How to start a skilled nursing facility in Connecticut

Connecticut requires a Chronic and convalescent nursing home (CCNH) license from Connecticut Department of Public Health, Facility Licensing & Investigations Section to operate a skilled nursing facility.

License required

Yes

License

Chronic and convalescent nursing home (CCNH) license

Issuing agency

Connecticut Department of Public Health, Facility Licensing & Investigations Section

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

CGS §17b-354 (moratorium on additional nursing home beds); CGS §19a-490 et seq.; RCSA §19-13-D8t

1. Because new nursing home beds are under an indefinite moratorium, acquire an existing licensed home
2. Send DPH a letter of intent at least 90 days before the ownership transfer
3. Apply for a nursing home license and submit to criminal background checks of officers and directors
4. Meet in person with DPH and DSS and sign pre-license physical plant and clinical consent orders
5. For Medicare/Medicaid, complete federal certification and enroll with Connecticut Medicaid

Program

Connecticut Medical Assistance Program (HUSKY Health)

Enrollment portal

CMAP Provider Enrollment/Re-enrollment Wizard (www.ctdssmap.com)

Fiscal agent

Gainwell Technologies (Provider Enrollment Unit, Hartford)

Application fee

Connecticut's application asks institutional providers to pay or attest to prior payment of the federal fee at enrollment, re-enrollment and when adding a service location; DSS sends a letter after submission if a fee is due. 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

The enrollment wizard states that fingerprint-based checks apply to providers placed in the high-risk level at enrollment or re-enrollment. 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

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

Connecticut calls revalidation 're-enrollment': most provider types re-enroll every five years, with a notice letter six months before their contract ends. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Connecticut Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Connecticut Office of Health Strategy, Health Systems Planning Unit (hospitals, surgery centers, behavioral health, imaging, ownership transfers); Department of Social Services for nursing homes and residential facilities for persons with intellectual disability

Services covered

• new health care facilities (hospitals, specialty hospitals)
• freestanding emergency departments
• outpatient surgical facilities
• mental health facilities
• substance abuse treatment facilities
• cardiac services
• termination of hospital services
• transfers of ownership of health care facilities and large group practices
• nursing homes (DSS)
• residential facilities for persons with intellectual disability / ICF (DSS)

Moratoria

CGS §17b-354 bars the Department of Social Services from accepting or approving requests for additional nursing home beds, with limited exceptions (e.g., beds restricted to AIDS or neurological rehabilitation patients, certain continuing care facility beds not used for Medicaid, and Medicaid bed relocations that meet a priority need in the state strategic plan).

Connecticut certificate of need details →

State minimum wage

$16.94 an hour

Effective

2026-01-01

Scheduled increases

Rises to $17.48 on 2027-01-01 (indexed to the employment cost index).

Rate pass-through

PA 25-168 raises nursing home Medicaid rates to fund wage increases for nursing, aide, dietary, housekeeping, laundry and maintenance staff: 3% on 2025-07-01, 3% on 2026-07-01 and 4% on 2027-01-01. A home that takes the add-on but does not raise wages may have its rate cut by the same amount. A further pool in FY2028 is aimed first at a $26/hour CNA minimum from 2028-01-01, to the extent funds allow.

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)

500 (as of Sep 13, 2026)

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

191 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

895,290 (as of Jun 1, 2026)

All Connecticut Skilled nursing Medicaid rates, ranked →