HomeCareAtlas Team · Updated November 2026
Researched from primary state regulatory sources.
How to Start a Home Care Agency in North Dakota
Starting a home care agency in North Dakota costs roughly $25,000 - $50,000 and takes 4-8 Weeks. Here's every step, fee, and deadline — sourced directly from North Dakota Health and Human Services (HHS) — Medical Services Division for QSP enrollment; Health Facilities Unit for home health agency licensing.
North Dakota does not require a state license for agencies that give only non-medical personal care, companionship, and homemaker services. You can start after you form a business, get insurance, and follow employment laws. If you serve only private-pay clients, you do not need to enroll with the state. To serve Medicaid (public pay) clients, you must enroll as a Qualified Service Provider (QSP) agency in the HHS QSP Enrollment Portal (hhs.nd.gov/qsp). The QSP Hub (NDQSPhub.org, 701-777-3432) is a free help desk that walks you through it. Note: Skilled "home health agencies" (an RN plus at least one other therapy service) must be licensed by HHS (N.D.C.C. ch. 23-17.3). Without that license, you may not use the words "home health agency" or "home health services" (ND Admin. Code 33-03-10.1-03). Heads up: since June 11, 2026, ND Medicaid is not taking new QSP agencies in Burleigh (Bismarck) or Cass (Fargo) County. The pause is set for 6 months and may be extended.
North Dakota does not require a state license to operate a non-medical home care agency. You can begin operations after completing standard business formation (LLC, EIN, business license) and obtaining insurance. Total startup costs range from $25,000 - $50,000, and you can be operational within 4-8 weeks. No state license for non-medical care. QSP enrollment with ND Health and Human Services is needed only for Medicaid and other public-pay clients. New QSP agencies in Burleigh and Cass counties are paused since June 11, 2026.
- License Required
- No — Business license only
- Regulatory Body
- North Dakota Health and Human Services (HHS) — Medical Services Division for QSP enrollment; Health Facilities Unit for home health agency licensing
- Application Fee
- $0 (no state license fee)
- Timeline
- 4-8 Weeks (business setup timeline (our estimate))
- Total Startup Cost
- $25,000 - $50,000
- Key Requirement
- No state license for non-medical care. QSP enrollment with ND Health and Human Services is needed only for Medicaid and other public-pay clients. New QSP agencies in Burleigh and Cass counties are paused since June 11, 2026.
- Last Verified
- November 2026 against North Dakota Health and Human Services (HHS) — Medical Services Division for QSP enrollment; Health Facilities Unit for home health agency licensing regulations
Business Setup Timeline (Our Estimate)
This is our best guess. Check with the North Dakota Health and Human Services (HHS) — Medical Services Division for QSP enrollment; Health Facilities Unit for home health agency licensing.
Residents Age 70+
Competitive Market
How North Dakota compares to neighboring states
| State | License Fee | Timeline | Startup Cost |
|---|---|---|---|
| North Dakota ← | $0 (no license) | 4-8 Weeks | $25,000 - $50,000 |
| South Dakota | $0 (no license) | 4-8 Weeks | $25,000 - $50,000 |
| Minnesota | $2,100 | 3-5 Months | $45,000 - $85,000 (our estimate) |
| Montana | $0 (no license) | 1-3 months | $33,500 - $94,000 |
North Dakota Licensing Overview
The North Dakota Health and Human Services (HHS) — Medical Services Division for QSP enrollment; Health Facilities Unit for home health agency licensing oversees all non-medical agencies.North Dakota does not require a state license for agencies that give only non-medical personal care, companionship, and homemaker services. You can start after you form a business, get insurance, and follow employment laws. If you serve only private-pay clients, you do not need to enroll with the state. To serve Medicaid (public pay) clients, you must enroll as a Qualified Service Provider (QSP) agency in the HHS QSP Enrollment Portal (hhs.nd.gov/qsp). The QSP Hub (NDQSPhub.org, 701-777-3432) is a free help desk that walks you through it. Note: Skilled "home health agencies" (an RN plus at least one other therapy service) must be licensed by HHS (N.D.C.C. ch. 23-17.3). Without that license, you may not use the words "home health agency" or "home health services" (ND Admin. Code 33-03-10.1-03). Heads up: since June 11, 2026, ND Medicaid is not taking new QSP agencies in Burleigh (Bismarck) or Cass (Fargo) County. The pause is set for 6 months and may be extended.
No State License for Non-Medical Care
North Dakota does not require a state license for agencies that give only non-medical personal care, companionship, and homemaker services. Business registration is enough for private-pay work.
QSP Enrollment for Medicaid
To take public-pay clients, enroll as a Qualified Service Provider (QSP) agency in the HHS QSP Enrollment Portal. You need a Type 2 NPI, proof of workers' comp (WSI) and unemployment insurance, and a trainer who has finished the state Fraud, Waste and Abuse and Onboarding Orientation trainings. The QSP Hub gives free one-on-one help.
Plan for Aide Pay and Winter
Check the BLS wage data for home care aides in your area before you set prices. Long drives and hard winters raise your costs. Build them into your rates.
Estimated Startup Costs (2026)
Budget for $25,000 - $50,000 to ensure 3-6 months of runway.
| Category | Low Est. | High Est. |
|---|---|---|
| Business Formation (LLC with SOS) | $100 | $400 |
| General Liability Insurance ($1M/$3M) | $800 | $2,500 |
| Professional Liability Insurance | $400 | $1,800 |
| Workers' Compensation Insurance | $400 | $1,800 |
| Background Checks (initial staff) | $200 | $800 |
| Office / Administrative Setup | $400 | $2,500 |
| Scheduling & Care Software | $400 | $1,800 |
| Initial Marketing & Website | $1,200 | $4,500 |
| Working Capital (3-6 months) | $12,000 | $28,000 |
We map every cost and file your North Dakota license for you.
How to Start a Home Care Agency in North Dakota
1-2 Weeks
Register Your Business
File your LLC or corporation with the North Dakota Secretary of State. Obtain an EIN from the IRS. Register for state tax accounts.
1-2 Weeks
Secure Insurance Coverage
Get general liability, professional liability, and workers' compensation insurance. Workers' comp comes from the state fund, WSI. The state does not require a bond for personal care QSP agencies. (Some other QSP services, like environmental modification, need bonding.) You may want crime (employee theft) coverage too.
2-3 Weeks
Develop Policies and Procedures
Create a complete policy manual covering client care, employee background checks, confidentiality, emergency protocols, infection control, patient rights, HIPAA compliance, and quality assurance.
1 Week
Set Up Background Check Process
Set up a background check process for all staff. This protects clients. For QSP agencies, HHS screens each direct care employee you enter in the Enrollment Portal against ND court records, sex offender registries, the federal SAM and OIG exclusion lists, and the ND exclusion list. It is not a fingerprint check. You must report any new conviction within 5 business days.
2-4 Weeks
Recruit and Train Staff
Hire caregivers, complete background checks, and train them. For QSP work, each direct care employee needs an SFN 749 Documentation of Competency signed by a licensed professional (RN, LPN, PT, OT, PA, NP, physician, or chiropractor) before serving clients, or a current ND CNA, LPN, or RN credential. The form is good for 5 years.
2-4 Weeks
Enroll as a QSP Agency (For Medicaid)
Apply in the HHS QSP Enrollment Portal (hhs.nd.gov/qsp). Upload your Secretary of State registration, WSI and unemployment insurance proof, org chart, job descriptions, ID for owners, a voided check, and each employee's SFN 749. Your designated trainer must finish the Fraud, Waste and Abuse and Onboarding Orientation trainings. Contact the QSP Hub for help. Note: new QSP agencies in Burleigh and Cass counties are on hold since June 11, 2026. The pause lasts 6 months (to about December 11, 2026) and may be extended. Applications not in final approval are denied.
2-4 Weeks
Build Referral Network and Launch
Set up a Google Business Profile. Meet hospitals, doctors, and community groups. Start with private-pay clients while you grow.
We can do all of them for you in North Dakota.
New 2026 Legal Mandates
No State License for Non-Medical Care
North Dakota does not require a state license for agencies that give only non-medical personal care, companionship, and homemaker services. A "home health agency" gives RN services plus at least one other therapy service. It must get a license from HHS (N.D.C.C. ch. 23-17.3).
QSP Enrollment for Public-Pay Clients (ND Century Code 50-06.2)
To be paid by ND Medicaid or state HCBS programs, your agency must enroll as a QSP in the HHS Enrollment Portal. Clients must be free to choose among QSPs (N.D.C.C. ch. 50-06.2). Private-pay-only agencies do not need to enroll. QSPs must use Electronic Visit Verification (EVV). Therap is the state system. You may use another EVV vendor if it sends data to the state's Sandata aggregator (QSP Agency Handbook).
Employee Screening for QSP Agencies
You must enter every direct care employee in the HHS Enrollment Portal before they serve public-pay clients. HHS screens them against ND courts, sex offender registries, SAM, the OIG exclusion list, and the ND exclusion list (ND Admin. Code 75-03-23-07). Tell HHS within 5 business days if an owner or employee is convicted of a crime.
Competency and Training for QSP Staff
Each direct care employee needs an SFN 749 Documentation of Competency signed by a licensed professional, or a current ND CNA, LPN, or RN credential. Redo it every 5 years. At hire, staff must review the fire safety, carbon monoxide, and universal precautions fact sheets. Your designated trainer must finish the state Fraud, Waste and Abuse and Onboarding Orientation trainings.
Workers' Compensation Through WSI
In North Dakota, employers get workers' compensation from the state fund, Workforce Safety and Insurance (WSI). QSP enrollment needs proof of WSI coverage. It also needs proof of unemployment insurance coverage.
HIPAA Compliance
HIPAA covers health care providers that bill insurance or Medicaid electronically. If you bill Medicaid, plan to follow HIPAA privacy and security rules. Keep all client records private either way.
Our North Dakota licensing team tracks the law so you do not have to.
Caregiver Mandates
Important Warning
Check BLS wage data for home care aides in your area before you set prices. Pay that is too low makes hiring hard. Hard winters affect schedules, driving, and staff. Have a winter backup plan.
- Background Screening: Run your own background check on every hire. For public-pay work, HHS also screens each employee you enter in the QSP Enrollment Portal (court records, sex offender registries, SAM, OIG, ND exclusion list). This is a name-based screen, not fingerprints.
- Initial Training and Orientation: Staff must complete orientation on agency policies, client rights, safety, emergency procedures, infection control, and HIPAA. QSP hires must also review the state fire safety, carbon monoxide, and universal precautions fact sheets at hire.
- Proof of Competency (SFN 749): For QSP work, each direct care employee needs an SFN 749 Documentation of Competency signed by a licensed professional before serving clients, or a current ND CNA, LPN, or RN credential. It is good for 5 years.
- Ongoing Competency: The state sets no yearly training hours for private-pay care. For QSP work, redo the SFN 749 before it expires (every 5 years). Regular check-ins and refresher training are good practice.
Regional Billing Snapshots
*Regional rates vary by specialized care needs (Dementia, Parkinson's) and local competition.*
We launch North Dakota home care agencies start to finish.
Regional Market Opportunities
North Dakota has about 800,000 people. About 143,000 are 65 or older (17.9%, Census 2025 estimate). It is a small market. Fargo and Bismarck have the most people. Rural areas have fewer agencies, but long drives and winters are hard. The billing rates below are our estimates, not official numbers.
Fargo-Moorhead Metro
North Dakota's largest metro (with Moorhead, MN). Sanford Health and Essentia Health are big local health systems.
Key: Build ties with hospital discharge planners. Serving Moorhead means following Minnesota rules too. Note: new QSP agencies in Cass County are on hold for now.
Bismarck-Mandan
State capital with CHI St. Alexius and Sanford Bismarck as big local hospitals. Many state government retirees live here.
Key: Note: new QSP agencies in Burleigh County are on hold for now. Plan on private pay first.
Grand Forks
University of North Dakota town. Altru Health System is the main local health system. A smaller market.
Key: University and Air Force base (Grand Forks AFB) create a diverse population base with retiree demand.
Minot
Northwestern hub with Minot Air Force Base nearby. Trinity Health is the main local health system.
Key: Military retirees from Minot AFB may add to demand. Check how many agencies already serve the area.
Rural / Western ND (Williston, Dickinson)
Oil and farm country. Few home care options. Hard winters and long drives are the biggest challenges.
Key: Don't try to serve too large a geographic area. Focus on one town and its surrounding radius. Weather planning is non-negotiable — have winter contingency protocols.
Cost of care in North Dakota
What agencies charge clients vs. what caregivers earn in North Dakota. The difference is the agency's gross margin per billable hour — before overhead like insurance, admin, marketing, and compliance costs.
$34.5
Avg. hourly rate charged to clients
$23.48
Avg. caregiver hourly wage
$11.02
Gross margin per hour
32%
Gross margin %
What this means for agency owners
In North Dakota, agencies keep roughly $11.02 per billable hour after paying the caregiver. That's a 32% gross margin.
This is a typical margin for the industry. You will need to manage overhead carefully, but profitability is achievable with good operations.
Sources: Avg. hourly rate from CareYaya and CareScout 2025 surveys (averaged). Caregiver wage from Care.com. Gross margin is before overhead costs like insurance, admin, marketing, and compliance.
North Dakota Medicaid Programs
Home and Community-Based Services (HCBS) Waiver
A Medicaid waiver for seniors and adults with disabilities. It pays for help like personal care, homemaker, companionship, and respite so people can stay home. ND also pays QSPs through state programs like SPED and through Medicaid State Plan personal care.
Qualified Service Provider (QSP) Enrollment
To serve Medicaid and state HCBS clients, agencies must enroll as QSPs in the HHS QSP Enrollment Portal. HHS reviews your forms, insurance, and employee competency. The QSP Hub (NDQSPhub.org, 701-777-3432) gives free help. QSP agencies can offer personal care, homemaker, companionship, respite, chore, and more. Heads up: since June 11, 2026, ND Medicaid is not taking new QSP agencies in Burleigh or Cass County. This pause lasts 6 months (to about December 11, 2026) and may be extended. Check the HHS Provider Enrollment Moratoria notice before you plan on Medicaid clients in Bismarck or Fargo.
Private-Pay First Strategy
The market is small. So many agencies start with private-pay clients. They add QSP enrollment once things run well. In Fargo and Bismarck, private pay is the only choice for new agencies until the QSP pause ends.
Becoming a Provider
Essential 2026 Tech Stack for Owners
Tiles outlined in teal are areas HomeCareAtlas covers in our platform.
North Dakota Licensing FAQ
Do I need a license to start a home care agency in North Dakota?
No. North Dakota does not license non-medical home care (personal care, companionship, homemaker services). You need business registration, insurance, and to follow employment laws. Skilled "home health agencies" must be licensed by the HHS Health Facilities Unit. To serve Medicaid clients, enroll as a QSP in the HHS QSP Enrollment Portal. Private-pay-only agencies do not need to enroll.
How much does it cost to start a home care agency in North Dakota?
Our estimate is $25,000 to $50,000. That covers business setup, insurance, background checks, marketing, and working capital. There is no state license fee for non-medical care.
How long does it take to start in North Dakota?
Our estimate is 4-8 weeks for business setup, since no state license is required. QSP enrollment for Medicaid adds more time. HHS approves your enrollment only when every form is complete and correct.
What is QSP enrollment?
A Qualified Service Provider (QSP) is an agency or person approved by ND Health and Human Services to be paid for HCBS services. You enroll in the HHS QSP Enrollment Portal. You need a Type 2 (organization) NPI, insurance proof, screened employees, and an SFN 749 competency form for each caregiver. The QSP Hub is a free help desk, not the enrollment agency. Enrollment is separate from business registration and only needed for public-pay clients.
Is North Dakota a good market for home care?
North Dakota is a small, niche market. About 143,000 people are 65 or older (Census 2025 estimate). Fargo and Bismarck have the most people. But new QSP agencies there are paused for now. It fits owners who want a small market they can know well.
What are the biggest challenges in North Dakota?
Hard winters, long rural drives, finding aides, and a small market. In Fargo and Bismarck, the QSP pause also blocks new Medicaid work for now. Don't try to serve too big an area at first. Focus on one town and the area around it.
What training is required for caregivers?
The state sets no training hours for private-pay non-medical care. For QSP work, each caregiver needs an SFN 749 Documentation of Competency signed by a licensed professional (or a current ND CNA, LPN, or RN credential), redone every 5 years. Your designated trainer must finish the state Fraud, Waste and Abuse and Onboarding Orientation trainings. Set your own orientation and yearly refresher policy.
Starting in a Nearby State?
Licensing requirements vary a lot between states. Compare your options:
South Dakota
No state license required · 4-8 Weeks
Minnesota
$2,100 fee · 3-5 Months
Montana
No state license required · 1-3 months
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Home care agencies in North Dakota
Want to see the competition up close? Look at who is already open, city by city.
- Home care agencies in Fargo
- Home care agencies in Dwight
- Home care agencies in Grand Forks
- Home care agencies in Lincoln
- Home care agencies in Logan
Looking for care for a family member? Find agencies near you
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Where our numbers come from
We check each fact against North Dakota's own rules. Tap a source to read it yourself.
- License needed?NoN.D.C.C. §23-17.3-01(6)· Oct 2026
- Who oversees itNorth Dakota Health and Human Services (HHS) — Medical Services Division for QSP enrollment; Health Facilities Unit for home health agency licensingN.D.C.C. §23-17.3-01(3); QSP program· Oct 2026
- License name—N.D.C.C. ch. 23-17.3· Oct 2026
- The rules—N.D.C.C. ch. 23-17.3· Oct 2026
- First license feeno feeN.D.C.C. ch. 23-17.3· Oct 2026
- License lasts—N.D.C.C. ch. 23-17.3· Oct 2026
- BondNoneQSP Agency Handbook (Jan 2026)· Oct 2026
- Owner/manager trainingNo state minimumQSP Agency Handbook (Jan 2026)· Oct 2026
- Caregiver trainingNo state minimumQSP Agency Handbook (Jan 2026); N.D. Admin. Code ch. 75-03-23· Oct 2026
- Background checksNone required by the state for private-pay agencies; for QSP (Medicaid) agencies, HHS screens each direct care employee entered in the Enrollment Portal (ND courts, sex offender registries, SAM, OIG, ND exclusion list)QSP Agency Handbook (Jan 2026), Employee Requirements; N.D. Admin. Code 75-03-23-07· Oct 2026
- How long it takes4-8 WeeksBest guess — not confirmed yet
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This guide is for informational purposes only and does not constitute legal, regulatory, or business advice. Licensing requirements, fees, and regulations change frequently. Always verify current requirements with your state's licensing agency before making business decisions. HomeCareAtlas is not responsible for the accuracy or completeness of this information.
Researched and reviewed by
John Helmy, Founder of HomeCareAtlasBuilding tools and resources to help home care agency owners navigate licensing, compliance, and growth.