How to start an assisted living facility in Alabama

Alabama requires a Assisted living facility license (family, group or congregate by size); separate specialty care assisted living facility (SCALF) license for residents with significant cognitive impairment from Alabama Department of Public Health, Bureau of Health Provider Standards to operate an assisted living facility. Fee: Application fee is set by statute (Code of Ala. §22-21-24); the rule does not print the amount. Fees are non-refundable and an application sent without a fee is returned.

License required

Yes

License

Assisted living facility license (family, group or congregate by size); separate specialty care assisted living facility (SCALF) license for residents with significant cognitive impairment

Issuing agency

Alabama Department of Public Health, Bureau of Health Provider Standards

Fee

Application fee is set by statute (Code of Ala. §22-21-24); the rule does not print the amount. Fees are non-refundable and an application sent without a fee is returned.

Renewal

Every year · Licenses run for the calendar year and expire December 31. Online renewal runs October 1 to December 31; a facility that has not renewed (and paid any late fees) by January 31 is no longer licensed.

Survey and inspection

Facilities are inspected periodically by the Board of Health; the first inspection may occur during construction (HHS 2015 profile).

Medicaid waiver coverage

HHS's 2015 compendium reported that Alabama did not pay for services in either type of assisted living facility through Medicaid or other public programs. No current state source reviewed says otherwise.

Regulation

Ala. Admin. Code ch. 420-5-4 (assisted living facilities); ch. 420-5-20 (specialty care assisted living facilities); Code of Ala. §22-21-20 et seq.

1. File the pre-license filing and licensure application with the Bureau of Health Provider Standards
2. Pay the statutory application fee
3. Pass the Board of Health inspection (may begin during construction)
4. Renew every calendar year online

Program

Alabama Medicaid

Enrollment portal

Alabama Medicaid Electronic Provider Enrollment Application Portal (AMMIS)

Fiscal agent

Gainwell Technologies (runs the Provider Enrollment Unit for the Alabama Medicaid Agency)

Application fee

Alabama collects the fee from new and re-enrolling institutional provider types on its fee list (e.g., ASCs, community mental health centers, DMEPOS suppliers, ESRD clinics, FQHCs), paid by certified or cashier's check to the Alabama Medicaid Agency; the agency's participation requirements document carries the current amount. Hardship exceptions can be requested through the fiscal agent. 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

Alabama says skilled nursing facilities were moved to the high/moderate risk tier at CMS's direction, and high-risk enrollment triggers a fingerprint-based criminal background check. 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

Alabama states SNFs get a site visit at initial enrollment and at each 5-year revalidation. 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

Alabama notifies providers when they are due and posts monthly lists of providers due for revalidation; a file closed for missing revalidation requires a brand-new application. Revalidations can be uploaded through the secure web portal. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Alabama Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Alabama State Health Planning and Development Agency (SHPDA); applications decided by the Certificate of Need Review Board

Services covered

• hospitals (general, specialized, psychiatric, long-term care)
• skilled nursing facilities
• intermediate care facilities
• rehabilitation centers
• ambulatory surgery facilities
• kidney disease treatment / freestanding dialysis
• community mental health centers
• alcohol and drug abuse facilities
• facilities for the developmentally disabled
• hospice
• home health agencies
• health maintenance organizations

Alabama 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.

Assisted living facilities — active organization NPIs (NPPES)

99 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

930,919 (as of Jun 1, 2026)

All Alabama Home care Medicaid rates, ranked →

• Community Transition (ACT) Waiver (1915(c))
• Community Waiver Program (1915(c))
• Home and Community-Based Waiver for the Elderly and Disabled (1915(c))
• Home and Community-Based Waiver for Persons with Intellectual Disabilities (1915(c))
• HCBS Living at Home Waiver for Persons with Intellectual Disabilities (LAH) Waiver (1915(c))
• SAIL Waiver (1915(c))
• Technology Assisted (TA) Waiver (1915(c))

Alabama waivers and waiting lists →