How to start a skilled nursing facility in New York

New York requires a Article 28 operating certificate — residential health care facility (nursing home) from New York State Department of Health; establishment approved by the Public Health and Health Planning Council to operate a skilled nursing facility.

License required

Yes

License

Article 28 operating certificate — residential health care facility (nursing home)

Issuing agency

New York State Department of Health; establishment approved by the Public Health and Health Planning Council

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

NY Public Health Law Article 28 (§§2801-a, 2802, 2802-b); 10 NYCRR Parts 600, 710 and 415

1. File a Certificate of Need application (with the CON schedules for administrative or full review) for establishment, construction, ownership change or change in service
2. Include a Health Equity Impact Assessment (PHL §2802-b)
3. DOH reviews public need, financial feasibility, and the character and competence of owners; PHHPC acts on establishment
4. Receive the operating certificate after construction and pre-opening survey
5. For Medicare/Medicaid, complete federal certification and enroll with NY Medicaid

Program

New York State Medicaid (NYS Department of Health; eMedNY)

Enrollment portal

NYS Medicaid Provider Services Portal (PSP)

Fiscal agent

eMedNY (NYS DOH's Medicaid claims system). Revalidation notices come from ProviderEnrollment@acentra.com. The eMedNY pages we reviewed do not name the claims contractor.

Application fee

Under 42 CFR 455.460, certain provider types and enrollment transactions owe an application fee, and the PSP tells you when one is due. The fee is waived if the provider is enrolled in Medicare or another state's Medicaid/CHIP program, or already paid the fee to Medicare. A hardship waiver can be requested with the application; New York forwards it to CMS. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.

Fingerprinting

High-risk providers undergo a fingerprint-based background check for every owner holding 5% or more. ABA providers, 1915(c) HCBS waiver providers and Licensed Home Care Services Agencies are newly designated high risk. Results of a Medicare screening can count toward fingerprinting.

Site visit

Moderate- and high-risk providers get pre- and post-enrollment site visits. Results of a Medicare screening can count toward the site visit requirement.

Revalidation

Revalidation frequency depends on risk level: high-risk every 3 years, moderate every 4, limited every 5. Since May 2026 all revalidation is done in the PSP; paper processes have ended. Under an April 2026 CMS directive, every provider is being revalidated over 24 months. Phase 1 covers high-risk, DME and providers not revalidated since the COVID-19 emergency began. Phase 2 (early 2027) covers newly high-risk ABA, 1915(c) HCBS and LHCSA providers. The remaining providers follow through June 2028. Wait for an individual notice before revalidating. Missing the deadline ends enrollment.

Full New York Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need (CON)

Agency

New York State Department of Health, Division of Planning & Licensure; Public Health and Health Planning Council (PHHPC) acts on establishment and full-review applications

Services covered

• hospitals
• nursing homes
• diagnostic and treatment centers (including ambulatory surgery and dialysis)
• midwifery birth centers
• certified home health agencies
• licensed home care services agencies
• long term home health care programs
• hospice
• establishment / transfers of ownership or control
• construction, renovation and major medical equipment

New York certificate of need details →

State minimum wage

$16.00 an hour

Effective

2026-01-01

Scheduled increases

No change on 2027-01-01: an off-ramp condition in the indexing law was met, so rates stay $17.00 (NYC, Long Island, Westchester) and $16.00 (rest of state).

Direct-care wage floor

Home care aide minimum wage: $19.65/hour in New York City, Long Island and Westchester and $18.65 elsewhere (from 2026-01-01), rising on 2027-01-01 to $20.00 and $19.00. Covers home health aides, personal care aides and similar in-home workers.

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)

1,169 (as of Sep 13, 2026)

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

593 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

6,380,652 (as of Jun 1, 2026)

All New York Skilled nursing Medicaid rates, ranked →