How to start a skilled nursing facility in Idaho

Idaho requires a Skilled nursing facility license from Idaho Department of Health and Welfare, Division of Licensing and Certification — Bureau of Facility Standards to operate a skilled nursing facility. Processing time: Initial license application due at least three months (90 days) before the planned opening or ownership date.

License required

Yes

License

Skilled nursing facility license

Issuing agency

Idaho Department of Health and Welfare, Division of Licensing and Certification — Bureau of Facility Standards

Renewal

License expires on the date shown on it; renew on the Department form before expiration.

Processing time

Initial license application due at least three months (90 days) before the planned opening or ownership date.

Medicare certification

Medicare certification needs CMS-855A filed with the Medicare Administrative Contractor (Noridian), the CMS-1561 health insurance benefit agreement, CMS-671 and CMS-672, Office for Civil Rights clearance, hospital transfer agreements, and a federal survey against 42 CFR Part 483. Idaho Medicaid enrollment is separate.

Regulation

IDAPA 16.03.02 (Skilled Nursing Facilities)

1. File the Department-approved initial license application at least three months before opening
2. Include evidence of a request for a Section 1122 (Social Security Act) applicability determination, the administrator's license, and a local building/fire certificate of occupancy
3. Submit the fiscal-year-end form, full policies and procedures, lease or deed, organizational charts and any management contract
4. Pass state licensure and fire/life safety review
5. For Medicare: file CMS-855A with the MAC, CMS-1561, CMS-671/672, Office for Civil Rights clearance and hospital transfer agreements
6. Enroll with Idaho Medicaid

Staffing

• Licensed nursing home administrator

Program

Idaho Medicaid (Department of Health and Welfare)

Enrollment portal

Idaho Medicaid Health PAS OnLine (www.idmedicaid.com) — Trading Partner Account and Provider Enrollment Application

Fiscal agent

Gainwell Technologies

Application fee

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

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

Idaho is moving its high-risk provider types to revalidation every three years, more often than the federal five-year minimum, and posts its 2026 revalidation correspondence with CMS on its enrollment page. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Idaho Medicaid enrollment guide →

CON program

No

Idaho 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)

172 (as of Sep 13, 2026)

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

80 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

307,060 (as of Jun 1, 2026)

All Idaho Skilled nursing Medicaid rates, ranked →