Starting a care business in North Dakota

Child care runs on headcount. Up to five children (no more than three under 24 months) can operate under a voluntary $15 self-declaration, which is not a license. A family child care license starts at four or more children aged 24 months and under, or six or seven through age 11, and allows up to seven children plus two school-age children. From 8 to 30 children you need a group child care license, in a home or a non-residential building, and above 30 a child care center license. The statute's definitions also describe a center as a program for 19 or more children, so ask your HHS licensing specialist which license a 19-to-30-child program would get. Every new owner first completes HHS's online Childcare Provider Orientation, then applies through the Child Care Licensing (CCL) portal. A 2025 law, HB 1119, set up an advisory committee to work with HHS on a full revision of the child care rules.

For adults who live where they receive care, the license follows the building and the staffing. Caring around the clock in your own home for more than one unrelated adult, or more than two related adults, takes a foster home for adults license. You must live in the home, take no more than four residents and enroll as an individual Qualified Service Provider (QSP), even if every resident pays privately. A building with at least five leased units, each with a lockable door and a private bath, serving five or more unrelated tenants needs an assisted living facility license, and that means two licenses: $75 a year from the Health Response and Licensure Section and $170 a year from Food and Lodging or, in some areas, a local health unit.

Offering 24-hour response staff or marketing a building as memory care turns it into a basic care facility, which has its own license. North Dakota law bars adding basic care beds to the state's licensed capacity from August 1, 2025 to July 31, 2029, apart from a few exceptions such as converted nursing beds or proof that nearby beds are at least 90% occupied. The freeze is one reason some operators open under the lighter assisted living rules instead, which works only if the service model genuinely fits them.

A home health agency license is defined by the service mix: a registered nurse plus at least one other therapeutic service, such as therapy or home health aides, provided on a regular basis. North Dakota repealed certificate of need for home health in 1995, and neither the statute nor the rule sets a license fee. Medicare is the bottleneck: CMS has not enrolled new home health agencies nationwide since May 13, 2026, under a six-month moratorium that can be extended.

Non-medical home care, such as companion and homemaker services, has no state license, and no adult day care license appears in North Dakota's statutes or HHS licensing pages. To be paid by HHS for clients on state-funded programs you enroll as a QSP; the HHS handbook says providers who serve only private-pay clients generally need not enroll. Since June 11, 2026, North Dakota Medicaid has paused new QSP agency enrollments in Burleigh and Cass counties for six months, extendable in six-month periods. A companion-care business may not call itself a home health agency or advertise home health services without that license.