HomeCareAtlas Team · Updated March 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 Licensure Unit (licenses HHAs only); Secretary of State (business registration).
Nebraska does not require a specific state license for private-pay non-medical home care agencies. You can start providing personal care, companionship, and homemaker services after forming your business and getting insurance. Important: do not confuse this with Home Health Agencies (HHAs) that provide skilled nursing — HHAs are separately licensed by DHHS and require a 60-120 day process. This guide covers the non-medical, private-pay pathway. Nebraska state law still requires background checks for agencies employing workers who provide in-home services, even without a license (LB 71-6501).
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 background checks are required by state law (LB 71-6501) even without licensing.
- License Required
- No — Business license only
- Regulatory Body
- Nebraska DHHS Licensure Unit (licenses HHAs only); Secretary of State (business registration)
- Application Fee
- $0 (no state license fee)
- Timeline
- 4-8 Weeks (business setup timeline)
- Total Startup Cost
- $25,000 - $50,000
- Key Requirement
- No state license for private-pay non-medical care, but background checks are required by state law (LB 71-6501) even without licensing.
- Last Verified
- March 2026 against Nebraska DHHS Licensure Unit (licenses HHAs only); Secretary of State (business registration) regulations
$0 (No State License Fee)
Business Setup Timeline
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 | $2,200 | 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 Licensure Unit (licenses HHAs only); Secretary of State (business registration) oversees all non-medical agencies.Nebraska does not require a specific state license for private-pay non-medical home care agencies. You can start providing personal care, companionship, and homemaker services after forming your business and getting insurance. Important: do not confuse this with Home Health Agencies (HHAs) that provide skilled nursing — HHAs are separately licensed by DHHS and require a 60-120 day process. This guide covers the non-medical, private-pay pathway. Nebraska state law still requires background checks for agencies employing workers who provide in-home services, even without a license (LB 71-6501).
No State License for Private-Pay Non-Medical
Nebraska does not require a state license for non-medical in-home personal services agencies. You need business registration with the Secretary of State, an EIN, and insurance. Faster startup than most neighboring states.
Background Checks Required by State Law
Even without a state license, Nebraska state law (LB 71-6501) requires background checks for workers providing in-home services. Do not skip this — it is a legal requirement, not just a best practice.
Insurance & Workers' Comp
General liability insurance ($1,000,000 per occurrence / $3,000,000 aggregate recommended) and workers' compensation for all employees. Surety bond is not state-mandated but consider $10,000+ if handling client funds.
Lower Regulatory Burden
Nebraska has a lower regulatory burden than neighboring states. No licensing fees, no surety bond requirement, and no state-mandated administrator certification for non-medical agencies.
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 ($1M/$3M) | $1,000 | $3,000 |
| Professional liability insurance | $500 | $2,000 |
| Workers' comp insurance | $500 | $2,000 |
| Background checks (initial staff, per LB 71-6501) | $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 |
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 general liability insurance ($1M per occurrence / $3M aggregate recommended), professional liability, and workers' compensation for all employees.
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 a background check process per LB 71-6501 — this is required by state law even without a license. Recruit caregivers and provide training on your agency's policies, client care, and safety procedures.
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)
If you plan to serve Medicaid clients, enroll through Nebraska DHHS. This opens access to the Aged and Disabled Waiver and other HCBS programs. Medicaid enrollment has its own requirements and adds timeline.
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.
Background Checks Required (LB 71-6501)
Ongoing - Nebraska state law requires background checks for workers providing in-home services, even for unlicensed agencies. This is a legal requirement, not a recommendation. Complete checks before staff provide any services.
Workers' Compensation Required
Ongoing - Nebraska requires workers' compensation insurance when you have employees.
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.
Caregiver Mandates
Important Warning
Even without a state license, Nebraska law (LB 71-6501) requires background checks for in-home care workers. Do not skip this step. Misclassifying caregivers as 1099 contractors is a major compliance risk.
- Criminal Background Check (LB 71-6501): State law requires background checks for all workers providing in-home services. Complete before any staff member provides care.
- Agency-Specific Training: Provide training on your policies, client care standards, emergency procedures, and safety protocols. 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.*
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.
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 Waiver
Nebraska's Medicaid HCBS program for elderly and disabled individuals. Enrollment through Nebraska DHHS is required to serve Medicaid-eligible 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
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. Nebraska state law (LB 71-6501) requires background checks for workers providing in-home services, even for unlicensed agencies. This is a legal requirement.
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?
Since there is no state licensing process, you can be operational in 4-8 weeks. The time is spent on business formation, insurance, policy development, and staff recruitment.
What insurance is required?
General liability insurance ($1M per occurrence / $3M aggregate recommended) and workers' compensation for all employees. A surety bond is not state-mandated but consider $10,000+ if handling client funds.
Is Nebraska a good market for home care?
Nebraska has about 330,000 seniors (17% of the population). Market rating is 3/5. Omaha and Lincoln metros have the most demand. Lower regulatory burden and startup costs than neighboring states make it an attractive entry point.
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
$2,200 fee · 3-5 Months
South Dakota
No state license required · 4-8 Weeks
Want us to handle your Nebraska licensing?
We take care of the entire process. You fill in your details, we handle the rest.
Ready to start your agency in Nebraska?
We handle the paperwork so you can focus on building your agency. State filing, entity formation, and licensing support — all done for you.
Register for free to access detailed, state-specific steps for Nebraska — including forms, fees, timelines, and what to file first.
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.