How to Start a Home Care Business in North Dakota: License Only for Home Health Agencies and Qualified Service Provider Enrollment for Medicaid Personal Care

If you search for a North Dakota home care license, you will probably expect one permit that covers everything. North Dakota does not work that way. The state has no general statewide business license, and a home care business needs a DHHS license only when its services meet the legal definition of a home health agency. Most new home care businesses instead complete three separate tracks: they file the business entity with the Secretary of State, decide whether they need a DHHS home health agency license, and enroll as a Qualified Service Provider (QSP) if they plan to bill Medicaid.

This article is informational content, not legal or tax advice. Licensing rules, fees and enrollment requirements change. Confirm every figure with the named agency before you spend money or sign a contract. For complex situations, consult a qualified North Dakota attorney and a CPA.

What You Need Before You Start

Gather these items before you file anything. Several steps depend on the others, and a missing document usually stalls the whole sequence.

• A short list of three to five business name options, each checked in the Secretary of State business search at firststop.sos.nd.gov/search/business
• A North Dakota registered agent with a physical address in the state, and that person's or company's written approval
• A written description of every service you plan to offer, including whether any service involves a registered nurse or another therapeutic service
• A federal Employer Identification Number from the IRS
• Proof of unemployment insurance coverage, which you will need for QSP enrollment
• Proof of workers' compensation coverage through WSI (WorkForce Safety & Insurance)
• Liability insurance and bonding quotes, since individual QSPs must show both
• A signed agreement with a physician or allowed practitioner if your services will include home health care
• An operating budget that includes the filing fees, insurance, and any tax permit costs listed in this guide

Step 1: Decide Which Model You Are Building

Your service mix decides which regulatory track applies. There are three common models, and a single business can operate under more than one.

• Licensed home health agency. North Dakota law defines a home health agency as an entity furnishing home health services that must include a registered nurse plus at least one other therapeutic service, provided with the approval of a physician or allowed practitioner (NDCC 23-17.3-01). Under NDCC 23-17.3-02, a person may not operate a home health agency without a DHHS license.
• Medicaid home and community based services provider. If you want to bill Medicaid for home and community based services, you enroll as a Qualified Service Provider through DHHS. You do not need a home health agency license to enroll, but you do need to meet the QSP requirements.
• Private-pay companion or homemaker services. Companion and homemaker services alone fall outside the home health agency definition. Private-pay clients do not require QSP enrollment. Still, confirm your exact service mix with DHHS licensing before you describe your business to clients or the public.

Do not assume that every home care agency needs a DHHS license. Many do not. The deciding factor is whether your services include a registered nurse plus at least one other therapeutic service.

Step 2: Choose and Reserve Your Business Name

Your legal name must comply with NDCC 10-32.1-11 for an LLC. It must include the words limited liability company, LLC, or L.L.C., and it cannot include words such as corporation, incorporated, limited partnership, or their abbreviations. It also must be distinguishable in the Secretary of State records from every other registered entity, reserved name, and registered trade name, trademark, or service mark. A name that implies a purpose the company is not organized for will also be rejected.

If you want to hold a name while you finish your paperwork, you can reserve it for 12 months for a $10 fee. Reservations are renewable for successive 12 month periods. Reserve through the Secretary of State registration page.

If you will operate under a brand name that differs from your legal name, you need a trade name registration. Trade name registration costs $25 to register, $25 to amend, and $25 to renew, and it must be renewed every 5 years. A trade name registration grants exclusive rights to that name within North Dakota only, and it does not protect the name in other states. Trade names are filed with the Secretary of State, not with a county.

Step 3: File Your Entity With the Secretary of State

Most home care owners choose a limited liability company. The formation document for an LLC is the Articles of Organization under NDCC Chapter 10-32.1, and the filing fee is $135. For a corporation, the Articles of Incorporation under NDCC Chapter 10-19.1 cost $100. Both are filed through the FirstStop portal.

The Secretary of State publishes no guaranteed turnaround time. Its business pages list fees and steps but do not state how many business days a filing takes. Call Business Services at (701) 328-2900 for current timing before you set a launch date. Some secondary sources cite about 5 business days for FirstStop filings, with longer waits during busy periods, but that figure is not confirmed on any state page. No expedited filing option is published.

Your registered agent must be approved by the person or company before you name them. The agent must be an individual who lives in North Dakota, or a North Dakota or out-of-state corporation or LLC registered with the Secretary of State with a business office in North Dakota. Your business cannot serve as its own registered agent. Agent-related fees are $10 for a statement of change of address or agent and $25 for service of process. A commercial registered agent pays $1,000 to be included in the listing and $500 for termination or removal. Failing to maintain a registered agent may result in involuntary dissolution.

After filing, calendar your annual report. An LLC annual report costs $50 and is due November 15 every year. Farming or ranching LLCs are due April 15 instead. A domestic corporation's Business Corporation Annual Report costs $25 and is due August 1 every year. Missing the due date triggers a $50 late fee under NDCC 10-32.1-92 for LLCs.

Step 4: Get a DHHS Home Health Agency License, If Your Services Qualify

Skip this step if your business will provide only companion or homemaker services. If your services will include a registered nurse plus at least one other therapeutic service, you need a DHHS home health agency license before you operate.

The licensing standards appear in NDAC 33-03-10.1, which was amended in October 2025. Read the current rule in full, paying attention to staffing, policies, and the physician or allowed practitioner relationship. North Dakota repealed its certificate of need requirement in 1995, so you do not need one for this license.

Neither the statute nor the rule states a license fee. Contact HHS Health Response and Licensure to confirm the fee and the application steps. Do not budget for a specific fee until you have that number in writing.

A practical approach is to write your service description, send it to HHS licensing with your questions, and ask them to confirm in writing whether your mix requires a license. This protects you if a client, payer, or inspector later questions your classification.

Step 5: Register for State Tax and Workers' Compensation

North Dakota levies no franchise tax and no separate LLC privilege tax. The only recurring state charge on the LLC itself is the $50 annual report. Income passes through to the owners of a pass-through LLC, who pay North Dakota individual income tax at 0 percent, 1.95 percent, or 2.50 percent depending on bracket. An LLC that elects federal C corporation treatment instead pays state corporate income tax at 1.41 percent, 3.55 percent, and 4.31 percent by bracket.

Sales tax is a separate question. The state sales tax rate is 5 percent, plus any city and county taxes. Any business making taxable sales must hold a sales and use tax permit from the Office of State Tax Commissioner, applied for through ND TAP about 30 days before opening. Whether your home care services are taxable sales is a question for the Tax Commissioner or a CPA, so confirm it before you collect any payment.

Workers' compensation in North Dakota is a state monopoly administered by WSI. If you have employees, you must carry WSI coverage, and you will need proof of that coverage for QSP enrollment. Unemployment insurance coverage through Job Service North Dakota is also required for QSP enrollment. Set up both accounts before you apply to DHHS.

Step 6: Enroll as a Qualified Service Provider for Medicaid

If you plan to bill Medicaid for home and community based services, enroll through the ND QSP enrollment portal at hhs.nd.gov/qsp. For questions, call the QSP Hub at 701-777-3432. Noridian does not enroll QSPs, so do not send your enrollment packet there.

Agency QSPs must upload three documents: proof of unemployment insurance coverage, proof of WSI coverage, and proof of Secretary of State registration. The January 2026 QSP Agency Handbook sets out these requirements, so download the current version from the DHHS QSP page and check each item against it.

Applicant type	Required proof
Agency QSP	Unemployment insurance coverage, WSI coverage, and Secretary of State registration
Individual QSP	Liability insurance, bonding, and the individual documentation listed in the handbook

Private-pay clients do not require QSP enrollment. If you plan to serve both private-pay and Medicaid clients, enroll as a QSP before you bill Medicaid for any service.

Step 7: Confirm Local Requirements

North Dakota has 53 counties, and counties do not license businesses. Cities license specific activities only, and no major city issues a general business license. Ask your city whether any activity-specific license applies to your services or your office location. Trade and occupational licenses are issued by state agencies and boards, not by a general business license office, so confirm with the appropriate agency if your services touch a licensed trade.

Common Mistakes to Avoid

• Assuming one license covers everything. North Dakota has no general business license. Your entity filing, any trade name registration, your DHHS license decision, and your QSP enrollment are separate steps.
• Assuming every home care business needs a DHHS license. Companion and homemaker services alone fall outside the home health agency definition. Confirm your service mix with HHS licensing in writing.
• Naming your business as its own registered agent. This is not allowed, and it can create a compliance problem from the first day.
• Using a prohibited word in your LLC name. Words such as corporation or incorporated are rejected under NDCC 10-32.1-11.
• Missing the November 15 annual report. The $50 late fee is avoidable, and the reinstatement fee for a terminated LLC is $135.
• Starting Medicaid billing before QSP approval. Begin enrollment early, because you cannot bill for services that you have not been approved to provide.
• Waiting too long on insurance and bonding. Individual QSPs must show liability insurance and bonding, so request quotes early.
• Operating under a brand name without a trade name registration. A trade name grants exclusive rights within North Dakota only, so register it if you plan to rely on the name.

What Results to Expect

A well-prepared filing sequence can help you launch on a predictable schedule, though no timeline is guaranteed. The Secretary of State does not publish a turnaround time, and DHHS does not publish a license fee in its statute or rule. Building a buffer into your plan is the most useful step you can take.

Many owners who complete the entity filing, WSI and unemployment insurance setup, and QSP documentation before opening find that the remaining work is operational, such as hiring, training, and scheduling. Those steps may take longer than the paperwork, so start them early. If your services require a DHHS home health agency license, plan for that approval to be the longest step in the sequence.

Next Steps

1. Confirm your service mix with HHS licensing and get the answer in writing.
2. Reserve your name, or file your Articles of Organization through FirstStop.
3. Appoint a registered agent and document their written approval.
4. Set up WSI and unemployment insurance coverage.
5. Apply for a sales and use tax permit through ND TAP only if your services are taxable sales.
6. Submit your QSP enrollment and any DHHS license application with the documents listed in the current handbook.
7. Calendar your annual report and your trade name renewal date.

This article is informational content, not legal or tax advice. Verify every fee, deadline, and requirement with the agency named in the text before you act on it. Because home care involves licensing, employment, insurance, and Medicaid billing, consult a qualified North Dakota attorney and a CPA before you finalize your structure or sign payer contracts.