Start a Home Care Agency in North Dakota

Starting a non-medical home care agency in North Dakota requires understanding the state’s requirements, service structure, and administrative expectations before providing care.

North Dakota is considered a non-regulated state for private-pay home care: the state does not license private-pay non-medical agencies, even when your employees provide hands-on personal care.

North Dakota does not license private-pay non-medical home care; only home health agencies providing skilled nursing are licensed (NDCC 23-17.3). Agencies that want Medicaid or SPED funding enroll with ND Health and Human Services as a Qualified Service Provider (QSP).

This guide outlines the key steps, expectations, and important considerations so you can better understand what is involved in opening a home care agency in North Dakota.

Understand North Dakota Home Care Requirements

North Dakota is a non-regulated state for private-pay, non-medical home care. No state license is required, even when your own employees provide hands-on personal care such as bathing, dressing, grooming and toileting.

North Dakota does not license private-pay non-medical home care; only home health agencies providing skilled nursing are licensed (NDCC 23-17.3). Agencies that want Medicaid or SPED funding enroll with ND Health and Human Services as a Qualified Service Provider (QSP).

You still need to set up your business properly, carry the right insurance, screen your caregivers and keep professional records.

What Makes North Dakota Different

North Dakota does not license private-pay non-medical agencies, which lowers the barrier to entry. Oversight comes mainly through Medicaid program rules (if you choose to serve Medicaid clients), and general business, employment and insurance requirements.

Define Your Services

Most home care agencies in North Dakota provide:

• personal care assistance
• companionship services
• meal preparation
• light housekeeping
• mobility support

Providing hands-on care places your agency under full regulatory oversight.

Complete Business Setup Requirements

Before applying, you must:

• register your business (LLC or Corporation)
• obtain a Federal EIN
• secure general liability insurance
• obtain workers’ compensation insurance (if hiring employees)
• establish a business location
• designate an administrator

North Dakota expects agencies to be properly structured before applying.

Prepare Your Administrative Documentation

A critical part of getting started is preparing your agency’s documentation.

This includes:

• policies and procedures
• caregiver hiring and training records
• client intake and service forms
• operational documentation

Documentation must be organized, consistent, and aligned with how your agency will operate.

Set Up for Private-Pay Services

There is no state license application for private-pay non-medical care in North Dakota. Before serving clients, make sure you have:

• a registered business entity and EIN
• general liability, professional liability and workers’ compensation insurance
• criminal background checks for every caregiver
• written policies, procedures and client agreements

If you plan to serve Medicaid clients, you will also need to enroll through the state Medicaid program.

Plan for Oversight (Medicaid Only)

Private-pay agencies are not surveyed by the state. If you enroll in Medicaid, expect program reviews, audits and documentation checks.

Begin Operations

You can begin serving private-pay clients once your business is set up, insured and your caregivers are screened. No state approval is needed for private-pay non-medical care.

Medicaid Pathway in North Dakota

North Dakota offers opportunities for agencies to participate in Medicaid programs.

This typically requires:

• additional enrollment
• compliance with program requirements
• adherence to service standards

North Dakota Home Care Startup Checklist

• Register your business entity
• Obtain an EIN and insurance
• Define your services
• Screen your caregivers
• Prepare policies and documentation
• Decide whether to enroll in Medicaid (optional)
• Begin private-pay services

Current Market Opportunity in North Dakota

North Dakota presents strong opportunities due to:

• rural and underserved communities
• an aging population
• limited availability of home care providers

Agencies that are well-prepared can meet important care needs across the state.

Startup Timeline

Because there is no state license for private-pay non-medical care, many North Dakota agencies can open within a few weeks of forming the business. Medicaid enrollment, if you pursue it, can take several months.

Level of Difficulty: Low to Moderate

North Dakota has no state license for private-pay non-medical care, so the main work is business setup, insurance, caregiver screening and strong documentation. Serving Medicaid clients adds program requirements.

Helpful Government Resources

North Dakota Department of Health and Human Services
https://www.hhs.nd.gov

What New Agency Owners Often Miss

Common challenges include:

• incomplete documentation
• confusion between private-pay and Medicaid rules
• inconsistent policies and forms
• unclear workflows

North Dakota-Specific Insight: No License, but Documentation Still Matters

Without a state license, clients, families and referral sources judge your agency by how professional it is. Clear policies, consistent forms and well-trained caregivers set you apart.

Building a Cohesive Home Care System

Many agency owners create documentation over time, which can lead to:

• inconsistent formatting
• disconnected policies and forms
• unclear workflows

A well-prepared agency should have documentation that is consistent, structured, and aligned with real-world operations.

A More Structured Approach for North Dakota

For non-regulated states like North Dakota, many agency owners choose a structured starting point.

Wise Caregiving® offers a non-regulated state startup bundle that includes:

• an all-state policy and procedure manual you customize yourself
• a structured framework for professional operations
• fully editable forms designed to support your policies
• a cohesive documentation system

This allows you to focus on preparing your business and moving forward with confidence.

Prepare with Confidence

Starting a home care agency in North Dakota requires preparation and organization.

Beginning with a structured system can help you move forward with clarity and confidence.

Explore the Non-Regulated State Startup Bundle →

Stay Updated

State requirements may change over time. This page is reviewed regularly.

Last Updated: October 2026