How to start a skilled nursing facility in Kentucky

Kentucky requires a Nursing facility license (provisional, then annual) from Kentucky Cabinet for Health and Family Services, Office of Inspector General (Division of Health Care) to operate a skilled nursing facility. Fee: Annual fee: 50 beds or fewer, $750 plus $25 per bed; 51 or more beds, $1,000 plus $25 per bed.

License required

Yes

License

Nursing facility license (provisional, then annual)

Issuing agency

Kentucky Cabinet for Health and Family Services, Office of Inspector General (Division of Health Care)

Fee

Annual fee: 50 beds or fewer, $750 plus $25 per bed; 51 or more beds, $1,000 plus $25 per bed.

Renewal

Every year

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

902 KAR 20:008 (license procedures and fee schedule); 902 KAR 20:300 (nursing facilities); KRS Chapter 216B

1. Obtain certificate of need approval from the Cabinet for new nursing facility beds or relocations that require it
2. Submit the Application for License to Operate a Long Term Care Facility to the Office of Inspector General with the fee
3. Receive a provisional license and pass the OIG inspection
4. Renew annually
5. For Medicare/Medicaid, complete federal certification and enroll with Kentucky Medicaid

Program

Kentucky Medicaid (Department for Medicaid Services)

Enrollment portal

Kentucky Medicaid Partner Portal Application (MPPA)

Fiscal agent

Gainwell Technologies (fiscal agent for KY Medicaid claim processing, KYHealth-Net)

Application fee

Kentucky's MAP-811 checklist tells providers subject to the fee to attach a check payable to the Kentucky State Treasurer; DMS's provider-type summaries say which types owe it. 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

Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Kentucky Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Kentucky Cabinet for Health and Family Services, Office of Inspector General

Services covered

• hospitals
• ambulatory surgical centers
• home health agencies
• hospice (including residential hospice by a non-hospice entity)
• nursing facilities, personal care homes, ICF and ICF/IID
• chemical dependency treatment programs
• psychiatric residential treatment facilities (Level I and II)
• PET, MRI, megavoltage radiation and cardiac catheterization
• open heart surgery and organ transplant programs
• special care neonatal beds
• prescribed pediatric extended care facilities
• ground ambulance providers (unless exempt)
• nonsubstantive review: adult day health, private duty nursing agencies, PACE, hospital-owned off-campus freestanding EDs, industrial ambulance, certain acute bed transfers

Kentucky 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)

626 (as of Sep 13, 2026)

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

267 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,264,449 (as of Jun 1, 2026)

All Kentucky Skilled nursing Medicaid rates, ranked →