How to start a skilled nursing facility in Alaska

Alaska requires a Nursing facility license (provisional initial license, then biennial license) from Alaska Department of Health, Health Facilities Licensing & Certification to operate a skilled nursing facility. Fee: Fees are set in 7 AAC 12.615; the application does not print the amount.

License required

Yes

License

Nursing facility license (provisional initial license, then biennial license)

Issuing agency

Alaska Department of Health, Health Facilities Licensing & Certification

Fee

Fees are set in 7 AAC 12.615; the application does not print the amount.

Renewal

Every 2 years · Renewal application due 90 days before the current license expires (AS 47.32.060); fees per 7 AAC 12.615.

Survey and inspection

Health Facilities Licensing & Certification nurse surveyors conduct state licensing surveys and federal certification surveys.

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

AS 47.32; 7 AAC 10; 7 AAC 12; AS 18.07.031 (certificate of need)

1. Obtain a Certificate of Need from the Department of Health (required to convert a building to a nursing home, and for qualifying capital expenditures)
2. Submit the state licensure application with fees
3. Set up criminal background checks through the Alaska Background Check Program
4. Receive a provisional license and pass the state licensing survey
5. Complete federal certification survey for Medicare/Medicaid participation

Staffing

• Administrator and supervising nurse/director of nursing named on the application

Program

Alaska Medicaid (Alaska Medical Assistance)

Enrollment portal

Alaska Medicaid Health Enterprise portal (online provider enrollment)

Fiscal agent

HMS Gainwell (Gainwell Technologies) — provider enrollment and fiscal agent services; the Health Enterprise MMIS is a Conduent system

Application fee

Alaska requires group providers and sole proprietors to pay the application fee (with an attestation form) at enrollment and again at revalidation, subject to the federal exceptions; a hardship waiver can be requested with a justification letter and financial records. 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

Alaska applies pre- and post-enrollment site visits to moderate- and high-risk group providers and sole proprietors at enrollment, revalidation and service-location changes; the site-visit date feeds into the enrollment effective date. 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

Alaska sets each provider's revalidation timing by its risk level; providers that miss their due date have payments held until the revalidation is processed. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Alaska Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Alaska Department of Health (decision by the commissioner)

Services covered

• hospitals (including psychiatric and tuberculosis hospitals)
• skilled nursing facilities / nursing home beds
• intermediate care facilities
• residential psychiatric treatment centers
• ambulatory surgical facilities
• kidney disease treatment centers / freestanding dialysis
• independent diagnostic testing facilities

Alaska certificate of need details →

State minimum wage

$14.00 an hour

Effective

2026-07-01

Scheduled increases

Rises to $15.00 on 2027-07-01 under Ballot Measure 1 (2024); annual inflation adjustments begin 2028-01-01.

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)

31 (as of Sep 13, 2026)

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

20 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

206,739 (as of Jun 1, 2026)

All Alaska Skilled nursing Medicaid rates, ranked →