How to start an assisted living facility in New Hampshire

New Hampshire requires a Assisted living residence–residential care facility license (He-P 804) or supported residential health care facility license (He-P 805) from New Hampshire Department of Health and Human Services, Health Facilities Administration (Health Facilities Licensing) to operate an assisted living facility. Fee: $15 per licensed bed for residential and supported residential care homes (804 and 805); no charge for beds of Choices for Independence (CFI) or state-placed residents.

License required

Yes

License

Assisted living residence–residential care facility license (He-P 804) or supported residential health care facility license (He-P 805)

Issuing agency

New Hampshire Department of Health and Human Services, Health Facilities Administration (Health Facilities Licensing)

Fee

$15 per licensed bed for residential and supported residential care homes (804 and 805); no charge for beds of Choices for Independence (CFI) or state-placed residents.

Renewal

Renewal uses the same application form and per-bed fee schedule.

Medicaid waiver coverage

HHS's 2015 compendium reported that New Hampshire's Choices for Independence 1915(c) waiver pays for assisted living services.

Regulation

RSA 151; N.H. Admin. Rules He-P 804 and He-P 805

1. Complete the Health Facilities Administration initial/renewal application under RSA 151:4
2. Submit supplemental information and the per-bed licensing fee
3. Pass the clinical and life safety inspection before the initial license issues

Program

New Hampshire Medicaid (Fee for Service and Medicaid Care Management), NH DHHS

Enrollment portal

New Hampshire MMIS Health Enterprise Portal

Fiscal agent

Conduent (runs the NH MMIS portal and the Provider Relations call center)

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. NH DHHS provider pages do not list a separate state fee.

Fingerprinting

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. NH DHHS provider pages do not list which provider types are high risk.

Site visit

NH DHHS says moderate- and high-risk providers must have a site visit and limited-risk providers do not. A Medicare site visit done within the past 5 years satisfies the requirement for NH Medicaid revalidation. 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.

Revalidation

Every enrolled provider (billing, rendering and ordering/referring/prescribing) revalidates about every 5 years, online in the MMIS portal only. The state mails and emails notices 60 days and 30 days before the due date and on the due date itself. No extensions are given. A provider who misses revalidation can have claims suspended, then loses fee-for-service enrollment and, after that, its health plan participation. Revalidating with Medicare, with another state or with a health plan does not count. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.

Full New Hampshire Medicaid enrollment guide →

CON program

No

Agency

New Hampshire Department of Health and Human Services (facility licensing)

Moratoria

RSA 151:2, VI bars new licenses and licensed-capacity increases for nursing homes, skilled nursing facilities, intermediate care facilities and rehabilitation facilities (including rehabilitation hospitals). Exceptions cover substance use / mental health rehabilitation facilities, continuing care facilities with an insurance-commissioner certificate of authority, and same-county transfers of beds that existed on July 1, 2016 without reducing county Medicaid beds. Pediatric ICFs existing before July 1, 2023 may house 2 extra residents through June 30, 2026.

New Hampshire 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)

91 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

167,648 (as of Jun 1, 2026)

All New Hampshire Home care Medicaid rates, ranked →

• NH Acquired Brain Disorder Waiver (1915(c))
• NH Choices for Independence Waiver (1915(c))
• NH Developmental Disabilities Waiver (1915(c))
• NH In Home Supports for Children with Developmental Disabilities (1915(c))

New Hampshire waivers and waiting lists →