Starting a care business in Nebraska

Nebraska sets its licensing lines in statute rather than in agency policy. The Child Care Licensing Act requires a license once you care for four or more children from other families at one time. The Assisted-Living Facility Act starts at four unrelated residents who pay for housing, meals and help with daily living. The adult day statute covers group programs of less than 24 consecutive hours for four or more people. Below those counts the state issues no license for the businesses on this page, although a few cities and counties with ordinances dating from 1984 may still license child care for two or three children.

Child care runs on a provisional year. A home with up to eight children (plus two school-age children outside school hours) in your own residence is a Family Child Care Home I; a Home II allows up to 12 children with two providers, in your residence or at another site, and needs local zoning approval everywhere. Thirteen or more children makes the program a child care center. Every new program gets a one-year provisional license, then a non-expiring operating license subject to annual inspections and fees. State fees are small ($25 a year below 30 children, $50 at 30 or more), but $100,000-per-occurrence liability insurance is required, and since September 22, 2025 inspectors ask to see proof at every unannounced visit.

Nebraska has no small-home license for adults. A house with four unrelated residents needs the same assisted living facility license as a large building, at the lowest fee tier of $950 for 1 to 10 beds. DHHS publishes no license or certification for homes with one to three residents. An ALF cannot provide routine care by RNs or LPNs, so residents who need complex nursing arrange it through a home health agency, hospice or private duty staff. There is no certificate of need (the program covers only rehabilitation and nursing home beds), but DHHS must approve all construction before anyone occupies it. The ALF rules date from 2007, and a 2016 memory care endorsement law still has no application listed on the DHHS page.

An adult day service is a small field: the DHHS roster of September 15, 2026 lists 20 licensed programs statewide. Fees run $200 to $300 by capacity, the rules rewritten in March 2024 set no staff-to-participant ratio, and every license expires July 31.

In-home care has a single license. Nebraska has no companion, homemaker or personal care agency license; instead, skilled nursing or any one listed therapeutic service, including home health aide help with bathing, dressing or toileting, requires a home health agency license. DHHS lists no license type for companionship and chores alone, so confirm a near-the-line model with the Licensure Unit. A licensed agency may serve only counties contiguous with its parent office's county. A federal moratorium has also stopped Medicare enrollment of new home health agencies since May 13, 2026, and because Nebraska Medicaid requires Medicare enrollment, a new agency cannot bill either program while the moratorium lasts.