How to start a home care agency in New Hampshire and reach your first client faster
New Hampshire licenses nonmedical home care, and the application works more like a facility license than most. Before you file, you publish a newspaper notice and collect sign offs from your town's health officer, building official, zoning officer and fire chief. DHHS inspects before it issues the license, every caregiver needs a criminal record check and a BAAS registry check, and Choices for Independence Medicaid enrollment comes after. 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 New Hampshire rulesRSA 151, He-P 822 and He-E 801 (Choices for Independence)
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what New Hampshire requires.
Nonmedical home care for Choices for Independence participants
- State license
- HCSPA license (RSA 151; He-P 822), then NH Medicaid enrollment as a CFI provider
- Who you deal with
- DHHS Health Facilities Administration, NH Medicaid, the Bureau of Adult and Aging Services and CFI case management agencies
- Must haves
- HCSPA license, NH Medicaid enrollment through the MMIS portal, BAAS registry checks, an individual provider care plan for each participant, EVV through NH AuthentiCare or an approved third party system
- Realistic time to first client
- Several months
Orientation for New Hampshire only. We confirm your exact path on the free call.
Three places new New Hampshire agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
The local approvals nobody expects
He-P 822 requires written approvals from your town's health officer, building official, zoning officer and fire chief, plus a water bill or well test, all dated no more than 90 days before you file. Owners who sign a lease first sometimes learn the space does not pass zoning or fire review. Others collect approvals too early and watch them expire.
What it costs: Weeks or months lost, and sometimes a lease on an office you cannot license.
Filing before the newspaper notice
A new license requires a public notice in at least two separate issues of a local newspaper, at least 10 business days before you file. If your office is within 15 miles of a critical access hospital, its chief executive also needs written notice by registered mail. Skip either and the application is not complete.
What it costs: A returned application and another round of notices before the clock starts again.
Caregivers you cannot put on a schedule
Every caregiver needs a criminal record check and a Bureau of Adult and Aging Services (BAAS) registry check before hire, a health screening and two step TB test, an orientation, and 8 hours of training before helping with bathing, dressing, transfers or feeding. Since August 31, 2026, registry checks must also be repeated every year.
What it costs: A client you cannot staff while paperwork catches up, and a caregiver who may take another job while they wait.
What does a delay cost your agency?
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Home care vs home health vs hospice in New Hampshire
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 | Personal care (bathing, dressing, toileting, transfers, feeding) or homemaker services (laundry, cleaning, cooking, shopping, transportation, companionship) | Skilled nursing, therapy and other medical care in the home | Hospice care for patients and their families in the patient's residence |
| State license | HCSPA license, personal care or homemaker (He-P 822) | Home health care provider license (RSA 151:2, I(b); He-P 809) | Home hospice care provider license (RSA 151:2, I(b); He-P 823) |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step |
| Main payers | Private pay, Choices for Independence (fee for service Medicaid), some Older Americans Act and Title XX programs | Medicare, NH Medicaid and its Care Management health plans, commercial insurance | Medicare hospice benefit, NH Medicaid |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment, once the CMS moratorium ends | Accreditation or state survey, then Medicare enrollment, once the CMS moratorium ends |
| Key staff | Administrator, director of client services, trained personal care service providers or homemakers | Administrator (bachelor's degree in business or a health field, or an RN), director of patient services, clinical staff | Administrator, full time director of patient services, medical director, volunteer, social services and spiritual or bereavement coordinators |
| Startup capital | Lowest, but you need a licensable office | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Months (licensure and inspection) before private pay; longer for CFI | Longest: licensure, survey, enrollment | Longest: licensure, survey, enrollment |
Unlike many states, New Hampshire licenses even companion and homemaker only agencies, so there is no unlicensed starting point for an agency with employees. Many owners start with the personal care classification because it covers homemaker tasks as well, build a caregiver team and cash flow, then add a home health license. Changing classification later means a new application and inspection, so we plan the right one from day one.
New Hampshire requirements at a glance
| Nonmedical home care license | Home care service provider agency (HCSPA) license under RSA 151 and He-P 822, classified as personal care services or homemaker services |
|---|---|
| Licensing agency | NH Department of Health and Human Services (DHHS), Health Facilities Administration, Health Facility Licensing Unit, 129 Pleasant Street, Concord |
| Before you file | Newspaper notice in two issues at least 10 business days ahead, local health, building, zoning and fire approvals within 90 days, water documentation, criminal record checks for owners and administrator |
| Home health and hospice | Home health care provider license (He-P 809) and home hospice care provider license (He-P 823), both under RSA 151:2, I(b) |
| Caregiver training | Orientation before client contact, at least 8 hours of training before bathing, dressing, transfers or feeding (LNAs exempt from the 8 hours), annual in service |
| Background screening | NH Department of Safety criminal record check and BAAS State Registry check before hire; registry checks also yearly from August 31, 2026; signed yearly disclosure statement |
| Medicaid route | Choices for Independence (CFI) waiver under He-E 801, paid fee for service; enroll as a NH Medicaid provider through the MMIS portal |
| Electronic visit verification | Required for Medicaid personal care and home health visits; the state offers NH AuthentiCare at no cost, or you can send data from your own system |
| Medicare (home health, hospice) | Accreditation or a DHHS Health Facility Certification Unit survey, then Medicare enrollment; new enrollment paused by a CMS moratorium from May 13, 2026 |
| Entity filing | NH Secretary of State, Corporation Division |
Summary of New Hampshire requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in New Hampshire
The order matters. Local approvals expire after 90 days and the newspaper notice must run at least 10 business days before filing, so time steps 3 and 5 together, and start caregiver checks early because criminal record results for all current staff must be on hand at the first inspection.
Form the business with the NH Secretary of State
File your LLC or corporation, get an EIN and register as an employer with New Hampshire Employment Security. Check the Business Enterprise Tax and Business Profits Tax filing thresholds with the Department of Revenue Administration.
You do this; we give you the checklistChoose your classification and payer mix
Personal care services or homemaker services, and private pay, Choices for Independence or both. Homemakers may not give hands on care beyond keeping a client safe, so most owners who plan any personal care choose that classification. Use the path finder above.
Decided on your free consultationSecure an office and the local approvals
Before signing a lease, confirm the space can pass review. Then collect written approvals from the health officer, building official, zoning officer and fire chief (or the select board or mayor where a position does not exist), dated no more than 90 days before you file, plus a water bill or private well test results.
You do this; we give you the checklistAppoint leadership and write He-P 822 policies
Name an administrator who meets He-P 822 education and experience rules and a director of client services with at least a high school diploma and 2 years of supervisory or personal care experience. Adopt policies for client rights and the Home Care Clients' Bill of Rights, admissions, assessments every 6 months, medication reminders, infection control, emergency plans and a quality improvement committee.
We write this for youPublish the notice and file the application
Run the newspaper notice in two separate issues at least 10 business days before filing, and notify any critical access hospital within 15 miles. Then send the Application for Residential or Health Care License with your Secretary of State certificate, the fee, the administrator's resume, local approvals, water documentation and criminal record checks for the applicant, licensee and administrator to DHHS in Concord.
We prepare the applicationBuild the caregiver pipeline
For every caregiver: a NH Department of Safety criminal record check, a BAAS State Registry check through NH EASY, a health screening and two step TB test from the past 12 months, orientation before client contact and 8 hours of training before hands on personal care. Track supervision every 6 months, quarterly observation and annual evaluations.
We set up the system and trackerPass the DHHS inspection
DHHS inspects before it issues a license. It can deny after the first inspection and up to 2 follow ups if you are not in full compliance, or if you go 3 months without contact after it tells you the application is complete.
We get you ready for the surveyEnroll in NH Medicaid for CFI and set up EVV
Enroll as a NH Medicaid provider through the MMIS Health Enterprise Portal, then introduce your agency to CFI case management agencies, which arrange services for participants. Submit the NH EVV System Declaration Form and complete AuthentiCare training before your first CFI visit.
We prepare and manage it
Caregiver training and background checks
He-P 822.17 sets the personnel rules surveyors test most. New Hampshire has no state certificate for personal care service providers, but the agency must train, screen, document and supervise every one of them, and keep the records at the licensed office where an inspector can see them.
- 8 hour personal care training: Required before helping clients with transfers, feeding, bathing or dressing. It covers the role of the caregiver, communication, home safety and emergency response, personal care skills, fall prevention, medication reminders and recordkeeping.
- LNAs: Licensed nursing assistants are treated as already having the 8 hour training but still need the agency orientation.
- Orientation and in service: Orientation before any client contact on client rights, the job, policies, infection control, emergency plans, mandatory reporting and body mechanics, then annual in service education.
- Health screening: A physical exam or health screening and two step TB testing, both within the 12 months before starting. A caregiver may work while the second TB step is pending if the first is negative.
- Criminal record check: From the NH Department of Safety before a final offer, for every employee, volunteer and contractor giving direct care. Nurses licensed by the Board of Nursing are exempt from this check under RSA 151:2-d.
- BAAS State Registry: Check every prospective hire before employment through the NH EASY system. Since August 31, 2026, SB 670 also requires yearly registry checks of current staff, contractors and volunteers. Anyone on the registry cannot be employed unless BAAS grants a waiver.
- Yearly disclosure: All personnel sign a statement when they accept an offer, and every year after, that they have no disqualifying convictions or findings.
- Supervision: Supervise each personal care service provider every 6 months; the director of client services or a designee observes performance quarterly and completes an annual evaluation.
Six mistakes that slow New Hampshire agencies down
We look for every one of these in the first week of an engagement.
Signing a lease before checking zoning and fire
- What it costs
- Rent on an office that cannot get local approvals, and a new search before you can file.
- How we prevent it
- We give you the local approval checklist before you commit to a space.
Letting local approvals expire
- What it costs
- Approvals older than 90 days at filing have to be collected again.
- How we prevent it
- We time the approvals, newspaper notice and filing as one sequence.
Licensing as homemaker, then giving hands on care
- What it costs
- Exposure to fines for providing services outside your license, and a new application and inspection to change classification.
- How we prevent it
- Clear service definitions and the right classification chosen on your first call.
Missing the yearly registry check
- What it costs
- Since August 31, 2026, current staff need BAAS registry checks every year, and missing records are cited at inspection.
- How we prevent it
- A tracker that flags registry checks, TB tests, training, supervision and disclosure statements for every caregiver.
Missing the 120 day renewal window
- What it costs
- A renewal not filed before expiration means a new initial application and a fine.
- How we prevent it
- We calendar the renewal at least 120 days before your license expires.
Letting unlicensed staff give medications
- What it costs
- He-P 822 lets caregivers remind clients and open containers, not administer medication without nurse delegation.
- How we prevent it
- Medication policies written to He-P 822.16 and the Board of Nursing delegation rules.
In a free 30 minute call we confirm your New Hampshire path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
New Hampshire 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.
- New Hampshire path and a dated launch plan
- Policy and procedure manual written to RSA 151, He-P 822 and He-E 801 (Choices for Independence)
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Choices for Independence ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Choices for Independence requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for NH Medicaid, with referrals from CFI case management agencies
- Survey and audit readiness
- New Hampshire city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to NH 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 New Hampshire 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 RSA 151, He-P 822 and He-E 801 (Choices for Independence) |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for NH Medicaid, with referrals from CFI case management agencies 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 New Hampshire home care startup checklist
Every New Hampshire 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 classification (personal care or homemaker) and payer mix
- Form your LLC or corporation with the NH Secretary of State
- Get an EIN and register as an employer with NH Employment Security
- Check Business Enterprise Tax and Business Profits Tax filing thresholds
- Buy workers' compensation, general and professional liability, and auto coverage
- and 17 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 New Hampshire
- 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 New Hampshire cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Choices for Independence, 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 New Hampshire
| Item | Notes |
|---|---|
| HCSPA license fee | DHHS's published fee list shows $25 for agencies with fewer than 10 clients and $100 for 10 or more, while He-P 822.04 still says $250 for more than 10 clients. Confirm the current amount with HFA before you send the check. |
| Home health or hospice license fee | $250 for a home health care provider (He-P 809) or a home hospice care provider (He-P 823), per the rules and the DHHS fee list |
| Newspaper notices | Two insertions in a newspaper of general circulation in your area |
| Entity formation | NH Secretary of State filing fee for your LLC or corporation, plus any trade name |
| Criminal record checks | NH State Police charges $25 for a NH criminal conviction check; the agency pays but may ask the applicant to cover the actual cost |
| Health screening and TB tests | Per caregiver, two step TB testing |
| Training | 8 hour personal care training, orientation and annual in service, delivered in house or by a vendor |
| Office | Rent for a licensable office that passes local zoning, building, health and fire review |
| Insurance | Workers' compensation, general and professional liability, auto coverage |
| Operating reserve | Covers payroll and rent through the inspection and while Medicaid enrollment or Medicare steps are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in New Hampshire
Months: newspaper notice and local approvals before filing, then the DHHS inspection before you can serve clients.
Several months: HCSPA licensure first, then NH Medicaid enrollment, EVV setup and relationships with case management agencies.
Longest: DHHS licensure and inspection, certification survey and Medicare enrollment, which is paused while the CMS moratorium lasts.
Demand is spread across very different regions. The southern tier around Manchester, Nashua and Salem and the Seacoast around Portsmouth have the most clients and the most competing agencies, and many families there also live in or near Massachusetts. In the North Country, the Lakes Region and the Upper Valley, distances are long and reliable staffing is your selling point with families and CFI case managers. Access to CFI services is a live public issue: a federal class action, Fitzmorris v. Weaver, alleges gaps in CFI home care, so agencies that can actually staff authorized hours stand out. Families search by town, which makes a strong Google Business Profile and clear town pages matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in New Hampshire?
Yes, if you provide personal care or homemaker services through employees. You need a home care service provider agency (HCSPA) license from the DHHS Health Facilities Administration under RSA 151 and He-P 822. A person who works directly for clients and employs no one registers as an individual home care service provider under He-P 820 instead.
What is the difference between the personal care and homemaker classifications?
Homemaker services are supportive tasks such as laundry, cleaning, cooking, shopping, transportation and companionship, with no hands on contact beyond keeping the client safe. Personal care adds hands on help such as bathing, dressing, toileting, transfers and feeding. Each license has one classification, and changing it requires a new application and inspection.
Who licenses home health and hospice agencies in New Hampshire?
The DHHS Health Facilities Administration. Home health care providers are licensed under RSA 151:2, I(b) and He-P 809, and home hospice care providers under He-P 823. Both require the newspaper notice, local approvals and an inspection, and each license fee is $250.
Does New Hampshire require a Certificate of Need for home health or hospice?
No. New Hampshire's licensing rules for home health and home hospice contain no Certificate of Need or need review. Licensure, local approvals, inspection and the Medicare steps still apply.
What training do New Hampshire caregivers need?
There is no state certificate for personal care service providers, but He-P 822 requires an orientation before any client contact, at least 8 hours of training before helping with bathing, dressing, transfers or feeding, and annual in service education. Licensed nursing assistants are treated as already trained but still need orientation.
What background checks do New Hampshire home care agencies run?
A NH Department of Safety criminal record check and a Bureau of Adult and Aging Services State Registry check before hire, through NH EASY for the registry. Since August 31, 2026, registry checks must also be repeated every year for current staff, contractors and volunteers. Staff also sign a yearly disclosure statement.
How do New Hampshire home care agencies get Medicaid clients?
Through the Choices for Independence (CFI) waiver for adults who meet nursing facility level of care. Personal care under CFI must come from a licensed HCSPA, a licensed home health care provider or an other qualified agency. You enroll with NH Medicaid through the MMIS portal, and CFI case management agencies arrange services with enrolled providers. CFI is paid fee for service, not through the Medicaid health plans.
Can a new home health agency or hospice enroll in Medicare right now?
CMS put a nationwide six month moratorium on new Medicare enrollment of home health agencies and hospices starting May 13, 2026. It can be extended in six month steps, so it may have ended or been extended by the time you read this. Check its current status with CMS before you plan Medicare revenue.
Is a franchise a better way to start a home care agency in New Hampshire?
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.
How much does New Hampshire home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Choices for Independence or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges, and we work in all 50 states and DC.
Sources checked for this guide (26)
- He-P 822, Home Care Service Provider Agencies (DHHS certified rule PDF, eff 1-3-19)
- He-P 809, Home Health Care Providers (DHHS rule PDF, readopted eff 8-26-25)
- He-P 823, Home Hospice Care Provider (DHHS rule PDF, eff 10-9-18)
- DHHS Health Facilities Administration (licensed provider types, fee list, contacts)
- DHHS Administrative Rules for Health Facilities
- DHHS Initial Applications Filed with HFA
- He-P 822.04, initial license application (Cornell LII)
- DHHS Home and Community Based Services (BAAS, Choices for Independence)
- Amended Choices for Independence Waiver 2022-2027 (NH.0060.R08.02, eff 07/01/26)
- He-E 801.24, CFI personal care services (Cornell LII)
- He-E 801.32, CFI provider participation (Cornell LII)
- DHHS Medicaid Provider Relations (MMIS enrollment, Care Management plans)
- DHHS Electronic Visit Verification (NH AuthentiCare)
- DHHS Bureau of Adult and Aging Services State Registry (NH EASY, SB 670 annual checks)
- RSA 151:2-d, criminal record check required (archived gencourt copy)
- NH State Police, Criminal History Record Requests
- NH Secretary of State, Corporation Division
- NH Department of Revenue Administration, Business Taxes
- NH Employment Security, Register as a NH Employer
- CMS Home Health and Hospice Nationwide Moratorium Q&As (revised 7/09/26)
- Federal Register 2026-09717, nationwide moratorium on Medicare enrollment of home health agencies
- Federal Register 2026-09718, nationwide moratorium on Medicare enrollment of hospices
- Fitzmorris v. Weaver, 2026 DNH 039 (U.S. District Court, D.N.H.)
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- CMS-855A Medicare enrollment application, institutional providers
This guide is general information and reflects New Hampshire requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the New Hampshire Department of Health and Human Services, NH 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.