How to start an assisted living facility in Arizona

Arizona requires a Assisted living facility license, either an assisted living home (10 or fewer residents) or an assisted living center (11 or more); adult foster care homes are a subclass. Licensed for supervisory, personal or directed care services. from Arizona Department of Health Services, Bureau of Residential Facilities Licensing to operate an assisted living facility. Fee: $50. Processing time: ADHS has up to 120 days to issue the license: 30 days of administrative review and 90 days of substantive review. The applicant has 180 days to reach substantial compliance.

License required

Yes

License

Assisted living facility license, either an assisted living home (10 or fewer residents) or an assisted living center (11 or more); adult foster care homes are a subclass. Licensed for supervisory, personal or directed care services.

Issuing agency

Arizona Department of Health Services, Bureau of Residential Facilities Licensing

Fee

$50

Fee details

A non-refundable $50 application fee is required of all health care institutions (A.R.S. §36-405(B)(5)). Separate licensing fees must be paid before the license is issued; those amounts were not in the source reviewed.

Processing time

ADHS has up to 120 days to issue the license: 30 days of administrative review and 90 days of substantive review. The applicant has 180 days to reach substantial compliance.

Survey and inspection

No license is issued until the facility is found in substantial compliance with the rules.

Medicaid waiver coverage

HHS's 2015 compendium reported that services in assisted living homes, centers and adult foster care are covered through the Arizona Long Term Care System (ALTCS), a managed care program under Arizona's Medicaid 1115 demonstration.

Regulation

A.A.C. Title 9, Ch. 10, Article 1 and Article 8 (Assisted Living Facilities); A.R.S. Title 36, Ch. 4

1. Submit a complete initial application packet meeting A.A.C. R9-10-105 by email to Residential Licensing (now through the online Licensing Management System)
2. Mail the $50 application fee separately
3. Pass ADHS review and inspection
4. Pay licensing fees; the license issues once the facility is in substantial compliance

Program

Arizona Health Care Cost Containment System (AHCCCS)

Enrollment portal

AHCCCS Provider Enrollment Portal (APEP)

Fiscal agent

None — AHCCCS runs provider enrollment and its own claims system in-house

Application fee

AHCCCS charges the enrollment fee to non-individual provider types at enrollment and can charge it again at revalidation; AHCCCS lists $750 for calendar year 2026, matching Medicare's fee. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

AHCCCS requires the fingerprint-based criminal background check (FCBC) only for high-risk provider types. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

AHCCCS applies site visits to moderate- and high-risk provider types, at enrollment and at revalidation. Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

AHCCCS requires revalidation every four years (stricter than the federal five) and may call for off-cycle revalidation; providers get 90 days from notice or their enrollment is terminated. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Arizona Medicaid enrollment guide →

CON program

No

Agency

Arizona Department of Health Services (ambulance certificates of necessity only)

Arizona certificate of need details →

State minimum wage

$15.15 an hour

Effective

2026-01-01

Scheduled increases

Rises to $15.65 on 2027-01-01 (annual CPI adjustment announced by the Industrial Commission).

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Assisted living facilities — active organization NPIs (NPPES)

1,140 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,611,827 (as of Jun 1, 2026)

All Arizona Home care Medicaid rates, ranked →

• Arizona Long Term Care System (ALTCS) — AHCCCS Section 1115 demonstration (1115)

Arizona waivers and waiting lists →