How to start an assisted living facility in Florida

Florida requires a Assisted living facility license: a Standard license, plus optional Specialty licenses for Extended Congregate Care, Limited Nursing Services and Limited Mental Health from Florida Agency for Health Care Administration (AHCA), Bureau of Health Facility Regulation — Assisted Living Unit to operate an assisted living facility. Fee: AHCA posts a licensure fee letter for ALFs; the amounts were not machine-readable in the copy retrieved.

License required

Yes

License

Assisted living facility license: a Standard license, plus optional Specialty licenses for Extended Congregate Care, Limited Nursing Services and Limited Mental Health

Issuing agency

Florida Agency for Health Care Administration (AHCA), Bureau of Health Facility Regulation — Assisted Living Unit

Fee

AHCA posts a licensure fee letter for ALFs; the amounts were not machine-readable in the copy retrieved.

Renewal

Renewals are filed through AHCA's Online Licensing system.

Medicaid waiver coverage

HHS's 2015 compendium reported that Florida covered ALF services under its statewide Medicaid managed long-term care program (1915(b)(c)), which replaced the Assisted Living for the Elderly waiver, plus the state plan Assistive Care Services benefit.

Regulation

Ch. 429 Part I, F.S.; Ch. 408 Part II, F.S.; Ch. 59A-36 and 59A-35, F.A.C.

1. Submit the ALF licensing application to AHCA (forms on AHCA's Applications for Licensure page)
2. Meet the core licensure requirements of Ch. 408 Part II F.S. and Ch. 59A-35 F.A.C.
3. Pass the AHCA survey
4. Renew through the Online Licensing system

Training

• ALF core training through an AHCA-registered core training provider (administrators)

Program

Florida Medicaid (Agency for Health Care Administration)

Enrollment portal

Florida Medicaid Web Portal (FLMMIS) — Enrollment Wizard

Fiscal agent

Gainwell Technologies (Florida Medicaid Web Portal / FLMMIS)

Application 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

Florida also requires Level 2 background screening (fingerprint-based, under s. 408.809, F.S.) as part of enrollment and revalidation. 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

AHCA assigns each provider type a limited, moderate or high risk level under 42 CFR 455.450. 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

Florida calls revalidation 'renewal': AHCA re-enrolls every provider at least every five years, mailing a notice about 90 days before the provider agreement expires. Claims suspend if the online renewal is not finished by the expiration date. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Florida Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Florida Agency for Health Care Administration (AHCA)

Services covered

• community nursing homes / skilled nursing facility beds
• hospice programs and hospice inpatient facilities
• intermediate care facilities for the developmentally disabled (ICF/DD)
• conversion from one type of covered facility to another

Florida certificate of need details →

State minimum wage

$15.00 an hour

Effective

2026-09-30

Scheduled increases

Stays $15.00 from 2026-09-30 through 2027-12-31; annual inflation adjustments resume with a September 2027 calculation that takes effect the following January 1.

Direct-care wage floor

The 2022-23 General Appropriations Act funded Medicaid fee schedule and managed care rate increases for the sole purpose of raising wages of Medicaid providers' direct care employees (including 1099 workers) to at least $15/hour.

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)

5,864 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

3,565,369 (as of Jun 1, 2026)

All Florida Home care Medicaid rates, ranked →

• Familial Dysautonomia Waiver (1915(c))
• Developmental Disabilities Individual Budgeting Waiver (1915(c))
• Comprehensive Intellectual and Developmental Disabilities Managed Care Pilot Program (1915(c))
• Long-Term Care Waiver (1915(c))
• Model Waiver (1915(c))

Florida waivers and waiting lists →