How to start a skilled nursing facility in Georgia

Georgia requires a Nursing home permit (provisional permit up to six months for a new home, then permit) from Georgia Department of Community Health, Healthcare Facility Regulation Division to operate a skilled nursing facility.

License required

Yes

License

Nursing home permit (provisional permit up to six months for a new home, then permit)

Issuing agency

Georgia Department of Community Health, Healthcare Facility Regulation Division

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

Ga. Comp. R. & Regs. 111-8-56 (Nursing Homes); O.C.G.A. §31-6 (CON)

1. Obtain a Certificate of Need from DCH's Office of Health Planning
2. File the permit application at least 30 days before opening, with professional staff bylaws, operating policies and staff acceptance certifications
3. Name the licensed administrator and licensed director of nursing on the application
4. Operate under a provisional permit (up to six months) while demonstrating compliance
5. Receive a full permit on satisfactory compliance; complete federal certification for Medicare/Medicaid

Staffing

• Licensed nursing home administrator
• Licensed director of nursing

Program

Georgia Medicaid and PeachCare for Kids (Department of Community Health)

Enrollment portal

Georgia Medicaid Management Information System (GAMMIS) — Enrollment Wizard

Fiscal agent

Gainwell Technologies (GAMMIS fiscal agent / third-party administrator; also handles CVO credentialing help)

Application fee

Georgia's Part I manual requires the fee from new, re-enrolling, revalidating and re-credentialing providers in the categories of service it lists, unless exempt, or a hardship waiver request instead. Applications without either are not processed, the fee is generally non-refundable, and an exempt provider pays once per service location even with several categories of service. 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

Georgia's high categorical risk categories are community mental health centers, newly enrolling home health agencies, and newly enrolling DME/orthotic and prosthetic supplier facilities. Georgia defines a criminal background check as a state and/or national fingerprint-based 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

DCH may do pre- and post-enrollment, unscheduled and unannounced site visits. Moderate-risk categories include ambulance providers, hospices, independent clinical labs, physical therapists, and revalidating home health agencies and DME suppliers. 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

DCH suspended providers that had not revalidated as of July 1, 2026; claims for dates of service from then on are not paid until the provider revalidates, and the new effective date is the revalidation submission date. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Georgia Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Georgia Department of Community Health (DCH), Office of Health Planning

Services covered

• hospitals (including destination cancer hospitals)
• special care units
• skilled nursing facilities
• intermediate care facilities
• personal care homes of 25 or more beds
• ambulatory surgical or obstetrical facilities
• freestanding emergency departments off a hospital's primary campus
• home health agencies
• health maintenance organizations
• certain diagnostic, treatment or rehabilitation centers
• bed capacity increases and new clinical services

Georgia 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)

839 (as of Sep 13, 2026)

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

356 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,817,766 (as of Jun 1, 2026)

All Georgia Skilled nursing Medicaid rates, ranked →