How to start a skilled nursing facility in Florida

Florida requires a Nursing home license from Florida Agency for Health Care Administration (AHCA), Division of Health Quality Assurance to operate a skilled nursing facility. Fee: License fee $112.50 per bed for initial, renewal and change-of-ownership applications (a reduced per-bed rate applies to qualifying Gold Seal facilities); biennial assessment fee $4.00 per bed capped at $1,000; $25 fee for changes during the licensure period. Late fee applies if renewal arrives less than 60 days before expiration.

License required

Yes

License

Nursing home license

Issuing agency

Florida Agency for Health Care Administration (AHCA), Division of Health Quality Assurance

Fee

License fee $112.50 per bed for initial, renewal and change-of-ownership applications (a reduced per-bed rate applies to qualifying Gold Seal facilities); biennial assessment fee $4.00 per bed capped at $1,000; $25 fee for changes during the licensure period. Late fee applies if renewal arrives less than 60 days before expiration.

Renewal

Every 2 years

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

Ch. 400 Part II, F.S.; Ch. 408 Part II, F.S.; Rule Ch. 59A-4, F.A.C.; CON: s. 408.036, F.S., Rule 59C-1

1. Obtain a Certificate of Need from AHCA for new community nursing home beds
2. Submit AHCA Form 3110-6001 with the per-bed license fee and biennial assessment
3. Respond to any omission notice within 21 days
4. Pass the AHCA licensure survey
5. For Medicare/Medicaid, complete the federal certification survey and enroll with Florida Medicaid

Program

Florida Medicaid (Agency for Health Care Administration)

Enrollment portal

Florida Medicaid Web Portal (FLMMIS) — Enrollment Wizard

Fiscal agent

Gainwell Technologies (Florida Medicaid Web Portal / FLMMIS)

Application fee

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

Florida also requires Level 2 background screening (fingerprint-based, under s. 408.809, F.S.) as part of enrollment and revalidation. 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

AHCA assigns each provider type a limited, moderate or high risk level under 42 CFR 455.450. 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

Florida calls revalidation 'renewal': AHCA re-enrolls every provider at least every five years, mailing a notice about 90 days before the provider agreement expires. Claims suspend if the online renewal is not finished by the expiration date. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Florida Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Florida Agency for Health Care Administration (AHCA)

Services covered

• community nursing homes / skilled nursing facility beds
• hospice programs and hospice inpatient facilities
• intermediate care facilities for the developmentally disabled (ICF/DD)
• conversion from one type of covered facility to another

Florida certificate of need details →

State minimum wage

$15.00 an hour

Effective

2026-09-30

Scheduled increases

Stays $15.00 from 2026-09-30 through 2027-12-31; annual inflation adjustments resume with a September 2027 calculation that takes effect the following January 1.

Direct-care wage floor

The 2022-23 General Appropriations Act funded Medicaid fee schedule and managed care rate increases for the sole purpose of raising wages of Medicaid providers' direct care employees (including 1099 workers) to at least $15/hour.

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)

1,983 (as of Sep 13, 2026)

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

694 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

3,565,369 (as of Jun 1, 2026)

All Florida Skilled nursing Medicaid rates, ranked →