396 to 449.3982, NRS Chapter 449B and Medicaid Services Manual Chapter 3500
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Nevada Medicaid PCS ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Nevada Medicaid PCS requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for Nevada Medicaid as Provider Type 30, and ADSD waiver programs for Frail Elderly and Physical Disabilities services
- Survey and audit readiness
- Nevada city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to HCQC 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 Nevada 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 NAC 449.396 to 449.3982, NRS Chapter 449B and Medicaid Services Manual Chapter 3500 |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for Nevada Medicaid as Provider Type 30, and ADSD waiver programs for Frail Elderly and Physical Disabilities services 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 Nevada home care startup checklist
Every Nevada 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.
- Confirm your license type: personal care agency, employment agency or ISO
- Form your LLC or corporation with the Nevada Secretary of State and get your state business license
- Get an EIN and register with DETR for unemployment insurance and the Modified Business Tax
- Sign a lease for a physical Nevada office and get a city or county business license or zoning approval
- Buy liability insurance with the Health Care Purchasing and Compliance Division as certificate holder
- 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 Nevada
- 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 Nevada cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Nevada Medicaid PCS, 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 Nevada
| Item | Notes |
|---|---|
| Personal care agency license | $1,374 initial and $687 yearly renewal under NAC 449.013, plus a fee of 6% of the renewal fee at issuance and each renewal. Not refundable, and an application expires after one year. |
| Home health and hospice licenses | $5,168 for a home health home office, $5,358 for a branch, $7,054 for a program of hospice care (NAC 449.013). Check current fees and the licensing pause with HCQC. |
| Surety bond | Premium set by the surety for a $5,000, $25,000 or $50,000 bond, depending on headcount (NRS 449B.185) |
| Entity filing and business licenses | Nevada Secretary of State filing and state business license fees, plus your city or county license |
| Fingerprinting | Fingerprinting and state and federal check fees for owners and every employee, paid by the agency |
| Training and screening | Trainer time, CPR and first aid courses, TB screening, and paid time for required training (NAC 449.39735) |
| Insurance | General and professional liability, workers' compensation, and auto coverage |
| Office lease | A physical Nevada location is required before you file |
| Operating reserve | Covers rent, bond and insurance while the license and Medicaid enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Nevada
Months: a complete HCQC application, the inspection and the license, then hiring and fingerprinting before your first client.
Several months after the license: Provider Type 30 enrollment, EVV setup, then referrals for authorized members.
Longest: state licensing and Medicaid enrollment were paused from June 2026, and Medicare enrollment from May 13, 2026, before the usual survey and enrollment steps.
Most Nevadans live in Clark County (Las Vegas, Henderson, North Las Vegas) and Washoe County (Reno, Sparks), so that is where most agencies compete for private pay families and referrals. Rural counties are spread out, and reliable staffing over long distances is the selling point there. Seniors, people with disabilities and waiver participants stayed in fee for service Nevada Medicaid when managed care expanded statewide on January 1, 2026, so the Provider Type 30 enrollment is the route to Medicaid personal care clients. Many families search for care for a parent from another state, so a strong Google Business Profile and clear city pages matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Nevada?
Yes. A business other than a single person working alone that provides personal care in the home to elderly people or people with disabilities needs a license from HCQC as an agency to provide personal care services in the home (NRS 449B.100). Placement agencies and intermediary service organizations have their own licenses.
How much does a Nevada personal care agency license cost?
NAC 449.013 sets a $1,374 initial fee and a $687 yearly renewal, plus a fee of 6% of the renewal fee when the license is issued and renewed. Fees are not refundable. You also need a surety bond, insurance, a Nevada office, business licenses and fingerprinting.
What surety bond does a Nevada personal care agency need?
NRS 449B.185 requires a $5,000 bond for fewer than 7 employees, $25,000 for 7 to 25 employees and $50,000 for more than 25, payable to the Aging and Disability Services Division. The license is suspended by law if the bond lapses.
Did Nevada's personal care agency law change in 2025?
Yes. Assembly Bill 519 (2025) moved personal care agencies, nonmedical employment agencies and intermediary service organizations into a new NRS Chapter 449B. Existing licenses stayed valid, and Medicaid personal care assistants must now complete the same training as agency attendants. The rules are still in NAC 449.396 to 449.3982.
Do Nevada caregivers need certification?
Personal care attendants do not need a state certificate. They need the NAC 449.3977 training and a documented competency evaluation before working alone, first aid and CPR within 6 months, 8 hours of training a year, elder abuse training and fingerprinting through NABS within 10 days of hire.
Can a Nevada personal care agency bill Medicaid?
Yes. A licensed agency can enroll with Nevada Medicaid as Provider Type 30 (Personal Care Services, Provider Agency) under Medicaid Services Manual Chapter 3500, and use an EVV system. Frail Elderly and Physical Disabilities waiver services use separate provider types and are operated with ADSD.
Can I open a home health agency or hospice in Nevada right now?
Not easily. The Nevada Health Authority paused new state home health and hospice licenses and new Nevada Medicaid enrollments from June 2026 for at least six months, with exemptions for areas with access concerns. CMS also paused new Medicare enrollment of both nationwide from May 13, 2026 for six months. Either may have ended or been extended, so check current status first.
Does Nevada require a Certificate of Need for home health or hospice?
No. Nevada's approval rule in NRS 439A.100 applies to new construction over $2,000,000 by health facilities in smaller counties and towns, not to opening a home health agency or hospice program. Licensing, survey and Medicare enrollment still apply.
How much does Nevada home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Nevada Medicaid or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges.
Do you only work in Nevada?
No. Lunaria works with owners in all 50 states and DC, so you can expand into a second state with the same team.
Sources checked for this guide (31)
- NRS Chapter 449B, agencies to provide personal care services (Nevada Legislature, rev. 4/15/2026, read via Internet Archive copy of July 2026)
- NAC Chapter 449 (Nevada Legislature, rev. 4/13/2026, read via Internet Archive copy of October 2026): NAC 449.013 fees, 449.396 to 449.3982 personal care agencies, 449.749 to 449.800 home health, 449.017 to 449.0188 hospice
- NRS Chapter 439A, NRS 439A.100 approval for certain projects (Nevada Legislature, read via Internet Archive copy of July 2026)
- AB 519 (2025), enrolled bill
- HCQC: Agency to provide personal care services in the home
- HCQC: Personal care agency licensing checklist
- HCQC: PCS initial and full survey workbook (June 2026, for applicants)
- HCQC: Background check requirements (NABS)
- HCQC: Training and education
- HCQC: Unlicensed caregiver infection control training
- HCQC: Home health agency (with moratorium notice and exemption forms)
- HCQC: Home health agency licensing checklist
- HCQC: Hospice agency
- HCQC: Health facility licensing and information
- Nevada Health Authority press release, June 5, 2026: pause on state licensure of hospice and home health
- Office of the Governor: Nevada Health Authority announces pause on state licensure of hospice and home health
- Nevada Medicaid web announcement 3940, June 11, 2026 (seen in search results only; site did not load)
- Medicaid Services Manual Chapter 3500, Personal Care Services Program (effective November 1, 2024, read via Internet Archive)
- Nevada Medicaid Provider Enrollment Checklist, Provider Type 30 (updated 01/17/2024, read via Internet Archive)
- Nevada Medicaid: Electronic Visit Verification (read via Internet Archive copy of February 2026)
- Nevada Medicaid: Statewide managed care program
- Nevada Medicaid: Waiver for the Frail Elderly
- ADSD: HCBS Waiver for the Frail Elderly
- NAC 441A.375, TB screening for employees (Cornell LII)
- Nevada Department of Taxation: Start or run a business (MBT registration through DETR)
- Federal Register 2026-09717: nationwide moratorium on Medicare enrollment of home health agencies (govinfo)
- Federal Register 2026-09718: nationwide moratorium on Medicare enrollment of hospices
- CMS accreditation and approved accrediting organizations
- 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)
This guide is general information and reflects Nevada requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with Health Care Quality and Compliance (Nevada Health Authority), Nevada Medicaid, ADSD 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.