How to start an assisted living facility in North Dakota

North Dakota requires a Assisted living facility license (5+ living units / 5+ unrelated people). Basic care facilities are a separate state license that makes them eligible for state basic care funding. from North Dakota Department of Health and Human Services — Health Response and Licensure Section, plus Food and Lodging licensing to operate an assisted living facility. Fee: $75.

License required

Yes

License

Assisted living facility license (5+ living units / 5+ unrelated people). Basic care facilities are a separate state license that makes them eligible for state basic care funding.

Issuing agency

North Dakota Department of Health and Human Services — Health Response and Licensure Section, plus Food and Lodging licensing

Fee

$75

Fee details

Annual assisted living license fee of $75 per facility (N.D.C.C. 50-32). A separate Food and Lodging license and fees also apply (N.D. Admin. Code 33-33-08).

Renewal

Every year · Assisted living facilities apply for a license every year.

Medicaid waiver coverage

HHS's 2015 compendium reported that North Dakota's HCBS 1915(c) waiver paid for residential care in basic care facilities (not ALFs), and the state plan Basic Care Assistance Program supplemented basic care costs. Basic care bed capacity is under a statutory expansion moratorium.

Regulation

N.D.C.C. ch. 50-32; N.D. Admin. Code 75-03-34 (assisted living); basic care: N.D.C.C. 23-09.3 and N.D. Admin. Code 33-03-24.1

1. Submit SFN 452, Application for a License to Operate an Assisted Living Facility, to the Health Response and Licensure Section
2. Get the Food and Lodging license
3. Pay the $75 annual license fee
4. Renew every year

Program

North Dakota Medicaid (ND Health and Human Services, Medical Services Division), including Medicaid Expansion

Enrollment portal

ND Health Enterprise MMIS Web Portal

Fiscal agent

Noridian Healthcare Solutions (provider enrollment contractor for every provider type except Qualified Service Providers)

Application fee

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. ND HHS's enrollment page does not list a separate state fee.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. ND HHS's enrollment page does not list high-risk provider types. It does collect ownership and controlling-interest conviction information on form SFN 1168.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. ND HHS's enrollment page does not describe a separate state site visit process.

Revalidation

All provider records revalidate at least every five years; DME suppliers every three years. ND HHS posts a list of providers with upcoming or past-due revalidations. If the group or individual is actively enrolled in Medicare, ND Medicaid relies on Medicare's screening to speed things up. If not, the provider repeats the application-requirement and Noridian-submission steps.

Full North Dakota Medicaid enrollment guide →

CON program

No

Agency

North Dakota Department of Health and Human Services (facility licensing; bed moratorium)

Moratoria

Nursing facility beds may not be added to the state's licensed bed capacity between August 1, 2025 and July 31, 2029, except when a facility reverts basic care beds to nursing beds or relicenses beds delicensed after July 31, 2011. Licensed bed capacity may be transferred between entities, and a facility may reconfigure its nursing bed capacity no more than twice in 12 months (NDCC 23-16-01.1).

North Dakota 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)

44 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

104,194 (as of Jun 1, 2026)

All North Dakota Home care Medicaid rates, ranked →

• ND Autism Spectrum Disorder (ASD) Birth through Twenty Waiver (1915(c))
• ND Children's Hospice Waiver (1915(c))
• ND Medicaid Waiver for Home and Community Based Services (1915(c))
• ND Medicaid Waiver for Medically Fragile Children (1915(c))
• ND Traditional IID/DD Home and Community Based Services Waiver (1915(c))

North Dakota waivers and waiting lists →