How to start a skilled nursing facility in Minnesota

Minnesota requires a Nursing home license from Minnesota Department of Health, Health Regulation Division to operate a skilled nursing facility. Fee: License fee in the amount set by statute (referenced in Minn. Stat. §144A.03); amount not restated here.

License required

Yes

License

Nursing home license

Issuing agency

Minnesota Department of Health, Health Regulation Division

Fee

License fee in the amount set by statute (referenced in Minn. Stat. §144A.03); amount not restated here.

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

Minn. Stat. §§144A.02–144A.04, 144A.071 (moratorium), 144A.073 (exceptions)

1. New licensed or Medicaid-certified nursing home beds are denied under the moratorium unless an exception applies (Minn. Stat. §144A.071 subd. 3/4a or the §144A.073 exception process)
2. Apply for a moratorium exception when the commissioner publishes a request for proposals (if the legislature funds exceptions)
3. Construction projects over $1,000,000 need approval under the moratorium rules
4. Submit the nursing home license application with business and legal entity names, bed capacity and license fee
5. Pass MDH licensure survey; for Medicare/Medicaid complete federal certification and enroll with Minnesota DHS

Program

Minnesota Health Care Programs (MHCP) — Medical Assistance and MinnesotaCare (Minnesota DHS)

Enrollment portal

Minnesota Provider Screening and Enrollment (MPSE) portal

Fiscal agent

None named — Minnesota DHS enrolls providers itself (MPSE/MN-ITS)

Application fee

DHS's Minnesota Revalidate 2026 FAQ refers to a revalidation fee that applies to some providers. 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

Minnesota runs background studies through NETStudy 2.0; DHS's revalidation FAQ covers when fingerprints are needed for high-risk revalidation. 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

As part of Minnesota Revalidate 2026, DHS does unannounced site visits for high-risk services, including at locations where providers had never had one before. 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

Under the federally directed 'Minnesota Revalidate 2026' effort, providers of 13 services designated high risk had to complete an off-cycle revalidation by May 31, 2026; those who did not got disenrollment notices, with appeal rights. Notices arrive in the MN-ITS mailbox and providers revalidate in MPSE. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Minnesota Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

No

Agency

Minnesota Department of Health (moratorium exceptions and public interest reviews)

Moratoria

Hospital moratorium (Minn. Stat. §144.551): no new hospitals and no construction that increases hospital bed capacity or relocates beds, except projects specifically listed in statute (many after a Department of Health public interest review). Nursing home moratorium (Minn. Stat. §144A.071): the commissioners of health and human services must deny requests for new licensed or certified nursing home or certified boarding care beds unless an exception or the moratorium exception process in §144A.073 applies.

Minnesota certificate of need details →

State minimum wage

$11.41 an hour

Effective

2026-01-01

Scheduled increases

Rises to $11.87 on 2027-01-01 (inflation adjustment); 90-day training wage for workers under 20 is $9.68.

Direct-care wage floor

Nursing Home Workforce Standards Board minimum wages for nursing home workers, effective 2026-09-10: general worker $19.00, CNA $22.50, trained medication aide $23.50, LPN $27.00; rising 2027-01-01 to $20.50, $24.00, $25.00 and $28.50.

Rate pass-through

Personal care assistance agencies must spend at least 72.5% of Medicaid PCA revenue on PCA wages and benefits.

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)

650 (as of Sep 13, 2026)

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

338 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,128,624 (as of Jun 1, 2026)

All Minnesota Skilled nursing Medicaid rates, ranked →