How to start an assisted living facility in Nebraska

Nebraska requires a Assisted living facility license, required for anyone providing assisted living services to 4 or more residents from Nebraska Department of Health and Human Services, Division of Public Health — Licensure Unit to operate an assisted living facility. Fee: Initial and renewal license fees: 1–10 beds $950; 11–20 beds $1,450; 21–50 beds $1,650; 51+ beds $1,950. Duplicate license $10. If an application is denied without an inspection, the fee is refunded minus a $25 administrative fee.

License required

Yes

License

Assisted living facility license, required for anyone providing assisted living services to 4 or more residents

Issuing agency

Nebraska Department of Health and Human Services, Division of Public Health — Licensure Unit

Fee

Initial and renewal license fees: 1–10 beds $950; 11–20 beds $1,450; 21–50 beds $1,650; 51+ beds $1,950. Duplicate license $10. If an application is denied without an inspection, the fee is refunded minus a $25 administrative fee.

Renewal

Every year · Licenses expire April 30 each year. DHHS mails a renewal notice at least 30 days before; renew with the application and the same bed-based fee, online or by mail.

Medicaid waiver coverage

HHS's 2015 compendium reported that Medicaid covers assisted living services through the Aged and Disabled 1915(c) waiver and the traumatic brain injury waiver.

Regulation

175 NAC 4 (Assisted-Living Facilities); Assisted-Living Facility Act; Health Care Facility Licensure Act

1. Submit the initial ALF application with the bed-based fee
2. Complete the administrator requirements, including initial administrator training
3. Pass the DHHS inspection
4. Renew every year by April 30

Training

• Initial ALF administrator training

Program

Nebraska Medicaid (Heritage Health managed care), Division of Medicaid & Long-Term Care, Nebraska DHHS

Enrollment portal

Maximus Provider Data Management System (PDMS)

Fiscal agent

Maximus is the enrollment and screening contractor. DHHS's page sends fee-for-service claim questions to Nebraska DHHS Medicaid Claims Customer Service and names no separate claims fiscal agent.

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. Nebraska's screening and enrollment page does not list a separate state fee. The $55 fingerprint check is a separate cost (see fingerprinting).

Fingerprinting

Provider types that fall in the 'high risk' level of the Nebraska Medicaid Provider Risk Level list must complete a Fingerprint Criminal Background Check, both at enrollment and at revalidation. DHHS Provider Relations sends the packet. The check costs $55 through the Nebraska State Patrol; other fingerprint sites may add a fee. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. Nebraska's enrollment page does not describe a state-specific site visit process.

Revalidation

Every 5 years from the date of first enrollment. Maximus emails a notice as early as 180 days before the due date and sends reminders after that. The provider logs into PDMS, updates the record and submits it. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.

Full Nebraska Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need (Nebraska Health Care Certificate of Need Act)

Agency

Nebraska Department of Health and Human Services

Services covered

• new long-term care beds (nursing facility beds)
• long-term care bed increases above 10 beds or 10% (whichever is less) over two years
• new rehabilitation beds and rehabilitation bed increases above 10 beds or 10% over two years
• hospital conversion of beds to long-term care or rehabilitation beds above the same limits

Moratoria

All long-term care beds that need a CON are under a statutory moratorium unless an exception applies, such as a department finding that individuals with complex or intensive care needs are underserved (Neb. Rev. Stat. §71-5829.04). All rehabilitation beds that need a CON are under a moratorium unless statewide rehabilitation occupancy exceeded 90% for the last three consecutive quarters, or a regional occupancy exception applies (§71-5829.06).

Nebraska certificate of need details →

State minimum wage

$15.00 an hour

Effective

2026-01-01

Scheduled increases

LB 258 (approved 2026-02-09) changed the annual adjustment that starts 2027-01-01 and lets employers pay a $13.50 youth/training wage. The Nebraska DOL must publish the 2027 rate by 2026-10-15; it was not yet found.

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)

306 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

330,435 (as of Jun 1, 2026)

All Nebraska Home care Medicaid rates, ranked →

• NE Comprehensive Developmental Disabilities Services Waiver (1915(c))
• NE Developmental Disabilities Day Services Waiver for Adults (1915(c))
• NE Family Support Waiver (1915(c))
• NE HCBS Waiver for Aged, Adults, and Children with Disabilities (1915(c))
• NE Traumatic Brain Injury Waiver (1915(c))

Nebraska waivers and waiting lists →