How to start a home care agency in New Hampshire

New Hampshire requires a Home Care Service Provider Agency (HCSPA) license (home health care provider license limited to personal care or homemaker services) from New Hampshire DHHS, Health Facilities Administration to operate a home care agency. Fee: Annual license fee set by RSA 151:5: $25 for an agency serving fewer than 10 clients, $250 for 10 or more clients.

License required

Yes

License

Home Care Service Provider Agency (HCSPA) license (home health care provider license limited to personal care or homemaker services)

Issuing agency

New Hampshire DHHS, Health Facilities Administration

Fee

Annual license fee set by RSA 151:5: $25 for an agency serving fewer than 10 clients, $250 for 10 or more clients.

Renewal

Every year · Same annual fee under RSA 151:5; renewal application due at least 120 days before the license expires.

Survey and inspection

Inspection required before the initial license is issued; ongoing inspections with plans of correction for deficiencies.

Regulation

RSA 151:2-b, RSA 151:5, RSA 151:9-a; N.H. Admin. Rules He-P 822

1. Publish a public notice of intent to apply in a newspaper in at least 2 issues, at least 10 business days before filing (and notify any critical access hospital within 15 miles)
2. Register the business with the NH Secretary of State
3. Submit the Application for Residential or Health Care License with fee, administrator resume, local approvals and criminal records checks
4. Department reviews for completeness and runs background screening
5. Pass a department inspection before the license is issued
6. Renew annually, filing at least 120 days before expiration

Staffing

• Administrator with an associate degree and 2 years HCSPA experience, a bachelor's and 1 year, or a high school diploma and 5 years
• Designated alternate administrator
• Director of client services
• Direct care staff at least 18 (with limited exceptions)

Training

• Orientation before client contact covering client rights, job duties, policies, infection control, emergency plans and mandatory abuse reporting
• Body mechanics training
• Annual in-service on client rights, infection control, fire/emergency procedures and mandatory reporting

Program

New Hampshire Medicaid (Fee for Service and Medicaid Care Management), NH DHHS

Enrollment portal

New Hampshire MMIS Health Enterprise Portal

Fiscal agent

Conduent (runs the NH MMIS portal and the Provider Relations call center)

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. NH DHHS provider pages do not list a separate state fee.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. NH DHHS provider pages do not list which provider types are high risk.

Site visit

NH DHHS says moderate- and high-risk providers must have a site visit and limited-risk providers do not. A Medicare site visit done within the past 5 years satisfies the requirement for NH Medicaid revalidation. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.

Revalidation

Every enrolled provider (billing, rendering and ordering/referring/prescribing) revalidates about every 5 years, online in the MMIS portal only. The state mails and emails notices 60 days and 30 days before the due date and on the due date itself. No extensions are given. A provider who misses revalidation can have claims suspended, then loses fee-for-service enrollment and, after that, its health plan participation. Revalidating with Medicare, with another state or with a health plan does not count. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.

Full New Hampshire Medicaid enrollment guide →

CON program

No

Agency

New Hampshire Department of Health and Human Services (facility licensing)

Moratoria

RSA 151:2, VI bars new licenses and licensed-capacity increases for nursing homes, skilled nursing facilities, intermediate care facilities and rehabilitation facilities (including rehabilitation hospitals). Exceptions cover substance use / mental health rehabilitation facilities, continuing care facilities with an insurance-commissioner certificate of authority, and same-county transfers of beds that existed on July 1, 2016 without reducing county Medicaid beds. Pediatric ICFs existing before July 1, 2023 may house 2 extra residents through June 30, 2026.

New Hampshire certificate of need details →

Model

hybrid

State vendor

Fiserv AuthentiCare

Services in scope

• personal care
• home health

Alternate EVV allowed

Yes

Program

https://www.dhhs.nh.gov/programs-services/adult-aging-care/electronic-visit-verification

New Hampshire EVV requirements →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Personal care / in-home supportive care organizations — active organization NPIs (NPPES)

148 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

167,648 (as of Jun 1, 2026)

All New Hampshire Home care Medicaid rates, ranked →

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New Hampshire waivers and waiting lists →