HomeCareAtlas Team · Updated September 2026
Researched from primary state regulatory sources.
How to Start a Home Care Agency in Nebraska
Starting a home care agency in Nebraska costs roughly $25,000 - $50,000 and takes 4-8 Weeks. Here's every step, fee, and deadline — sourced directly from Nebraska DHHS Division of Public Health, Licensure Unit (licenses home health agencies only); Nebraska Secretary of State (business registration).
Nebraska does not license private-pay non-medical home care agencies. You can offer personal care, companionship, and homemaker help once you form your business and get insurance. Do not confuse this with a Home Health Agency. Home health agencies give skilled nursing. DHHS licenses those under the Health Care Facility Licensure Act and 175 NAC 14. This guide covers the non-medical, private-pay path. State law still sets rules for your workers. Neb. Rev. Stat. 71-6501 to 71-6504 cover "in-home personal services agencies." You must check each worker's criminal history and driving record. You must keep those records at your office.
Nebraska 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 private-pay non-medical care. But state law (Neb. Rev. Stat. 71-6501 to 71-6504) still requires criminal history, driving record, and registry checks on every worker.
- License Required
- No — Business license only
- Regulatory Body
- Nebraska DHHS Division of Public Health, Licensure Unit (licenses home health agencies only); Nebraska Secretary of State (business registration)
- Application Fee
- $0 (no state license fee)
- Timeline
- 4-8 Weeks (business setup timeline (estimate))
- Total Startup Cost
- $25,000 - $50,000
- Key Requirement
- No state license for private-pay non-medical care. But state law (Neb. Rev. Stat. 71-6501 to 71-6504) still requires criminal history, driving record, and registry checks on every worker.
- Last Verified
- September 2026 against Nebraska DHHS Division of Public Health, Licensure Unit (licenses home health agencies only); Nebraska Secretary of State (business registration) regulations
Business Setup Timeline (estimate)
This is our best guess. Check with the Nebraska DHHS Division of Public Health, Licensure Unit (licenses home health agencies only); Nebraska Secretary of State (business registration).
Residents Age 70+
Competitive Market
How Nebraska compares to neighboring states
| State | License Fee | Timeline | Startup Cost |
|---|---|---|---|
| Nebraska ← | $0 (no license) | 4-8 Weeks | $25,000 - $50,000 |
| Iowa | $0 (no license) | No timeline | $18,000 - $40,000 |
| Kansas | $250 | 60-90 Days | $30,000 - $55,000 |
| Colorado | $2,720.30 | 3-5 Months | $40,000 - $80,000 |
| South Dakota | $0 (no license) | 4-8 Weeks | $25,000 - $50,000 |
Nebraska Licensing Overview
The Nebraska DHHS Division of Public Health, Licensure Unit (licenses home health agencies only); Nebraska Secretary of State (business registration) oversees all non-medical agencies.Nebraska does not license private-pay non-medical home care agencies. You can offer personal care, companionship, and homemaker help once you form your business and get insurance. Do not confuse this with a Home Health Agency. Home health agencies give skilled nursing. DHHS licenses those under the Health Care Facility Licensure Act and 175 NAC 14. This guide covers the non-medical, private-pay path. State law still sets rules for your workers. Neb. Rev. Stat. 71-6501 to 71-6504 cover "in-home personal services agencies." You must check each worker's criminal history and driving record. You must keep those records at your office.
No State License for Private-Pay Non-Medical
Nebraska does not license non-medical in-home personal services agencies. You need a business registered with the Secretary of State, an EIN, and insurance. That means a faster start than in states that require a license.
Worker Rules Set by State Law
Even without a license, Neb. Rev. Stat. 71-6502 and 71-6503 apply to you. Workers must be 18 or older. You must run a criminal history check and a driving record check (if they drive). You must check the APS, child abuse, nurse aide, medication aide, and sex offender registries. Keep the records at your office.
Insurance & Workers' Comp
Nebraska law requires workers' comp once you have one employee (Neb. Rev. Stat. 48-106). Most agencies also carry general liability. Ask an agent what limit fits your size. The state has no bond rule. Some agencies buy a theft bond if staff handle client money.
Fewer State Rules
For non-medical agencies, Nebraska has no license fee. It has no bond rule. It has no required administrator course.
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 Secretary of State) | $100 | $500 |
| General liability insurance | $1,000 | $3,000 |
| Professional liability insurance | $500 | $2,000 |
| Workers' comp insurance | $500 | $2,000 |
| Background & registry checks (initial staff, per Neb. Rev. Stat. 71-6503) | $200 | $800 |
| Office setup (or home office) | $500 | $3,000 |
| Policies & procedures development | $1,000 | $3,000 |
| Scheduling & billing software | $500 | $2,000 |
| Marketing & branding | $1,500 | $5,000 |
| Working capital (3-6 months) | $12,000 | $25,000 |
We map every cost and file your Nebraska license for you.
How to Start a Home Care Agency in Nebraska
1-2 Weeks
Plan your services & market
Define your services (companionship, meal prep, personal care, light housekeeping). Decide on your service area — Omaha and Lincoln metros have the most demand. Develop a business plan with pricing and financial projections.
1-2 Weeks
Register your business
Register your LLC or corporation with the Nebraska Secretary of State. Get your EIN from the IRS, open a business bank account, and register with the Nebraska Department of Revenue for state taxes.
1-2 Weeks
Secure insurance coverage
Get workers' comp (required once you have an employee). Also get general liability and professional liability. Ask an agent what limits fit your size.
2-3 Weeks
Create policies and procedures
Write policies covering client care, emergency plans, employee training, hiring practices, background check procedures, safety protocols, complaint resolution, and quality assurance.
2-4 Weeks
Set up background checks & recruit staff
Set up your hiring checks per Neb. Rev. Stat. 71-6502 and 71-6503. Run a criminal history check on each worker. Check the driving record if they will drive. Check the state registries (APS, child abuse, nurse aide, medication aide, sex offender). Keep the records at your office. Then recruit caregivers and train them on your policies, client care, and safety.
2-4 Weeks
Build marketing & referral network
Build a professional website. Set up Google Business Profile. Network with Omaha and Lincoln hospitals, rehab centers, physicians, and senior centers for referrals.
4-8 Weeks
Enroll as a Medicaid provider (optional)
Want to serve Medicaid clients? Enroll as a provider with Nebraska DHHS. This opens the Aged and Disabled (AD) Waiver. Medicaid has its own rules. It adds time.
We can do all of them for you in Nebraska.
New 2026 Legal Mandates
No State License for Non-Medical Private-Pay
Ongoing - Nebraska does not require a state license for private-pay non-medical home care agencies. DHHS licenses Home Health Agencies (skilled) separately — do not confuse the two. You must still comply with all federal and state employment laws and local business requirements.
In-Home Personal Services Worker Rules (Neb. Rev. Stat. 71-6501 to 71-6504)
Ongoing - State law sets rules for unlicensed in-home personal services agencies. Workers must be 18 or older. They must have good moral character. They cannot have a disqualifying felony conviction. They must have no adverse findings on the APS Central Registry, the child abuse central registry, the Medication Aide Registry, the Nurse Aide Registry, or the sex offender registry. They must speak English or the client's language. They must have enough training for the services they give. You must run criminal history and driving record checks and keep the records at your office. These rules do not apply to people who give personal assistant, respite, habilitation, or "aged and disabled" services (71-6504). Those programs have their own rules.
Workers' Compensation Required
Ongoing - Nebraska's workers' comp law covers every employer with one or more employees (Neb. Rev. Stat. 48-106).
Federal Employment Compliance
Ongoing - Comply with IRS employment rules, FLSA wage and hour laws, I-9 verification, and OSHA workplace safety standards. Classify caregivers as W-2 employees, not 1099 contractors.
HIPAA Compliance
Ongoing - All home care agencies that handle protected health information must comply with HIPAA privacy and security rules.
Our Nebraska licensing team tracks the law so you do not have to.
Caregiver Mandates
Important Warning
Even without a state license, Nebraska law (Neb. Rev. Stat. 71-6502 and 71-6503) sets worker rules. You must check criminal history, driving records, and state registries. Do not skip this step. Misclassifying caregivers as 1099 contractors is a major compliance risk.
- Criminal History & Driving Record Check (Neb. Rev. Stat. 71-6503): You must run a criminal history record check on every worker. Check the driving record if they will drive. Keep the records at your office for inspection. Do this before they give care.
- Registry Checks & Age 18+ (Neb. Rev. Stat. 71-6502): Workers must be 18 or older. They must have no adverse findings on the APS Central Registry, child abuse central registry, Nurse Aide Registry, Medication Aide Registry, or sex offender registry.
- Training Sufficient for the Job (Neb. Rev. Stat. 71-6502): The state does not set a number of hours. Workers must have enough training for the services they give. Provide training on your policies, client care, emergencies, and safety. Document all training.
- Drug Testing (Recommended): While not state-mandated for non-medical care, drug testing is strongly recommended as a standard best practice.
Regional Billing Snapshots
*Regional rates vary by specialized care needs (Dementia, Parkinson's) and local competition.*
We launch Nebraska home care agencies start to finish.
Regional Market Opportunities
Nebraska demand is concentrated in the Omaha and Lincoln metros. Rural areas have less competition but require more travel and face staffing challenges. The billing rates below are our estimates, not official numbers.
Omaha Metro
Largest metro area and highest concentration of seniors in Nebraska. Strong hospital systems and referral networks.
Key: Start here for the best volume. Build relationships with the major Omaha hospital systems and discharge planners.
Lincoln Metro
State capital with a steady senior population. University of Nebraska presence creates a stable economy.
Key: Good secondary market with less competition than Omaha. State government retirees add to demand.
Grand Island / Central Nebraska
Mid-size market with moderate demand. Less competition and lower operating costs.
Key: Good entry point for new agencies willing to serve a smaller market with less competition.
Rural Nebraska
Vast rural areas with underserved senior populations. Distance and staffing are the biggest challenges.
Key: Only expand into rural areas after your metro operations are stable. Travel costs eat into margins fast.
Cost of care in Nebraska
What agencies charge clients vs. what caregivers earn in Nebraska. The difference is the agency's gross margin per billable hour — before overhead like insurance, admin, marketing, and compliance costs.
$33
Avg. hourly rate charged to clients
$20.33
Avg. caregiver hourly wage
$12.67
Gross margin per hour
38%
Gross margin %
What this means for agency owners
In Nebraska, agencies keep roughly $12.67 per billable hour after paying the caregiver. That's a 38% 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.
Nebraska Medicaid Programs
Nebraska Medicaid Aged and Disabled (AD) Waiver
Nebraska's Medicaid waiver for people 65+ and people with disabilities. It helps them stay home instead of a nursing home. DHHS runs it through its Division of Disability and Aging. Services include personal care, chore, companion, and respite. You must enroll with Nebraska Medicaid to serve these clients.
Agency Angle: Medicaid enrollment is a separate process with its own requirements. It opens a revenue stream but adds compliance, documentation, and billing complexity. Consider starting with private-pay and adding Medicaid later.
Becoming a Provider
Essential 2026 Tech Stack for Owners
Tiles outlined in teal are areas HomeCareAtlas covers in our platform.
Nebraska Licensing FAQ
Do I need a license to start a home care agency in Nebraska?
No. Nebraska does not require a state license for private-pay non-medical home care. You need business registration, insurance, and compliance with employment laws. Do not confuse this with Home Health Agencies (skilled nursing) which do require DHHS licensure.
Are background checks required?
Yes. Neb. Rev. Stat. 71-6503 requires a criminal history check on each worker. You must also check driving records if they drive. Workers must be clear on the state registries (APS, child abuse, nurse aide, medication aide, sex offender). This applies even to unlicensed agencies.
How much does it cost to start?
Total startup costs typically range from $25,000 - $50,000. There are no state licensing fees. The main costs are insurance, office setup, marketing, and working capital.
How long does it take to start?
There is no state license to wait for. Most owners can open in about 4-8 weeks. That is our estimate. The time goes to setting up your business, insurance, policies, and staff.
What insurance is required?
Workers' comp is required once you have one employee (Neb. Rev. Stat. 48-106). The state does not set other insurance rules for non-medical agencies. Most carry general liability. Ask an agent what limit fits. No bond is required.
Is Nebraska a good market for home care?
Nebraska has about 368,000 adults 65 and older. That is about 18% of the state (Census, 2025). Omaha and Lincoln have the most demand. No state license means lower startup costs.
Starting in a Nearby State?
Licensing requirements vary a lot between states. Compare your options:
Iowa
No state license required · N/A
Kansas
$250 fee · 60-90 Days
Colorado
$2,720.30 fee · 3-5 Months
South Dakota
No state license required · 4-8 Weeks
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Home care agencies in Nebraska
Want to see the competition up close? Look at who is already open, city by city.
- Home care agencies in Omaha
- Home care agencies in Lincoln
- Home care agencies in Abbott
- Home care agencies in Fremont
- Home care agencies in Norfolk
Looking for care for a family member? Find agencies near you
Considering other states?
- Alabama
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Where our numbers come from
We check each fact against Nebraska's own rules. Tap a source to read it yourself.
- License needed?NoNeb. Rev. Stat. §71-415· Oct 2026
- Who oversees itNebraska DHHS Division of Public Health, Licensure Unit (licenses home health agencies only); Nebraska Secretary of State (business registration)Neb. Rev. Stat. §71-410· Oct 2026
- License name—Neb. Rev. Stat. §71-415· Oct 2026
- The rulesNo state license; Neb. Rev. Stat. 71-6501 to 71-6504 (in-home personal services worker rules)Neb. Rev. Stat. §§71-6501 to 71-6504· Oct 2026
- First license feeno feeNeb. Rev. Stat. §71-415· Oct 2026
- License lasts—Neb. Rev. Stat. §71-415· Oct 2026
- BondNoneNeb. Rev. Stat. §§71-6501 to 71-6504· Oct 2026
- Owner/manager trainingNo state minimumNeb. Rev. Stat. §§71-6501 to 71-6504· Oct 2026
- Caregiver trainingNo state minimumNeb. Rev. Stat. §71-6502(6)· Oct 2026
- Background checksCriminal history check on each worker, driving record check if they drive, and clear APS, child abuse, nurse aide, medication aide, and sex offender registriesNeb. Rev. Stat. §§71-6502(4), 71-6503· 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.