How to start a skilled nursing facility in Wyoming

Wyoming requires a Nursing care facility license (provisional, then full) from Wyoming Department of Health, Aging Division — Healthcare Licensing and Surveys (HLS) to operate a skilled nursing facility. Fee: Licensure fee per WDH Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees; amount not restated here.

License required

Yes

License

Nursing care facility license (provisional, then full)

Issuing agency

Wyoming Department of Health, Aging Division — Healthcare Licensing and Surveys (HLS)

Fee

Licensure fee per WDH Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees; amount not restated here.

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

WDH HLS Rules Chapter 19 (Licensure of Nursing Care Facilities) and Chapter 11 (Program Administration, eff. 07/01/2020)

1. Submit the HLS license application with the required fee and the paperwork on the licensure checklist
2. Contact HLS engineers to review building requirements and complete construction review
3. Receive a provisional license once items are approved
4. Pass the initial licensure survey; renew annually after renewal surveys
5. License does not enroll the facility in Medicare/Medicaid; complete federal certification separately

Program

Wyoming Medicaid and Kid Care CHIP (Wyoming Department of Health, Division of Healthcare Financing, Office of Medicaid)

Enrollment portal

Discover Your Provider (DyP) provider enrollment portal, run by HHS Technology Group (HTG)

Fiscal agent

CNSI (operates the Benefits Management System claims processing); provider enrollment is contracted to HHS Technology Group (HTG)

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. WDH's enrollment page does not list a separate state fee.

Fingerprinting

WDH says enrolling under a taxonomy considered high-risk can add steps, and a provider specialist will reach out. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. WDH's enrollment page does not describe a separate state site visit process.

Revalidation

Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. After an April 2026 CMS request, WDH sent CMS a two-year off-cycle revalidation plan on June 5, 2026. Under an August 17, 2026 notice, high-risk providers must revalidate in the DyP portal by October 31, 2026. Every enrolled provider must also report an NPI by then; providers without one are treated as high risk. Missing the deadline means payment suspension, then termination on February 1, 2027.

Full Wyoming Medicaid enrollment guide →

CON program

No

Wyoming 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)

79 (as of Sep 13, 2026)

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

36 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

59,335 (as of Jun 1, 2026)

All Wyoming Skilled nursing Medicaid rates, ranked →