How to start an assisted living facility in District of Columbia

District of Columbia requires a Assisted living residence (ALR) license; community residence facilities are a separate, lower-acuity license from DC Health, Health Regulation and Licensing Administration — Community Residence Facilities Branch to operate an assisted living facility.

License required

Yes

License

Assisted living residence (ALR) license; community residence facilities are a separate, lower-acuity license

Issuing agency

DC Health, Health Regulation and Licensing Administration — Community Residence Facilities Branch

Medicaid waiver coverage

HHS's 2015 compendium reported that the Elderly and Persons with Disabilities (EPD) 1915(c) waiver covers assisted living services in ALRs.

Regulation

Assisted Living Residence Regulatory Act of 2000 (D.C. Code §44-101.01 et seq.); 22-B DCMR Chapter 101

1. Submit a completed application package to the CRF Branch through DC Health's online license application portal
2. CRF Branch reviews, processes and schedules licensing surveys
3. License issues after a successful survey

Program

DC Medicaid (Department of Health Care Finance)

Enrollment portal

DC Medicaid Provider Data Management System (PDMS)

Fiscal agent

Gainwell Technologies (fiscal agent and claims vendor since March 2, 2026, replacing Conduent)

Application fee

DHCF has collected the institutional application fee at enrollment and re-enrollment since May 1, 2015, under the District's Medicaid provider screening, enrollment and termination rule. 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

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

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

Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full District of Columbia Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

State Health Planning and Development Agency (SHPDA), DC Health

Services covered

• hospitals (general, psychiatric, rehabilitation, specialty)
• skilled nursing facilities
• intermediate care facilities
• ambulatory care centers / clinics
• ambulatory surgical facilities
• kidney disease treatment / freestanding hemodialysis
• diagnostic health care facilities
• home health agencies
• hospice
• new health services by facilities with operating budgets of $500,000+
• capital expenditures of $6M+ (hospitals) or $3.5M+ (other facilities)
• major medical equipment ($3.5M hospitals / $2M other facilities / $350,000 single physician-owned unit)
• bed relocations and redistribution

Moratoria

SHPDA may impose a moratorium of up to 120 days on CONs for a specific service while it develops review standards; the same service cannot be placed under moratorium more than once in 12 months (D.C. Code §44-418). No standing moratorium identified.

District of Columbia certificate of need details →

State minimum wage

$18.40 an hour

Effective

2026-07-01

Scheduled increases

Adjusted each July 1 by formula (US DOL); the July 2027 rate was not yet published in the sources reviewed.

Direct-care wage floor

For FY2026, DC must pay direct care service providers a rate that supports direct care professional pay at the highest of: 117.6% of the DC living wage in effect on 2025-07-01, the current DC minimum wage, or the current DC living wage. DHCF's supplemental payment program requires eligible HCBS providers to pay their direct care workforce, on average, at or above the target wage.

Rate pass-through

Supplemental payments must fund wages, salaries and benefits of direct care professionals (DHCF Transmittal 25-03).

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)

55 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

237,170 (as of Jun 1, 2026)

All District of Columbia Home care Medicaid rates, ranked →

• Adult Day Health Program (ADHP) (1915(i))
• Elderly and Persons with Physical Disabilities Waiver (1915(c))
• People with Intellectual and Developmental Disabilities (IDD) Waiver (1915(c))
• Individual and Family Support (IFS) Waiver (1915(c))

District of Columbia waivers and waiting lists →