How to start a skilled nursing facility in Michigan

Michigan requires a Nursing home license from Michigan Department of Licensing and Regulatory Affairs (LARA), Bureau of Survey and Certification to operate a skilled nursing facility.

License required

Yes

License

Nursing home license

Issuing agency

Michigan Department of Licensing and Regulatory Affairs (LARA), Bureau of Survey and Certification

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

Public Health Code, MCL 333.21701 et seq.; CON Review Standards for Nursing Home and HLTCU Beds (CON-217)

1. Obtain a Certificate of Need from MDHHS under the CON Review Standards for Nursing Home and HLTCU Beds (CON-217)
2. Clear any outstanding LARA code deficiencies with an approved plan of correction (required by the CON standards for applicants with existing facilities)
3. Apply to LARA for the nursing home license and pass licensure survey
4. For Medicare/Medicaid, complete federal certification and enroll with Michigan Medicaid

Program

Michigan Medicaid (Michigan Department of Health and Human Services)

Enrollment portal

Community Health Automated Medicaid Processing System (CHAMPS) — Provider Enrollment

Fiscal agent

None named — MDHHS runs CHAMPS provider enrollment itself

Application fee

Michigan's 2012 bulletin MSA 12-55 charges the fee to every provider type except individual physicians and non-physician practitioners, for each enrolled provider type at initial enrollment and re-enrollment but not at revalidation or for updates. Medicare- or other-state-enrolled providers are exempt, and hardship exceptions can be requested in writing. 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

MSA 12-55 classes newly enrolling home health agencies and DMEPOS suppliers as high risk, subject to fingerprint-based checks; every enrolled provider and 5%+ owner must consent to background checks including fingerprints. 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

MSA 12-55 puts ambulance services, community mental health centers, CORFs, hospices, independent labs, physical therapists, and revalidating home health agencies and DMEPOS suppliers in the moderate tier, subject to unannounced pre- and post-enrollment site visits. 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

MDHHS revalidates at least every five years (or sooner on request), with a 90-day window to finish in CHAMPS. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Michigan Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Michigan Department of Health and Human Services, Certificate of Need Program; review standards set by the CON Commission

Services covered

• new health facilities and changes in bed capacity
• covered capital expenditures of $2,500,000+ (indexed annually)
• neonatal intensive care / special newborn nursing
• open heart surgery
• extrarenal organ transplantation
• lithotripsy
• megavoltage radiation therapy
• PET
• surgical services (freestanding outpatient surgery, ASCs, hospital surgical departments)
• cardiac catheterization
• fixed and mobile MRI
• fixed and mobile CT
• air ambulance
• child/adolescent specialized psychiatric programs

Michigan certificate of need details →

State minimum wage

$13.73 an hour

Effective

2026-01-01

Scheduled increases

Rises to $15.00 on 2027-01-01 under PA 337 of 2018 as amended in 2025.

Rate pass-through

Medicaid pays a direct care worker wage add-on of $3.40/hour (funded for 2024-10-01 to 2026-09-30); MDHHS and the MI Choice, MI Health Link and PIHP plans must pass it through. The FY2026-27 conference budget keeps the $3.40 increase, requires the uplift to go directly to workers with documented proof, and directs recoupment from employers that do not pass it through.

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)

832 (as of Sep 13, 2026)

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

422 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

2,130,181 (as of Jun 1, 2026)

All Michigan Skilled nursing Medicaid rates, ranked →