Last updated 2026-07-25
TL;DR
There's no federal assisted living license. Each state's health or aging agency issues its own, typically requiring a business entity, a suitable building (with fire marshal and health department sign-off), written policies, staff qualifications, a criminal background check, and a pre-licensure survey. Timelines commonly run 3 to 9 months and fees usually range from a few hundred to a few thousand dollars.
What is assisted living?
Assisted living is a licensed residential setting for adults, usually seniors, who need help with daily activities like bathing, dressing, medication reminders, and meals but don't need the round-the-clock skilled nursing care of a nursing home. It sits between independent living and a nursing facility on the care spectrum. The federal government doesn't define or regulate assisted living directly. There's no federal assisted living license, no CMS certification for the category the way there is for nursing homes. Each state writes its own definition, licensing category, and rulebook, which is why a "Level II" home in Florida looks nothing like an "Adult Foster Care" home in Michigan or a "Residential Care Facility for the Elderly" in California. The Centers for Medicare & Medicaid Services confirms this directly on Medicare.gov: assisted living costs fall under "long-term care," and Medicare "doesn't cover long-term care (also called custodial care) if that's the only care you need" [1]. Most states require the operator to hold a state-issued license before admitting a single resident, and that license attaches to a specific physical address, not to a person or a company name. Move the business, and you re-license.
What is a group home?
A group home is a small residential facility, often a single-family house, where a handful of unrelated residents live together and receive supervision or care from paid staff. The term gets used loosely, but in licensing language it usually means something smaller and more home-like than a big assisted living building. Group homes serve different populations depending on the state and the license type: adults with intellectual or developmental disabilities, people in mental health recovery, or seniors who need less medical support than a nursing home but more than living alone allows. Some states fold "group home" and "assisted living" into the same licensing category (adult foster care states like Michigan and Oregon do this). Others keep them completely separate, with group homes for IDD or behavioral health licensed by one agency and senior assisted living licensed by another. If you're planning a small home serving 4 to 8 residents, check whether your state's assisted living rules even apply, or whether you actually need a group home / adult foster care / community residential license instead. Picking the wrong category on your application is one of the most common delays operators run into.
What is an assisted living facility?
An assisted living facility (ALF) is the licensed building and business itself, the physical place where residents live, plus the staff, meal service, medication management, and activities program that come with it. States use different official names for the same basic concept: Residential Care Facility, Personal Care Home, Assisted Living Residence, Adult Care Home. All of them share a common structure in the rules. There's a licensing category based on resident acuity (how much care residents need), a maximum capacity, staffing ratios tied to that capacity, physical plant requirements (room size, number of bathrooms, fire suppression), and an inspection or survey before the license gets issued. Florida's statute defines an assisted living facility as any building or buildings, section, or distinct part of a building, private home, boarding home, home for the aged, or other residential facility that undertakes through its ownership or management to provide housing, meals, and one or more personal services for a period exceeding 24 hours to one or more adults who are not relatives of the owner or administrator [2]. That 24-hour threshold is common across states as the line between assisted living and simple short-term lodging.
What does assisted living provide?
Assisted living typically provides a private or semi-private room, three meals a day, housekeeping and laundry, help with activities of daily living (bathing, dressing, toileting, transferring, eating), medication management or reminders, social and recreational activities, and 24-hour staff availability for supervision and emergencies. What it does not provide, in most states, is skilled nursing care. Assisted living residents generally cannot require ventilators, IV therapy, complex wound care, or continuous nursing supervision. If a resident's needs exceed what the license allows, the facility has to either get a higher-acuity license endorsement (many states offer one, like a "limited nursing services" add-on) or discharge the resident to a nursing home. Medication management deserves its own callout because it's the single most cited deficiency category in state surveys. Staff in most states can assist with self-administration (opening bottles, reminding, logging) but cannot administer medications themselves unless they hold a specific certification the state recognizes, often a medication aide or CNA-plus credential. Get this wrong and it shows up on your first survey.
How do I start a group home or assisted living business?
Starting a group home or assisted living facility follows roughly the same nine-step sequence in almost every state, even though the specific forms and agency names differ. 1. Pick your license category and population. Confirm with your state licensing agency whether you need an assisted living, residential care, or adult foster care license, and what resident population and acuity level it allows. 2. Form your business entity. Most states require an LLC or corporation registered with the Secretary of State before you can apply for a license, since the license is issued to the entity, not to an individual. 3. Secure and zone the property. Confirm your local zoning allows a residential care use at that address, and budget for a possible zoning variance or conditional use permit. See our guide on zoning and property issues specific to group homes. 4. Pass fire marshal and building/health inspections. Expect requirements around sprinklers, egress, smoke detectors, and ADA-style accessibility depending on capacity. 5. Write your policy and procedure manual. States require written policies covering admission/discharge criteria, medication management, emergency preparedness, resident rights, staffing plans, and abuse reporting. 6. Hire and background-check staff. Administrators often need a specific license or certification (confirm with your state licensing agency for hour requirements), and direct care staff need cleared background checks before hire. 7. Submit the license application and fee. Fees vary widely by state and by capacity; confirm current amounts with your state licensing agency. 8. Pass the pre-licensure survey. A state surveyor inspects the physical plant, reviews your policy manual, and checks staff files before issuing the initial license. 9. Get your license and open. Most states issue an initial license for one year, with renewal tied to an annual or biennial survey cycle. Building this paperwork from scratch, state statute by state statute, is the part that eats the most time. That's the exact gap our $299 State Group Home Licensing Kit is built to close: state-specific policy manual templates, staffing plan worksheets, and application checklists so you're not reinventing a medication management policy from a blank page.
What is the difference between assisted living and a nursing home?
| Federal oversight | None (state-only) | CMS certification for Medicare/Medicaid [1] | |
|---|---|---|---|
| Care level | ADL help, medication reminders | Skilled nursing, rehab, complex medical care | |
| Staffing | Direct care aides, admin, often no RN required 24/7 | Licensed nurses on duty, physician oversight | |
| Typical setting | Private/semi-private room, home-like | Hospital-like, medical equipment | |
| Payer | Private pay, long-term care insurance, some state Medicaid waivers | Medicare (short-term), Medicaid, private pay | The practical dividing line most surveyors use: if a resident needs a nurse managing their care continuously, or needs rehabilitation after a hospital stay, that's a nursing home stay. If they mainly need supervision, help with ADLs, and a safe place to live, that's assisted living. |
Assisted living and nursing homes differ mainly in the level of medical care provided and the regulatory body that oversees them. Nursing homes provide skilled nursing care around the clock, ordered and supervised by physicians, and they're certified by CMS for Medicare and Medicaid participation. Assisted living provides help with daily living activities but not skilled nursing, and it has no federal certification at all. | Feature | Assisted living | Nursing home |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board or personal care services at an assisted living facility. Medicare.gov states plainly that Medicare "doesn't cover long-term care (also called custodial care)" if that's the only care a person needs, which is exactly the service model assisted living provides [1]. Medicare can still pay for Medicare-covered medical services a resident receives while living in assisted living, things like doctor visits, physical therapy, or a covered hospital stay, but it will not pay the facility's monthly rate for housing, meals, or personal care assistance. Medicaid is a different story, and it's state-dependent. Many states cover some assisted living costs through a Medicaid Home and Community-Based Services (HCBS) waiver under Section 1915(c) of the Social Security Act, which lets states pay for services (not room and board) in a residential setting as an alternative to nursing home placement [3]. Coverage, waiting lists, and eligibility rules vary enormously by state, so any resident or family relying on Medicaid needs to check that specific state's waiver program, not assume coverage exists.
What staffing does an assisted living license require?
Every state sets minimum staffing based on resident count and acuity, but the general shape is the same: an administrator who holds (or is working toward) a state-required credential, direct care staff on-site 24 hours a day, and someone awake and available overnight even in facilities that don't require awake overnight staff for every resident. Most states require the administrator to complete a state-approved training course, sometimes 40 to 100 hours depending on the state, plus continuing education to renew. Direct care staff typically need a criminal background check clearance, a TB test or health screening, and orientation training within the first 30 to 90 days of hire, covering topics like resident rights, emergency procedures, and infection control. Staff-to-resident ratios are almost never written as a single number in the statute; they're usually tied to acuity level and time of day (day shift needs more staff than night shift, and a home with higher-acuity residents needs more staff than one with independent residents who just need meal service). Confirm your state's specific ratio and credentialing requirements with your state licensing agency before you build a staffing budget, because guessing wrong here is the fastest way to fail a survey.
What does the assisted living license application and inspection process look like?
The application itself is usually a packet: entity documents, floor plans, fire marshal approval, health department approval, policy manual, staffing plan, administrator credentials, and the license fee. Processing time after a complete application is submitted commonly runs 30 to 90 days, though incomplete applications or ones needing zoning appeals can stretch to 6 to 9 months overall. Before the state issues the initial license, a surveyor visits the property. This is not a courtesy walkthrough. Surveyors check life safety (fire extinguishers, exit signage, smoke detectors, sprinkler documentation), sanitation (kitchen storage temperatures, pest control), resident record systems, medication storage and logs, and staff files for background checks and training documentation. After licensure, expect ongoing surveys. Most states survey licensed facilities annually, some every two years, plus complaint-driven inspections that can happen any time someone files a report. Our inspections guide walks through what surveyors flag most often and how to prep a mock survey before the real one.
How much does it cost to get an assisted living license?
License application fees themselves are usually the smallest cost in the whole process, often ranging from a few hundred dollars up to a couple thousand, frequently scaled by facility capacity. That number is nowhere near the real cost of getting open. The bigger costs are the property (purchase, lease, or renovation to meet fire and ADA-style code), sprinkler system installation if the building doesn't already have one, staff wages before you have paying residents, liability insurance, and the policy manual and staffing plan development if you're paying a consultant to write it. Confirm your specific license fee, renewal fee, and any per-bed surcharge with your state licensing agency, since these numbers change and vary by capacity tier. A realistic budget planning exercise treats the state license fee as a rounding error and the building/fire code compliance as the real capital cost. Operators who underestimate the fire suppression and egress requirements are the ones who blow past their opening date.
What policies and procedures does an assisted living license require?
States require a written policy and procedure manual as part of the license application, and surveyors check it against actual practice during the survey. Core required policies typically include: admission and discharge criteria, medication management and storage, emergency preparedness and evacuation, infection control, resident rights and grievance procedures, abuse/neglect reporting, staffing plans by shift, and incident/accident reporting. The manual can't just exist on paper. Surveyors interview staff and check logs to confirm the facility actually follows what the manual says. A beautiful medication management policy means nothing if the medication log has gaps or the med room isn't locked. See our guide to policies and procedures for a section-by-section breakdown of what belongs in each required policy, and what surveyors specifically look for when they review yours.
Where can I learn more about assisted living facilities by state?
Because every state runs its own licensing system, the single best starting point is always your specific state's health department, department of aging, or department of social/human services (the responsible agency varies by state). Search "[your state] assisted living license application" and look for a.gov domain. For a broader look at what an assisted living facility is and how definitions vary, or research on assisted living facilities near a specific market, our state-by-state guides break down the agency names, license categories, and typical fee ranges state by state. We also cover assisted living at home models for operators considering a smaller residential setting instead of a large facility, and how to evaluate senior assisted living facilities near me style competitive research before choosing a market.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential option for adults who need help with daily activities like bathing, dressing, and medication reminders, but don't need full-time skilled nursing care. It's regulated entirely at the state level; there's no federal assisted living certification or license, per CMS guidance on long-term care coverage.
What is a group home?
A group home is a small residential facility, often a house, where a handful of unrelated residents live together with staff support. States use the term for different populations, adults with disabilities, mental health recovery residents, or seniors, depending on the licensing category, so check your state's specific definition before applying.
What is an assisted living facility?
An assisted living facility is the licensed building and business providing housing, meals, and personal care services to residents for more than 24 hours at a time. Florida law, for example, defines it as a facility providing housing, meals, and one or more personal services to adults needing help with daily living.
What is assisted living vs nursing home?
Assisted living provides help with daily activities in a home-like setting with no federal certification; nursing homes provide skilled, physician-supervised medical care and are certified by CMS for Medicare and Medicaid. The core difference is medical acuity: nursing homes handle complex or continuous medical needs, assisted living does not.
What does assisted living provide?
Assisted living typically provides a room, meals, housekeeping, help with bathing/dressing/toileting, medication reminders, social activities, and 24-hour staff availability. It generally does not provide skilled nursing care like IV therapy or ventilator support, which would require a nursing home or a higher-acuity licensed setting instead.
How do I start a group home?
Confirm your state's license category and population rules, form a business entity, secure a zoning-compliant property, pass fire and health inspections, write required policies, hire background-checked staff, submit your license application and fee, and pass the pre-licensure survey. The exact sequence and forms vary by state licensing agency.
Does Medicare cover assisted living facilities?
No. Medicare.gov states Medicare doesn't cover long-term custodial care, which is the core service model of assisted living. Medicare may cover specific medical services a resident receives while living there, like doctor visits or physical therapy, but not room, board, or personal care costs.
Does Medicaid pay for assisted living?
In many states, yes, partially, through Medicaid Home and Community-Based Services waivers authorized under Section 1915(c) of the Social Security Act, which can cover services (not room and board) in a residential setting. Coverage, eligibility, and waiting lists vary significantly by state, so check your specific state Medicaid agency.
How long does it take to get an assisted living license?
Once a complete application is submitted, processing commonly takes 30 to 90 days. Total time from starting the process (entity formation, zoning, property renovation, staffing) to opening day often runs 3 to 9 months, longer if zoning appeals or major construction are involved.
How much does an assisted living license cost?
State license application fees typically range from a few hundred to a couple thousand dollars, often scaled by facility capacity. That's usually the smallest cost; property, fire suppression system installation, insurance, and pre-opening staffing wages cost far more. Confirm exact fees with your state licensing agency.
Do I need a special credential to run an assisted living facility?
Most states require the facility administrator to complete a state-approved training course, often 40 to 100 hours, and hold a state administrator license or certificate. Requirements and hour counts vary by state, so confirm the exact credential and renewal requirements with your state licensing agency before hiring or acting as administrator.
What's the difference between assisted living and adult foster care?
Adult foster care usually means a smaller, home-based setting (often under state caps like 6 residents) licensed under a different statute than large assisted living facilities, though some states use the terms almost interchangeably. Capacity limits, staffing ratios, and physical plant rules differ, so confirm which category fits your planned home size.
Sources
- Medicare.gov, Long-Term Care coverage: Medicare doesn't cover long-term custodial care and assisted living is regulated at the state level, not federally certified
- Florida Statutes Section 429.02, Definitions (Assisted Living Facilities Act): Florida's statutory definition of an assisted living facility, including the 24-hour housing/meals/personal services threshold
- Medicaid.gov, Home & Community-Based Services 1915(c): States can use Section 1915(c) HCBS waivers to cover services in residential settings as an alternative to nursing home placement
- 42 CFR 483.5, Definitions (skilled nursing facility and nursing facility): Federal definitions distinguishing skilled nursing facilities from other residential care settings, underpinning CMS certification for nursing homes but not assisted living
- Social Security Act Section 1915(c), 42 U.S.C. 1396n(c): Statutory authority allowing states to waive Medicaid requirements to cover home and community-based services as an alternative to institutional care