Starting a care business in New Hampshire

The four adult-side licenses share one application form (the August 2025 "Application for Residential, Health Care, or Special Health Care Services") and one set of habits. Before you file, your town's health officer, building official, zoning officer and fire chief must each sign off in writing, no more than 90 days before submission. Licenses run one year, renewals are due 120 days before expiry, and DHHS posts initial applications on its website as soon as they are filed. Fees are set in RSA 151:5: $15 per bed for an assisted living residence and $200 for an adult day program, which is required once you serve 3 or more adults for under 12 hours a day.

Residential care starts at 2 people: services beyond room and board to 2 or more individuals require a license, whether in a private house or a purpose-built building. You choose the level when you apply. He-P 804 (residential care) admits only residents who can get themselves out in a fire; residents who cannot need a supported residential health care license under He-P 805 and a building that meets the health care occupancy chapter of the fire code.

Home care is one statutory category split by what your staff do. An agency whose employees give only personal care or homemaker services gets a home care service provider agency license under He-P 822, at $25 a year below 10 clients and $250 at 10 or more (the DHHS FAQ page lists $100 for the upper tier, which conflicts with the statute). Add nursing, home health aide or therapy services and you need a home health care provider license under He-P 809, at $250 a year. NH Medicaid pays for home health only through Medicare-certified agencies, and CMS stopped enrolling new home health agencies nationwide on May 13, 2026. A self-employed caregiver with no employees registers as an individual home care service provider for $25 instead.

Child care has no license fee in RSA 170-E or He-C 4002 (adopted rule dated August 26, 2025), and both the home and the center routes begin with a 6-month permit after inspection, followed by a 3-year license once you show compliance while operating. Caring for your own children plus up to 4 others is exempt; beyond that, a family day care home takes up to 6 children plus 3 school-age, and 7 to 12 children needs the family group license. Towns must allow both by right in residential zones. A group child day care center needs local health and fire approvals dated within 12 months, 35 square feet of indoor space per child and a director with 1,500 hours of experience.

There is no certificate of need for any of these businesses; the bed moratorium in RSA 151:2, VI applies only to nursing homes, skilled nursing, intermediate care and rehabilitation facilities. He-P 818 for adult day programs is being rewritten in 2026, with a public hearing on October 22 and comments due October 29. New Hampshire has no separate license for small adult care homes. The closest model, the adult family care residence (He-P 813), is a certification for a home with 1 or 2 residents and is written around Medicaid waiver residents, so a privately paid 2-resident home should ask the licensing unit in writing whether the assisted living license applies.