How to start a skilled nursing facility in Alabama

Alabama requires a Nursing facility license from Alabama Department of Public Health, Bureau of Health Provider Standards (State Board of Health) to operate a skilled nursing facility. Fee: Statutory fee set by Code of Ala. 1975 §22-21-24; the rule does not print the amount.

License required

Yes

License

Nursing facility license

Issuing agency

Alabama Department of Public Health, Bureau of Health Provider Standards (State Board of Health)

Fee

Statutory fee set by Code of Ala. 1975 §22-21-24; the rule does not print the amount.

Renewal

Every year · Licenses run for the calendar year and expire December 31; online renewal runs October 1 to December 31, with late fees through January 31.

Survey and inspection

ADPH Division of Health Care Facilities inspects for licensure and acts as the state survey agency for federal certification.

Certificate of need

Required

Medicare certification

Separate from the state license. The state survey agency runs an unannounced standard health survey, a Life Safety Code survey and an emergency-preparedness survey against 42 CFR Part 483 Subpart B. For a Medicare SNF the state certifies and the CMS Location decides Medicare participation; for a Medicaid-only NF the state's certification is final and the state Medicaid agency decides participation.

Regulation

Ala. Admin. Code ch. 420-5-10; Code of Ala. 1975 §22-21-20 et seq.; State Health Plan ch. 410-2-4 (nursing home bed need)

1. Obtain a Certificate of Need from the State Health Planning and Development Agency for new nursing home beds
2. Complete the ADPH pre-license filing
3. Submit the licensure application on the Board's form with the statutory fee
4. Pass the ADPH licensure inspection; a regular license issues on substantial compliance
5. For Medicare/Medicaid, complete the federal certification survey and enroll with the MAC and Alabama Medicaid

Program

Alabama Medicaid

Enrollment portal

Alabama Medicaid Electronic Provider Enrollment Application Portal (AMMIS)

Fiscal agent

Gainwell Technologies (runs the Provider Enrollment Unit for the Alabama Medicaid Agency)

Application fee

Alabama collects the fee from new and re-enrolling institutional provider types on its fee list (e.g., ASCs, community mental health centers, DMEPOS suppliers, ESRD clinics, FQHCs), paid by certified or cashier's check to the Alabama Medicaid Agency; the agency's participation requirements document carries the current amount. Hardship exceptions can be requested through the fiscal agent. 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

Alabama says skilled nursing facilities were moved to the high/moderate risk tier at CMS's direction, and high-risk enrollment triggers a fingerprint-based criminal background check. 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

Alabama states SNFs get a site visit at initial enrollment and at each 5-year revalidation. 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

Alabama notifies providers when they are due and posts monthly lists of providers due for revalidation; a file closed for missing revalidation requires a brand-new application. Revalidations can be uploaded through the secure web portal. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Alabama Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Alabama State Health Planning and Development Agency (SHPDA); applications decided by the Certificate of Need Review Board

Services covered

• hospitals (general, specialized, psychiatric, long-term care)
• skilled nursing facilities
• intermediate care facilities
• rehabilitation centers
• ambulatory surgery facilities
• kidney disease treatment / freestanding dialysis
• community mental health centers
• alcohol and drug abuse facilities
• facilities for the developmentally disabled
• hospice
• home health agencies
• health maintenance organizations

Alabama 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.

Skilled nursing facilities — active organization NPIs (NPPES)

413 (as of Sep 13, 2026)

Medicare/Medicaid-certified nursing homes (CMS Care Compare)

224 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

930,919 (as of Jun 1, 2026)

All Alabama Skilled nursing Medicaid rates, ranked →