How to start a skilled nursing facility in Illinois

Illinois requires a Long-term care facility license — skilled nursing facility (Nursing Home Care Act) from Illinois Department of Public Health, Office of Health Care Regulation — Bureau of Long-Term Care to operate a skilled nursing facility. Fee: $1,990.

License required

Yes

License

Long-term care facility license — skilled nursing facility (Nursing Home Care Act)

Issuing agency

Illinois Department of Public Health, Office of Health Care Regulation — Bureau of Long-Term Care

Fee

$1,990

Fee details

$1,990 application fee for an annual license; a 2-year license costs double the annual fee.

Renewal

Every year

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

210 ILCS 45 (Nursing Home Care Act); 77 Ill. Adm. Code 300.120; 20 ILCS 3960 (Health Facilities Planning Act)

1. Obtain a permit (certificate of need) from the Health Facilities and Services Review Board under the Health Facilities Planning Act, or written confirmation that none is required
2. Submit the IDPH project/plan review for construction (life safety and construction)
3. File the license application on IDPH forms with the permit and the $1,990 fee
4. Pass the IDPH licensure inspection
5. For Medicare/Medicaid, complete the federal certification survey and enroll with HFS

Program

Illinois Medical Assistance Program (Department of Healthcare and Family Services)

Enrollment portal

IMPACT (Illinois Medicaid Program Advanced Cloud Technology) provider enrollment system

Fiscal agent

None named — HFS runs provider enrollment itself through IMPACT Provider Enrollment Services

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

IMPACT uses CMS's risk levels and sets its own for provider types CMS does not classify; high-risk providers must submit fingerprints and pass criminal background checks before enrollment. DMEPOS suppliers are high risk and must be licensed (or exempt) and accredited by a recognized body. 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

IMPACT does onsite visits before and after enrollment for moderate- and high-risk providers, including at 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

HFS restarted revalidation in IMPACT in rolling stages from September 3, 2024; providers revalidate through the 'Provider Revalidation List' in IMPACT and may be asked for more documents. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Illinois Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need permit (Illinois Health Facilities Planning Act)

Agency

Illinois Health Facilities and Services Review Board (HFSRB), staffed by the Illinois Department of Public Health

Services covered

• hospitals
• ambulatory surgical treatment centers
• skilled and intermediate long-term care facilities (nursing homes)
• ID/DD and MC/DD skilled and intermediate care facilities
• Specialized Mental Health Rehabilitation Act facilities
• kidney disease treatment centers / freestanding hemodialysis
• state-operated hospitals, nursing homes, surgery and dialysis centers

Illinois certificate of need details →

State minimum wage

$15.00 an hour

Effective

2025-01-01

Scheduled increases

No scheduled change found in the official sources reviewed.

Direct-care wage floor

Department on Aging homemaker rates were raised to $30.80/hour from 2026-01-01 to sustain a minimum wage of $18.75/hour for direct service workers (after $17 in 2024 and $18 in 2025).

Rate pass-through

In-home service providers must certify they pay the mandated wage increase, and may not cut fringe benefits (paid time off, training pay, health insurance, travel) in response to the rate increases.

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)

1,761 (as of Sep 13, 2026)

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

666 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

2,932,625 (as of Jun 1, 2026)

All Illinois Skilled nursing Medicaid rates, ranked →