How to start a skilled nursing facility in Iowa

Iowa requires a Nursing facility license from Iowa Department of Inspections, Appeals, and Licensing (DIAL), Health Facilities Division to operate a skilled nursing facility. Fee: Statutory license fee under Iowa Code chapter 135C; amount not restated in the rule.

License required

Yes

License

Nursing facility license

Issuing agency

Iowa Department of Inspections, Appeals, and Licensing (DIAL), Health Facilities Division

Fee

Statutory license fee under Iowa Code chapter 135C; amount not restated in the rule.

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

481 IAC 58 (rule 58.3) and 481 IAC 61; Iowa Code chapters 135C and 135

1. Obtain Health Facilities Council approval (certificate of need) for the beds under Iowa Code chapter 135
2. Submit a letter of intent and a written résumé of the resident care program
3. Apply on department forms (at least 60 days before a change of ownership)
4. Submit floor plans and front/side elevation photographs
5. Obtain a state fire marshal certificate of fire-safety compliance
6. Pay the statutory fee and pass inspection
7. For Medicare/Medicaid, complete federal certification and enroll with Iowa Medicaid

Program

Iowa Medicaid (Iowa HHS) — IA Health Link managed care

Enrollment portal

Iowa Medicaid Provider Enrollment Unit (Universal Provider Enrollment Application 470-0254); Iowa Medicaid Portal Access (IMPA) for enrolled providers

Fiscal agent

Iowa Medicaid Enterprise (IME) Provider Enrollment Unit (state-run; no separate fiscal agent named on the enrollment page)

Application fee

Iowa charges institutional providers the fee when enrolling for the first time, adding a practice location or re-enrolling. Its fee table lists which provider types pay and whether the fee goes to Medicare or to Iowa Medicaid (for example, residential care facilities and ICF/ID pay Iowa Medicaid). 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

Iowa names newly enrolling home health agencies and DMEPOS suppliers (and those adding a practice location) as high risk and subject to fingerprinting; under its 2026 strategy some HCBS providers flagged by risk indicators can be raised to high risk. 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

Iowa does pre- and post-enrollment site visits for moderate-risk providers but skips them when Medicare or another state screened the provider at moderate risk in the past 12 months. 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

Iowa says providers revalidate every five years. Its 2026-2028 revalidation strategy, sent to CMS, revalidates high-risk providers first from July 1, 2026, then past-due providers, sending notices in waves. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Iowa Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Iowa Department of Health and Human Services (CON program staff and State Health Facilities Council)

Services covered

• hospitals
• health care facilities as defined in Iowa Code 135C.1 (nursing facilities, ICF/ID, ICF for persons with mental illness)
• organized outpatient health facilities
• ambulatory surgical centers
• community mental health facilities
• new or relocated institutional health facilities and changed institutional health services, including mobile health services

Iowa 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.

Skilled nursing facilities — active organization NPIs (NPPES)

747 (as of Sep 13, 2026)

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

387 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

674,521 (as of Jun 1, 2026)

All Iowa Skilled nursing Medicaid rates, ranked →