How to start a skilled nursing facility in Maine

Maine requires a Skilled nursing facility / nursing facility (or multi-level) license from Maine Department of Health and Human Services, Division of Licensing and Certification — Medical Facilities Unit to operate a skilled nursing facility.

License required

Yes

License

Skilled nursing facility / nursing facility (or multi-level) license

Issuing agency

Maine Department of Health and Human Services, Division of Licensing and Certification — Medical Facilities Unit

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

10-144 CMR Ch. 110; 22 MRSA Chapter 103-A (CON)

1. For a new facility, obtain Certificate of Need approval through DHHS's CON program (22 MRSA ch. 103-A)
2. After CON approval, apply for the nursing home or multi-level license following DLC's instructions
3. Pass the DLC licensing survey
4. For Medicare/Medicaid, complete federal certification (DLC holds federal survey jurisdiction) and enroll with MaineCare

Program

MaineCare (Office of MaineCare Services, Maine DHHS)

Enrollment portal

MIHMS Health PAS Online Portal — Provider Enrollment Application (PEA) via Trading Partner Account (moving to the new 'MaineCare Partner Portal' in late September 2026)

Fiscal agent

Gainwell Technologies (MaineCare provider enrollment vendor/MIHMS)

Application fee

MaineCare charges the fee to providers that are newly enrolling, revalidating or adding a practice location, unless exempt, paid by debit or credit card in the Trading Partner Account; its fee spreadsheet lists the provider types that pay. Home health agencies and DME suppliers must also post a surety bond at enrollment, revalidation and new locations. 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

MaineCare runs automated criminal history checks on all providers and on 5%+ owners, board members, managing employees and rendering providers. 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

MaineCare does site visits on revalidating provider locations assigned moderate or high risk; risk is set by provider type and service-location specialty (Risk Category Assignments, May 2024). 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

MaineCare revalidates at least every five years (every three years for DME providers) or whenever it asks; it has a federally required 2026-2028 off-cycle revalidation plan. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Maine Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need (Maine Certificate of Need Act of 2002)

Agency

Maine Department of Health and Human Services (CON Unit, Division of Licensing and Certification)

Services covered

• hospitals and psychiatric hospitals
• nursing facilities
• kidney disease treatment centers / freestanding hemodialysis
• rehabilitation facilities
• ambulatory surgical facilities
• independent radiological service centers
• independent cardiac catheterization centers
• cancer treatment centers
• transfers of ownership or control of a health care facility
• major medical equipment acquisitions

Maine certificate of need details →

State minimum wage

$15.10 an hour

Effective

2026-01-01

Scheduled increases

Rises to $15.70 on 2027-01-01 (CPI-W Northeast indexing).

Direct-care wage floor

MaineCare and state-funded reimbursement for essential support workers must build in at least 125% of the state minimum wage for the labor portion of the rate, plus related taxes and benefits, updated whenever the minimum wage rises (in effect since 2022-01-01). This is a rate floor, not a direct wage mandate on employers.

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)

133 (as of Sep 13, 2026)

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

78 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

327,698 (as of Jun 1, 2026)