HomeCareAtlas Team · Updated September 2026
Researched from primary state regulatory sources.
How to Start a Home Care Agency in New Hampshire
Starting a home care agency in New Hampshire costs roughly $35,000 - $70,000 and takes 30-90 Days. Here's every step, fee, and deadline — sourced directly from New Hampshire Department of Health and Human Services (DHHS), Health Facilities Administration.
New Hampshire requires a Home Care Service Provider Agency (HCSPA) license. It covers agencies that employ people to give personal care or homemaker services in a client's home. The license is for one of two types: personal care or homemaker (He-P 822.05). The rules are in He-P 822, adopted under RSA 151. You mail or hand-deliver your application to the DHHS Health Facilities Administration. Before you apply, you must run a notice in a local newspaper twice (He-P 822.04). DHHS inspects you before it issues the license (He-P 822.05). The license fee is set by RSA 151:5. It is $250 a year, or $25 if you serve fewer than 10 clients. Licenses last one year. No Certificate of Need (CON) is required. Individuals who work directly for a client (not through an agency) register under He-P 820 instead. Skilled home health agencies are licensed under He-P 809, not He-P 822. All licensed agencies must post and follow the Home Care Clients' Bill of Rights (RSA 151:21-b).
To start a non-medical home care agency in New Hampshire, you need a Home Care Service Provider Agency (HCSPA) License from the New Hampshire Department of Health and Human Services (DHHS), Health Facilities Administration. The application fee is $250 (annual license fee ($25 if under 10 clients)), the process takes approximately 30-90 days, and total startup costs range from $35,000 - $70,000. You need an HCSPA license under He-P 822. The fee is only $250 a year. DHHS inspects before it issues the license. Staff who help with bathing, dressing, feeding, or transfers need 8 hours of training.
- License Required
- Yes — Home Care Service Provider Agency (HCSPA) License
- Regulatory Body
- New Hampshire Department of Health and Human Services (DHHS), Health Facilities Administration
- Application Fee
- $250 (annual license fee ($25 if under 10 clients))
- Timeline
- 30-90 Days (application to license (estimate))
- Total Startup Cost
- $35,000 - $70,000
- Key Requirement
- You need an HCSPA license under He-P 822. The fee is only $250 a year. DHHS inspects before it issues the license. Staff who help with bathing, dressing, feeding, or transfers need 8 hours of training.
- Last Verified
- September 2026 against New Hampshire Department of Health and Human Services (DHHS), Health Facilities Administration regulations
Annual License Fee ($25 if under 10 clients)
Source: He-P 822.04(a)(3); RSA 151:5, XII · Checked Oct 2026
Application to License (estimate)
This is our best guess. Check with the New Hampshire Department of Health and Human Services (DHHS), Health Facilities Administration.
Residents Age 70+
Moderate Opportunity
How New Hampshire compares to neighboring states
| State | License Fee | Timeline | Startup Cost |
|---|---|---|---|
| New Hampshire ← | $250 | 30-90 Days | $35,000 - $70,000 |
| Massachusetts | $0 (no license) | 4-8 Weeks | $55,000 - $100,000 (our estimate) |
| Maine | $500 | 9-12 Months | $35,000 - $70,000 |
| Vermont | $0 (no license) | 1-3 months | $40,000 - $70,000 |
New Hampshire Licensing Overview
The New Hampshire Department of Health and Human Services (DHHS), Health Facilities Administration oversees all non-medical agencies.New Hampshire requires a Home Care Service Provider Agency (HCSPA) license. It covers agencies that employ people to give personal care or homemaker services in a client's home. The license is for one of two types: personal care or homemaker (He-P 822.05). The rules are in He-P 822, adopted under RSA 151. You mail or hand-deliver your application to the DHHS Health Facilities Administration. Before you apply, you must run a notice in a local newspaper twice (He-P 822.04). DHHS inspects you before it issues the license (He-P 822.05). The license fee is set by RSA 151:5. It is $250 a year, or $25 if you serve fewer than 10 clients. Licenses last one year. No Certificate of Need (CON) is required. Individuals who work directly for a client (not through an agency) register under He-P 820 instead. Skilled home health agencies are licensed under He-P 809, not He-P 822. All licensed agencies must post and follow the Home Care Clients' Bill of Rights (RSA 151:21-b).
HCSPA License Required
Agencies providing non-medical home care must get an HCSPA license under He-P 822 from the DHHS Health Facilities Administration. DHHS inspects before it issues the license.
Low Fee, Yearly Renewal
The fee is $250 a year for an agency (RSA 151:5). If you serve fewer than 10 clients, it is $25. Licenses expire one year after they are issued. Send your renewal at least 120 days before it expires (He-P 822.06).
No Wage Tax, No Sales Tax
New Hampshire has no tax on wages and no sales tax. That draws retirees. But businesses still pay state business taxes. These are the Business Profits Tax (RSA 77-A) and Business Enterprise Tax (RSA 77-E).
Estimated Startup Costs (2026)
Budget for $35,000 - $70,000 to ensure 3-6 months of runway.
| Category | Low Est. | High Est. |
|---|---|---|
| HCSPA License Fee (annual, RSA 151:5) | $25 | $250 |
| Business Formation (LLC with SOS) | $75 | $400 |
| General Liability Insurance | $1,200 | $3,500 |
| Professional Liability Insurance | $600 | $2,200 |
| Workers' Compensation Insurance | $800 | $2,500 |
| Newspaper notice (2 issues, He-P 822.04) | $100 | $500 |
| Background Checks & TB Tests (initial staff) | $400 | $1,200 |
| Office / Administrative Setup | $800 | $3,500 |
| Initial Marketing & Website | $1,500 | $5,500 |
| Working Capital (3-6 months) | $15,000 | $40,000 |
We map every cost and file your New Hampshire license for you.
How to Get a New Hampshire HCSPA License
1-2 Weeks
Register Your Business
Register your LLC with the New Hampshire Secretary of State. Obtain an EIN from the IRS. An LLC is recommended for liability protection.
1-2 Weeks
Secure Insurance
Get workers' comp, general liability, and professional liability. New Hampshire's HCSPA rules set no insurance amounts. They have no bond rule. Ask an agent what limits fit your size.
2-4 Weeks
Develop Policies and Procedures
Write a policy manual. Cover client rights (Home Care Clients' Bill of Rights, RSA 151:21-b), HIPAA, emergency plans, personnel, training, infection control, and quality improvement as He-P 822 requires.
1-2 Weeks
Submit HCSPA License Application
First, run a notice about your plan in a local newspaper. It must run in 2 issues, at least 10 business days before you apply. Then mail or hand-deliver your packet to DHHS Health Facilities Administration, 129 Pleasant Street, Concord. Under He-P 822.04 you send: the application form, proof of Secretary of State registration, the fee ($250, or $25 if under 10 clients), the administrator's resume, criminal records checks for the owners and administrator, and written approvals from local health, building, zoning, and fire officials.
2-6 Weeks
Pass Licensing Inspection
DHHS inspects before it issues a license (He-P 822.05 and 822.09). The inspection checks that you meet RSA 151 and He-P 822. Have criminal records checks ready for all current staff. Fix any problems they find.
2-4 Weeks
Hire and Train Staff
Recruit caregivers. Run the NH Department of Safety criminal records check and the BEAS registry check before hire. Get a health screening and 2-step TB test. Give orientation. Staff who help with transfers, feeding, bathing, or dressing need at least 8 hours of training (He-P 822.17).
2-4 Weeks
Build Referral Network and Launch
Establish relationships with local hospitals, physicians, Area Agencies on Aging, and community organizations. Start with private-pay clients while building volume.
We can do all of them for you in New Hampshire.
New 2026 Legal Mandates
HCSPA License (He-P 822; RSA 151)
New Hampshire requires agencies that give personal care or homemaker services to hold an HCSPA license. Apply through the DHHS Health Facilities Administration. DHHS inspects before it issues the license. The fee is $250 a year ($25 if under 10 clients) under RSA 151:5.
Home Care Clients' Bill of Rights (RSA 151:21-b)
All licensed home care agencies must post the Home Care Clients' Bill of Rights in a public area (He-P 822.14). Your policies must reflect these rights. Staff must be trained on them.
Criminal Records Checks (RSA 151:2-d; He-P 822.17)
Owners, the administrator, and all direct care staff must have a criminal records check from the NH Department of Safety. You must review it before you make a final job offer (RSA 151:2-d). You must also confirm each hire is not on the BEAS registry.
Health Screening & TB Test (He-P 822.17)
Each staff member needs a physical exam or health screening by a licensed nurse or practitioner. They also need 2-step TB testing. Both must be done within the 12 months before they start.
He-P 820 Is for Individual Providers, Not Agencies
He-P 820 covers individuals who work directly for a client under their own agreement. Those people register with DHHS. They are exempt from He-P 822. If you employ caregivers and send them to clients, you need the He-P 822 agency license instead.
No Certificate of Need Required
New Hampshire repealed its Certificate of Need law (RSA 151-C). Home care agencies do not need one.
Our New Hampshire licensing team tracks the law so you do not have to.
Caregiver Mandates
Important Warning
New Hampshire does not set a big training hour number for non-medical caregivers. But He-P 822.17 has clear rules. Staff who help with transfers, feeding, bathing, or dressing need at least 8 hours of training. Every hire needs a criminal records check, a BEAS registry check, a health screening, and a 2-step TB test before they start.
- Minimum 8 Hours of Training for Personal Care: Staff who assist with transfers, feeding, bathing, or dressing need at least 8 hours of training (He-P 822.17). All new hires get an orientation on client rights, job duties, agency policies, infection control, emergencies, and mandatory reporting.
- Criminal Records Check & BEAS Registry: A NH Department of Safety criminal records check is required before employment (RSA 151:2-d). You must also check the BEAS registry. Staff licensed by the NH Board of Nursing are exempt from the DHHS check.
- Age 18+, Health Screening & TB Test: Direct care staff must be at least 18. Each needs a health screening and 2-step TB test within the 12 months before they start.
- Supervision & Ongoing Training: Personal care staff get a performance observation each quarter and an evaluation each year. Annual in-service education is required. It covers policies, infection control, fire procedures, and reporting rules.
Regional Billing Snapshots
*Regional rates vary by specialized care needs (Dementia, Parkinson's) and local competition.*
We launch New Hampshire home care agencies start to finish.
Regional Market Opportunities
New Hampshire has about 1.4 million people. About 325,000 are 65 or older. That is 23.0%, one of the highest shares in the U.S. (Census, 2025). No wage tax and no sales tax draw retirees. The southern tier gets Boston spillover. Many people work in Massachusetts but live in NH. The billing rates below are our estimates, not official numbers.
Manchester-Nashua (Southern NH)
Largest population center and part of the Boston-Cambridge-Nashua MSA. Strong Boston suburb spillover creates high demand from affluent professionals and their aging parents. Highest competition but also highest rates and volume.
Key: Don't underprice for this market — southern NH families have Boston-level expectations and budgets. Understand Massachusetts competitor dynamics since Boston agencies may serve this area.
Concord / Central NH
State capital with government worker retirees, Concord Hospital referral base, and moderate competition. Stable market with good private-pay potential.
Key: State government retirees provide steady demand. Less competitive than southern NH.
Seacoast (Portsmouth, Dover, Rochester)
Affluent coastal communities with high home values and strong private-pay demand. Growing retirement population attracted by the coast and no wage tax.
Key: Premium market with high willingness to pay. Portsmouth area attracts wealthy retirees from Massachusetts and beyond.
Lakes Region (Laconia, Wolfeboro)
Lake Winnipesaukee area draws retirement-age residents. Seasonal population swings with summer visitors. Limited year-round home care options.
Key: Seasonal demand spikes in summer when families visit and assess their parents' needs. Build a year-round base with seasonal capacity.
Upper Valley / North Country
Rural northern New Hampshire with Dartmouth-Hitchcock Medical Center as the anchor institution in the Upper Valley. Very limited home care options in the North Country.
Key: Dartmouth-Hitchcock referrals drive Upper Valley demand. North Country is severely underserved but geographic distances are challenging.
Cost of care in New Hampshire
What agencies charge clients vs. what caregivers earn in New Hampshire. The difference is the agency's gross margin per billable hour — before overhead like insurance, admin, marketing, and compliance costs.
$36.5
Avg. hourly rate charged to clients
$21.61
Avg. caregiver hourly wage
$14.89
Gross margin per hour
41%
Gross margin %
What this means for agency owners
In New Hampshire, agencies keep roughly $14.89 per billable hour after paying the caregiver. That's a 41% gross margin.
This is a strong margin that gives you room to cover overhead costs (insurance, admin, marketing, compliance) and still run a profitable agency.
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.
New Hampshire Medicaid Programs
Choices for Independence (CFI)
New Hampshire's Medicaid home and community-based services program for seniors and adults with disabilities. CFI covers personal care, homemaker services, and related supports. Provider enrollment through NH DHHS is required to serve Medicaid-eligible clients.
Private-Pay Advantage
With high incomes and no wage or sales tax, New Hampshire has a strong private-pay market. Many agencies find success focusing primarily on private-pay clients, with Medicaid as a supplementary revenue stream rather than the primary one.
Becoming a Provider
Essential 2026 Tech Stack for Owners
Tiles outlined in teal are areas HomeCareAtlas covers in our platform.
New Hampshire Licensing FAQ
What license do I need for home care in New Hampshire?
You need a Home Care Service Provider Agency (HCSPA) license from the DHHS Health Facilities Administration. The rules are in He-P 822 under RSA 151. It covers agencies that employ people to give personal care or homemaker services.
How much does a New Hampshire home care license cost?
The fee is $250 a year for an agency (RSA 151:5). If you serve fewer than 10 clients, it is $25. We estimate total startup costs at $35,000 to $70,000. That includes insurance, staffing, and working capital.
How long does licensing take in New Hampshire?
We estimate 30-90 days from a complete application. DHHS does not publish a set time. DHHS must inspect you before it issues the license (He-P 822.05). A complete packet and a ready office speed this up.
How many hours of training do caregivers need?
New Hampshire does not set a large hour count for non-medical caregivers. Under He-P 822.17, staff who help with transfers, feeding, bathing, or dressing need at least 8 hours of training. All staff need orientation and yearly in-service education. Longer hour rules you may see are for licensed nursing assistants, not HCSPA caregivers.
Is New Hampshire a good market for home care?
Yes. About 23% of people in New Hampshire are 65 or older (Census, 2025). That is one of the highest shares in the U.S. There is no wage tax and no sales tax. Southern NH gets Boston spillover. We estimate billing rates at $30-$45 an hour.
Do I need a Certificate of Need?
No. New Hampshire repealed its Certificate of Need law (RSA 151-C). Home care agencies do not need one.
How does the Boston market affect New Hampshire?
Southern NH (Manchester, Nashua, Salem) is part of the Boston-Cambridge-Nashua MSA. Many residents work in Massachusetts but live in NH for the tax advantage. This creates Boston-level demand and pricing in southern NH, but also means Massachusetts-based agencies may compete in your market.
Starting in a Nearby State?
Licensing requirements vary a lot between states. Compare your options:
Massachusetts
No state license required · 4-8 Weeks
Maine
$500 fee · 9-12 Months
Vermont
No state license required · 1-3 months
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Home care agencies in New Hampshire
Want to see the competition up close? Look at who is already open, city by city.
- Home care agencies in Manchester
- Home care agencies in Portsmouth
- Home care agencies in Nashua
- Home care agencies in Broad Acres
- Home care agencies in Londonderry
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 New Hampshire's own rules. Tap a source to read it yourself.
- License needed?YesHe-P 822.02; RSA 151:2-b· Oct 2026
- Who oversees itNew Hampshire Department of Health and Human Services (DHHS), Health Facilities AdministrationHe-P 822.04(b)· Oct 2026
- License nameHome Care Service Provider Agency (HCSPA) LicenseHe-P 822.01· Oct 2026
- The rulesHe-P 822N.H. Code Admin. R. He-P 822· Oct 2026
- First license fee$250He-P 822.04(a)(3); RSA 151:5, XII· Oct 2026
- License lasts1 yearRSA 151:5· Oct 2026
- BondNoneHe-P 822; RSA 151· Oct 2026
- Owner/manager trainingNo state minimumHe-P 822.15(d)· Oct 2026
- Caregiver training8 hoursHe-P 822.17(n)· Oct 2026
- Background checksNH Department of Safety criminal records check and BEAS registry check for direct care staffHe-P 822.17(b)· Oct 2026
- How long it takes30-90 DaysBest 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.