How to start an assisted living facility in Idaho

Idaho requires a Residential assisted living facility (RALF) license from Idaho Department of Health and Welfare, Division of Licensing and Certification — Residential Assisted Living Facility Program to operate an assisted living facility. Fee: $500.

License required

Yes

License

Residential assisted living facility (RALF) license

Issuing agency

Idaho Department of Health and Welfare, Division of Licensing and Certification — Residential Assisted Living Facility Program

Fee

$500

Fee details

The rule requires a $500 initial building evaluation fee with the request for a building evaluation. Other license fees were not identified.

Renewal

Every year · Facilities file an annual report and renewal application at least 30 days before the license expires.

Medicaid waiver coverage

HHS's 2015 compendium reported that Idaho pays for personal care in RALFs through both the Medicaid state plan personal care option and the Aged and Disabled 1915(c) waiver.

Regulation

IDAPA 16.03.22 (Residential Assisted Living Facilities); Idaho Code Title 39, Ch. 33

Program

Idaho Medicaid (Department of Health and Welfare)

Enrollment portal

Idaho Medicaid Health PAS OnLine (www.idmedicaid.com) — Trading Partner Account and Provider Enrollment Application

Fiscal agent

Gainwell Technologies

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

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

Idaho is moving its high-risk provider types to revalidation every three years, more often than the federal five-year minimum, and posts its 2026 revalidation correspondence with CMS on its enrollment page. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Idaho Medicaid enrollment guide →

CON program

No

Idaho certificate of need details →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

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)

206 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

307,060 (as of Jun 1, 2026)

All Idaho Home care Medicaid rates, ranked →

• Adult Developmental Disabilities Waiver (1915(c))
• Aged and Disabled Waiver (1915(c))
• 1915(i) State Plan HCBS Benefit for Children with Developmental Disabilities (1915(i))

Idaho waivers and waiting lists →