Navigating the world of assisted living can feel overwhelming, so understanding the rules and regulations in your state is the key to making an informed decision for your family member. Assisted living is a licensed and regulated care option for older adults who need help with daily activities but do not require full-time nursing care. Every state sets its own standards for how facilities operate—who they can admit, the level of care they provide, and how they are monitored for safety and quality. These regulations shape everything from pre-admission medical assessments to Medicaid eligibility and private pay requirements, ultimately influencing the cost, services, and protections available to residents.
Whether you’re a spouse searching for the right care setting, an adult daughter or son navigating options for aging parents, or someone planning ahead for your own future, this guide will break down everything you need to know—state by state. With one click, you can jump directly to your state’s requirements and start preparing for this next chapter with confidence.
Why This Information Matters for Families Choosing Assisted Living
Choosing an assisted living facility is a major decision—one that affects not just your family members’ health, but also their quality of life, financial planning, and long-term well-being. Understanding the rules and regulations in your state helps you prepare ahead of time, ask the right questions, and avoid unnecessary surprises when touring facilities or making financial arrangements.
Each section of this guide highlights critical details directly impacting how you choose and plan for assisted living. Our goal at Primary Record is to empower families with clear, actionable information to navigate the complex world of assisted living confidently. This is why each month CEO, Jean Ross, RN partners with Daughterhood to host an “Unpacking Senior Living” Circle to guide daughters to ask the right questions, understand the options, and get organized before that first visit.
How to Use This Guide to Confidently Navigate the Search
If you’re helping a family member transition into assisted living, you may already feel the pressure to get everything right. The truth is—every state plays by its own rules. That means where you live can impact everything from whether a facility can accept your parent to how much you’ll pay and what rights your parent has once they move in.
This guide helps you break through the confusion. Each state section covers:
- Who licenses assisted living and what protections exist
- What evaluations (medical, cognitive, or functional) are required before admission
- What criteria facilities use to accept residents—and who gets to decide
- Whether Medicaid is accepted and how long private-pay funds need to last
- How often residents are reassessed and what happens if care needs change
Use this information to get ahead of the process. Before you start touring:
- Check your state’s requirements so you know what to expect.
- Talk with your parent’s doctor about their current care needs and whether a formal assessment is needed.
- Make a shortlist of facilities and call to ask about their admission criteria and payment options.
- If Medicaid may be involved, research waiver programs early or speak with an eldercare attorney.
Understanding your state’s rules will save you from unnecessary surprises and give you confidence that you’re asking the right questions. Click your state in the table of contents to get started!
Pick Your State:
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
Alabama
Governing Agency & Regulations
Alabama’s assisted living facilities are licensed by the Alabama Department of Public Health, following guidelines outlined in the Alabama Administrative Code (e.g., §§420-5-4 and 420-5-20).
Pre-Admission Requirements
Before admission, facilities conduct an RN screening along with a physician exam (within 30 days) to assess functional and cognitive status.
Admission Criteria & Who Decides
Facilities determine eligibility—residents who are bedridden or require more than 24-hour skilled nursing care are generally excluded.
Who Performs the Evaluations
Assessments are performed by registered nurses and facility administrators using standardized ADL and cognitive tools.
Medicaid vs. Private Pay
Alabama does not have a Medicaid waiver for assisted living; most residents are private-pay.
Reassessment, Appeal & Resident Rights
Ongoing evaluations are conducted monthly or annually. Facilities must provide a 30-day discharge notice, and residents can appeal through the state long-term care ombudsman.
Alaska
Governing Agency & Regulations
Regulated by the Alaska Department of Health (Division of Healthcare Services) under the Alaska Assisted Living Homes Act.
Pre-Admission Requirements
A comprehensive care assessment and a signed residential contract are completed at move-in, along with a review of medical records.
Admission Criteria & Who Decides
Eligibility is based on the facility’s licensed scope, excluding individuals who need continuous nursing.
Who Performs the Evaluations
Assessments are performed by facility administrators or qualified staff who review ADLs, cognitive status, and mobility.
Medicaid vs. Private Pay
Alaska offers a Medicaid waiver (Med-QUEST) that requires an additional level-of-care screening. Private-pay residents follow the standard process.
Reassessment, Appeal & Resident Rights
Care plans are updated quarterly or annually, with a 30-day discharge notice required and an appeals process through the ombudsman.
Arizona
Governing Agency & Regulations:
Arizona’s assisted living facilities are regulated by the Arizona Department of Health Services under specific AHC regulations for Assisted Living Facilities.
Pre-Admission Requirements:
A pre-admission assessment is conducted within 14 days that includes a review of medical history as well as cognitive and behavioral screenings. A physician’s exam (within 30 days prior to admission) is also required.
Admission Criteria & Who Decides:
The facility determines eligibility, excluding residents who require continuous nursing care or are bedridden. The decision is based on the facility’s licensed scope of care.
Who Performs & Criteria:
Assessments are performed by managers, licensed nurses, or other qualified staff using standardized tools to evaluate activities of daily living (ADLs), cognitive function, and mobility. Special evaluations are conducted for memory care when needed.
Medicaid vs Private Pay:
Arizona’s Medicaid program (ALTCS) requires an additional screening process, while private-pay residents follow the standard facility assessment.
Reassessment, Appeal & Resident Rights:
Periodic reassessments (quarterly or annually) are conducted. Facilities must issue a 30-day discharge notice, and residents have the right to appeal through the state ombudsman.
Arkansas
Governing Agency & Regulations:
The Arkansas Department of Human Services oversees both Level I and Level II Assisted Living Facilities under state regulations.
Pre-Admission Requirements:
An interdisciplinary assessment is performed—including a physician’s exam (within 30 days) and an RN evaluation—to ensure the resident’s needs align with the facility’s capabilities.
Admission Criteria & Who Decides:
Facilities decide on admission based on criteria that exclude residents requiring 24-hour skilled nursing or those who are bedridden.
Who Performs & Criteria:
A registered nurse typically coordinates the evaluation using standardized ADL and cognitive assessment tools.
Medicaid vs Private Pay:
A Medicaid waiver is available for Level II facilities via a PAS screening process; otherwise, residents are generally private-pay.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day notice provided for involuntary discharge. Residents have the right to appeal via state hearings and ombudsman channels.
California
Governing Agency & Regulations:
California’s Residential Care Facilities for the Elderly (RCFEs) are regulated by the Department of Social Services, Community Care Licensing Division under Title 22 of the California Code of Regulations.
Pre-Admission Requirements:
Facilities must complete a pre-admission appraisal along with a physician’s report (using Form LIC 602) within 30 days that examines functional and cognitive abilities.
Admission Criteria & Who Decides:
The facility determines admission eligibility, excluding those who require 24-hour skilled nursing or have other disqualifying health conditions.
Who Performs & Criteria:
Evaluations are performed by the facility’s administrator or designated staff—often a nurse or social worker—using standardized assessments. Special memory care assessments are also conducted when needed.
Medicaid vs Private Pay:
Some counties offer Medi-Cal assisted living waivers; otherwise, residents are private-pay, following the facility’s standard assessment.
Reassessment, Appeal & Resident Rights:
Reassessments occur annually or when there is a significant change in condition. A 30-day discharge notice is required, and residents can appeal through the DSS and the Long-Term Care Ombudsman.
Colorado
Governing Agency & Regulations:
Colorado’s assisted living residences are regulated by the Colorado Department of Public Health and Environment under 6 CCR 1011-1.
Pre-Admission Requirements:
A comprehensive pre-admission assessment is conducted that includes a recent health evaluation (physician exam and TB test) within 30 days.
Admission Criteria & Who Decides:
Facilities determine eligibility by excluding residents who are bedfast or who require nursing care beyond what the facility can offer.
Who Performs & Criteria:
Licensed nurses or facility administrators perform assessments using standardized evaluations of ADLs, cognitive status, and overall functional ability.
Medicaid vs Private Pay:
A Medicaid HCBS waiver is available that requires an additional level-of-care screening; private-pay residents undergo the standard facility process.
Reassessment, Appeal & Resident Rights:
Annual (or need-driven) reassessments are performed with a 30-day notice for discharge. An appeals process is available through state long-term care ombudsman channels.
Connecticut
Governing Agency & Regulations:
Connecticut’s Assisted Living Services are delivered via an Assisted Living Services Agency (ALSA) under regulations set by the Connecticut Department of Public Health.
Pre-Admission Requirements:
A registered nurse conducts a pre-admission assessment within 7 days of move-in that covers ADLs, cognitive function, and medical history.
Admission Criteria & Who Decides:
Eligibility is determined by the ALSA based on the resident’s overall stability and ability to be served by the care model. There isn’t a strict exclusion list, but residents must be “chronic and stable.”
Who Performs & Criteria:
All assessments are performed by a licensed RN who collaborates closely with families and the resident’s physicians to create an individualized service plan.
Medicaid vs Private Pay:
Medicaid-funded clients undergo an additional eligibility review through the Connecticut Home Care Program for Elders (CHCPE), while private-pay residents follow the ALSA’s standard process.
Reassessment, Appeal & Resident Rights:
The individualized service plan is reviewed and updated at least every 120 days, and facilities must provide a 30-day notice for discharge. Residents also have a formal appeals process through state agencies and an ombudsman.
Delaware
Governing Agency & Regulations:
Delaware’s assisted living facilities are regulated by the Delaware Department of Health and Social Services, Division of Health Care Quality (Title 16 of the Delaware Administrative Code).
Pre-Admission Requirements:
Facilities perform a pre-admission evaluation that includes a physician’s exam within 30 days of admission along with a functional and cognitive assessment (often using a Uniform Assessment Instrument).
Admission Criteria & Who Decides:
The facility determines eligibility, generally excluding residents who require continuous skilled nursing care, ventilation support, or who have severe pressure ulcers.
Who Performs & Criteria:
Assessments are conducted by a registered nurse using state-approved tools; the physician’s evaluation supports the decision.
Medicaid vs Private Pay:
Delaware offers a Medicaid waiver (Diamond State Health Plan Plus) that requires additional DMMA screening, while private-pay residents follow the standard facility process.
Reassessment, Appeal & Resident Rights:
Facilities develop a written service plan that is updated annually. A 45-day discharge notice is required, and residents can appeal decisions through state hearings and the Long-Term Care Ombudsman.
District of Columbia
Governing Agency & Regulations:
The District of Columbia’s assisted living residences are regulated by the DC Department of Health under DCMR Title 22‑B, Chapter 34.
Pre-Admission Requirements:
A comprehensive pre-admission assessment is conducted—including a physician’s exam within 30 days—which forms the basis of an Individualized Service Plan (ISP).
Admission Criteria & Who Decides:
Facilities decide on admission based on whether a resident’s needs (e.g., requiring more than 35 hours/week of nursing care or continuous skilled care) fall within their licensed scope.
Who Performs & Criteria:
Assessments are performed by a registered nurse and case manager using standardized forms approved by the Mayor.
Medicaid vs Private Pay:
Medicaid-funded residents must undergo additional level-of-care screening under the Medicaid EPD Waiver, while private-pay residents follow the facility’s standard evaluation.
Reassessment, Appeal & Resident Rights:
ISPs are reviewed at least every six months. A 30‑day discharge notice is required, and residents have the right to appeal via the department and the Long-Term Care Ombudsman.
Florida
Governing Agency & Regulations:
Florida’s assisted living facilities are licensed by the Agency for Health Care Administration (AHCA) under Chapter 429, Florida Statutes, and Rule 59A‑36 of the Florida Administrative Code.
Pre-Admission Requirements:
A face‑to‑face medical exam (using Form 1823) must be completed within 60 days prior to—or 30 days after—admission, assessing physical, cognitive, and functional status.
Admission Criteria & Who Decides:
Facilities determine eligibility; typically, those who require 24‑hour nursing care or are bedridden (unless in specialized units) are excluded.
Who Performs & Criteria:
Evaluations are performed by a physician (or PA/ARNP) and further reviewed by the facility administrator during an internal screening.
Medicaid vs Private Pay:
Florida’s Medicaid LTC waiver (via CARES) may substitute for the exam if current; otherwise, the standard facility process applies to private‑pay residents.
Reassessment, Appeal & Resident Rights:
Periodic nurse reassessments are conducted (monthly or as needed), with a 30‑to‑45‑day discharge notice required. Residents may appeal decisions via the Long‑Term Care Ombudsman and AHCA channels.
Georgia
Governing Agency & Regulations:
Georgia’s assisted living facilities (ALCs and Personal Care Homes) are regulated by the Georgia Department of Community Health.
Pre-Admission Requirements:
A pre‑admission evaluation—including a physician’s exam (within 30 days) and facility screening (with an emphasis on emergency evacuation capability)—is performed.
Admission Criteria & Who Decides:
Facilities decide on admission based on their licensed scope; they generally exclude residents who cannot evacuate or require continuous nursing care.
Who Performs & Criteria:
Assessments are carried out by an admissions coordinator or facility administrator, often with input from an RN. Evaluations include mobility, ADLs, and cognitive testing.
Medicaid vs Private Pay:
While Medicaid participation is limited in assisted living, certain waivers (e.g., CCSP/SOURCE) require additional screening. Most residents are private‑pay.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30‑day discharge notice mandated. Residents can appeal via state procedures and through the Long‑Term Care Ombudsman.
Hawaii
Governing Agency & Regulations:
Hawaii’s assisted living facilities are regulated by the Hawaii Department of Health’s Office of Health Care Assurance (OHCA) under Title 11, Chapter 90.
Pre-Admission Requirements:
Facilities perform an assessment of functional and health status—including ADLs, cognitive ability, and medication needs—prior to move‑in, with a review of medical records.
Admission Criteria & Who Decides:
The facility sets eligibility criteria, generally excluding those needing 24‑hour nursing care, based on its licensed scope.
Who Performs & Criteria:
Evaluations are conducted by facility administrators or registered nurses, using standardized assessment tools.
Medicaid vs Private Pay:
A Medicaid waiver (Med‑QUEST) is available, requiring an extra level‑of‑care screening; private‑pay residents follow the standard process.
Reassessment, Appeal & Resident Rights:
Facilities conduct annual reassessments, issue a 30‑day discharge notice when needed, and provide an appeals process through OHCA and the Long‑Term Care Ombudsman.
Idaho
Governing Agency & Regulations:
Idaho’s assisted living facilities are regulated by the Idaho Department of Health and Welfare under IDAPA 16.03.22.
Pre-Admission Requirements:
A comprehensive functional assessment is completed, including a physician or nurse practitioner exam within 90 days before admission.
Admission Criteria & Who Decides:
The facility determines eligibility, excluding residents requiring continuous skilled nursing or advanced care.
Who Performs & Criteria:
Assessments are carried out by registered nurses or trained staff who evaluate ADLs, cognitive status, and overall function.
Medicaid vs Private Pay:
Idaho’s Medicaid Aged & Disabled Waiver requires an additional case manager screening; private‑pay residents are processed via the standard evaluation.
Reassessment, Appeal & Resident Rights:
Reassessments occur quarterly, with a 30‑day discharge notice required, and appeals are managed through the Medicaid fair hearing process.
Illinois
Governing Agency & Regulations:
Illinois’ assisted living facilities (RCFEs) are regulated by the Illinois Department of Public Health under the Assisted Living and Shared Housing Act (210 ILCS 9).
Pre-Admission Requirements:
A health evaluation and functional assessment—including a physician’s report—is required within 120 days before move‑in.
Admission Criteria & Who Decides:
Facilities determine admission eligibility, generally excluding residents who require 24‑hour skilled nursing or total assistance with ADLs.
Who Performs & Criteria:
Evaluations are performed by licensed nurses or administrators, with specialized cognitive assessments for residents with dementia.
Medicaid vs Private Pay:
The Medicaid Supportive Living Program (SLP) requires an independent assessment; private‑pay residents follow the facility’s standard process.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, along with a 30‑day discharge notice. Residents may appeal via the Illinois Department of Public Health’s complaint process.
Indiana
Governing Agency & Regulations:
Indiana’s assisted living facilities are regulated by the Indiana State Department of Health under 410 IAC 16.2.
Pre-Admission Requirements:
A comprehensive health assessment is conducted, including a physician or nurse practitioner exam within 90 days prior to admission.
Admission Criteria & Who Decides:
Facilities decide on admission based on whether a resident’s needs—such as requiring continuous skilled nursing or being completely immobile—fall within their licensed capacity.
Who Performs & Criteria:
Assessments are performed by registered nurses or facility administrators, evaluating ADLs, cognitive function, and behavioral status.
Medicaid vs Private Pay:
Indiana’s Medicaid Aged & Disabled Waiver requires a Pre‑Admission Screening (PAS); private‑pay residents are evaluated through the standard process.
Reassessment, Appeal & Resident Rights:
Residents are reassessed annually or sooner if their condition changes, with a 30‑day discharge notice required and an appeals process available via the state ombudsman.
Iowa
Governing Agency & Regulations:
Iowa’s assisted living facilities are regulated by the Iowa Department of Inspections, Appeals, & Licensing under Chapter 69 of the Iowa Administrative Code.
Pre-Admission Requirements:
A functional assessment is required before admission, including a physician’s report within 30 days.
Admission Criteria & Who Decides:
Facilities determine admission, typically excluding those requiring 24/7 nursing care.
Who Performs & Criteria:
Assessments are conducted by facility nurses or administrators and include ADLs, cognitive status, and memory care screening.
Medicaid vs Private Pay:
Iowa’s Medicaid HCBS waiver requires an independent assessment, while private-pay residents follow facility assessments.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, and residents have 30-day discharge notices and appeal rights through the state ombudsman.
Kansas
Governing Agency & Regulations:
Kansas’ assisted living facilities are overseen by the Kansas Department for Aging and Disability Services.
Pre-Admission Requirements:
A comprehensive health and functional assessment, including physician certification, must be completed within 90 days before admission.
Admission Criteria & Who Decides:
Facilities determine eligibility, generally excluding those who are bedbound or require 24-hour nursing care.
Who Performs & Criteria:
Assessments are conducted by licensed nurses or administrators, with evaluations focused on ADLs and cognitive function.
Medicaid vs Private Pay:
Kansas offers a Medicaid HCBS-Frail Elderly Waiver requiring additional screening, while private-pay residents follow standard assessments.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, and facilities must provide a 30-day discharge notice. Appeals are handled via the state ombudsman.
Kentucky
Governing Agency & Regulations:
Kentucky’s assisted living facilities are regulated by the Kentucky Department for Aging and Independent Living.
Pre-Admission Requirements:
A pre-admission assessment, including an RN evaluation and physician’s report, is required within 30 days before admission.
Admission Criteria & Who Decides:
Facilities determine eligibility, excluding residents who require full-time skilled nursing, are bedridden, or need restraints.
Who Performs & Criteria:
Registered nurses or administrators conduct assessments, evaluating ADLs, cognitive function, and behavior.
Medicaid vs Private Pay:
Medicaid does not cover assisted living room and board; waiver services for in-home care require additional screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, and a 30-day discharge notice is mandated. Residents can appeal via state hearings.
Louisiana
Governing Agency & Regulations:
Louisiana’s assisted living facilities are licensed by the Louisiana Department of Health.
Pre-Admission Requirements:
Facilities require a functional assessment and physician’s exam within 30 days before admission.
Admission Criteria & Who Decides:
Residents requiring 24-hour skilled nursing or total dependency are generally excluded.
Who Performs & Criteria:
Assessments are performed by facility administrators or RNs and include ADL and medication needs evaluations.
Medicaid vs Private Pay:
A Medicaid Community Choices Waiver is available with an additional level-of-care assessment.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, and a 30-day discharge notice is standard. Appeals are handled via LDH and ombudsman services.
Maine
Governing Agency & Regulations:
Maine’s assisted living facilities are licensed by the DHHS Division of Licensing and Certification.
Pre-Admission Requirements:
A licensed professional must conduct a pre-admission assessment, including a physician’s evaluation within 30 days.
Admission Criteria & Who Decides:
Facilities determine eligibility based on medical and functional status.
Who Performs & Criteria:
Registered nurses or facility administrators perform evaluations of ADLs, cognition, and mobility.
Medicaid vs Private Pay:
Maine’s Medicaid HCBS waiver requires additional screening, while private-pay residents follow facility procedures.
Reassessment, Appeal & Resident Rights:
Annual reassessments and 30-day discharge notices are required. Residents can appeal through the DHHS ombudsman.
Maryland
Governing Agency & Regulations:
Maryland’s assisted living facilities are regulated by the Office of Health Care Quality (OHCQ) under COMAR 10.07.14.
Pre-Admission Requirements:
A physician’s evaluation must be completed within 30 days before admission.
Admission Criteria & Who Decides:
Facilities exclude residents requiring continuous skilled nursing or those who cannot evacuate.
Who Performs & Criteria:
Licensed nurses or administrators conduct standardized assessments.
Medicaid vs Private Pay:
Medicaid Community Options Waiver is available with additional level-of-care screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, and residents receive a 45-day discharge notice.
Massachusetts
Governing Agency & Regulations:
Massachusetts Executive Office of Elder Affairs regulates assisted living facilities.
Pre-Admission Requirements:
A pre-admission functional and medical evaluation must be completed within 30 days.
Admission Criteria & Who Decides:
Residents requiring 24-hour nursing care or who cannot evacuate are typically excluded.
Who Performs & Criteria:
Assessments are conducted by RNs or administrators and include functional and cognitive evaluations.
Medicaid vs Private Pay:
The Medicaid GAFC waiver is available with clinical eligibility screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, and residents have a 30-day discharge notice and appeal rights.
Michigan
Governing Agency & Regulations:
Michigan’s assisted living facilities are regulated by the Bureau of Community and Health Systems.
Pre-Admission Requirements:
A physician’s exam must be completed within 90 days before admission.
Admission Criteria & Who Decides:
Facilities exclude residents needing continuous skilled nursing or who are bedbound.
Who Performs & Criteria:
Assessments are performed by RNs or administrators, evaluating functional and cognitive status.
Medicaid vs Private Pay:
Michigan’s Medicaid MI Choice Waiver is available with additional screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice for involuntary discharge.
Minnesota
Governing Agency & Regulations:
Minnesota’s assisted living facilities are licensed by the Minnesota Department of Health under Minnesota Statutes, Chapter 144G.
Pre-Admission Requirements:
A comprehensive pre-admission assessment must be completed within 30 days prior to admission, including a functional and health evaluation.
Admission Criteria & Who Decides:
Residents requiring 24-hour skilled nursing or those with unmanaged medical conditions are typically not admitted.
Who Performs & Criteria:
Assessments are conducted by a registered nurse or licensed healthcare professional using standardized ADL and cognitive evaluation tools.
Medicaid vs Private Pay:
Minnesota offers the Elderly Waiver (EW) program, which requires additional level-of-care screening for Medicaid residents.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and the right to appeal through the Office of Ombudsman for Long-Term Care.
Mississippi
Governing Agency & Regulations:
Mississippi’s assisted living facilities are licensed by the State Department of Health.
Pre-Admission Requirements:
A physician’s evaluation must be completed within 30 days before admission.
Admission Criteria & Who Decides:
Facilities exclude residents requiring continuous skilled nursing or who are immobile.
Who Performs & Criteria:
Assessments are conducted by RNs or administrators.
Medicaid vs Private Pay:
A Medicaid E&D Waiver is available with PAS screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice.
Missouri
Governing Agency & Regulations:
Missouri’s assisted living facilities are regulated by the Missouri Department of Health and Senior Services under 19 CSR 30-86.047.
Pre-Admission Requirements:
A physician’s health assessment must be conducted within 30 days before admission, including a functional and cognitive evaluation.
Admission Criteria & Who Decides:
Residents needing skilled nursing beyond 45 days or those with uncontrolled aggression are typically excluded. The facility determines admission eligibility.
Who Performs & Criteria:
A licensed nurse or administrator conducts assessments focused on ADLs and evacuation ability.
Medicaid vs Private Pay:
Missouri offers a Medicaid Aged & Disabled Waiver with PASRR screening; private-pay residents follow facility procedures.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, and a 30-day discharge notice must be provided. Appeals are handled via DHSS.
Montana
Governing Agency & Regulations:
Montana’s assisted living facilities are licensed by the Department of Public Health and Human Services, Quality Assurance Division.
Pre-Admission Requirements:
A physician or NP evaluation must be completed within 30 days before admission, along with a facility assessment.
Admission Criteria & Who Decides:
Residents requiring 24-hour continuous nursing or extreme isolation measures are generally not admitted.
Who Performs & Criteria:
Assessments are conducted by RNs or administrators focusing on ADLs, cognition, and behavioral status.
Medicaid vs Private Pay:
A Medicaid waiver is available with level-of-care screening; private-pay residents follow facility protocols.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, and residents have a 30-day discharge notice and appeal rights through the ombudsman.
Nebraska
Governing Agency & Regulations:
Nebraska’s assisted living facilities are overseen by the Nebraska Department of Health & Human Services.
Pre-Admission Requirements:
A physician’s medical exam must be completed within 90 days before admission.
Admission Criteria & Who Decides:
Residents requiring 24/7 skilled nursing or who are unable to evacuate are generally excluded.
Who Performs & Criteria:
A registered nurse or administrator conducts the assessment using state-approved tools.
Medicaid vs Private Pay:
Nebraska’s Medicaid A&D Waiver requires a level-of-care assessment; private-pay residents follow facility evaluation processes.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, and residents are entitled to a 30-day discharge notice and appeals process.
Nevada
Governing Agency & Regulations:
Nevada’s assisted living facilities are licensed by the Division of Public and Behavioral Health (DPBH).
Pre-Admission Requirements:
A physician’s evaluation must be completed within 30 days prior to admission.
Admission Criteria & Who Decides:
Residents requiring full-time nursing care or who have severe psychiatric disorders are typically not admitted.
Who Performs & Criteria:
Licensed nurses or administrators conduct standardized functional and cognitive evaluations.
Medicaid vs Private Pay:
Nevada offers a Medicaid Frail Elderly Waiver, requiring an additional level-of-care screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are mandatory, and residents must receive a 30-day discharge notice with appeal rights.
New Hampshire
Governing Agency & Regulations:
New Hampshire’s assisted living facilities are regulated by the Department of Health and Human Services.
Pre-Admission Requirements:
A physician’s evaluation must be completed within 30 days before admission.
Admission Criteria & Who Decides:
Residents requiring continuous skilled nursing or psychiatric seclusion are excluded.
Who Performs & Criteria:
Assessments are performed by licensed nurses or administrators.
Medicaid vs Private Pay:
A Medicaid Choices for Independence (CFI) waiver is available with an eligibility review.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeal process.
New Jersey
Governing Agency & Regulations:
New Jersey’s assisted living facilities are regulated by the Department of Health under the New Jersey Administrative Code (N.J.A.C.) 8:36.
Pre-Admission Requirements:
A physician’s health assessment must be completed within 30 days prior to admission.
Admission Criteria & Who Decides:
Residents requiring full-time skilled nursing or advanced medical interventions are generally not admitted.
Who Performs & Criteria:
Assessments are performed by licensed nurses or facility administrators using state-approved functional evaluation tools.
Medicaid vs Private Pay:
New Jersey’s Medicaid Managed Long Term Services and Supports (MLTSS) program provides funding for eligible residents.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals managed through the NJ Long-Term Care Ombudsman.
New Mexico
Governing Agency & Regulations:
New Mexico’s assisted living facilities are regulated by the Department of Health, Division of Health Improvement.
Pre-Admission Requirements:
A health evaluation, including a physician’s exam within 30 days, is required.
Admission Criteria & Who Decides:
Residents requiring 24-hour skilled nursing or severe behavioral management are excluded.
Who Performs & Criteria:
Registered nurses or administrators conduct standardized evaluations.
Medicaid vs Private Pay:
A Medicaid Centennial Care Waiver is available, requiring additional level-of-care screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals via DOH.
New York
Governing Agency & Regulations:
New York’s assisted living facilities are overseen by the Department of Health under Title 18 NYCRR Part 487 & 488.
Pre-Admission Requirements:
A physician’s exam within 30 days is required, along with a functional and cognitive assessment.
Admission Criteria & Who Decides:
Residents requiring 24-hour skilled nursing or those unable to evacuate independently are excluded.
Who Performs & Criteria:
Registered nurses or administrators conduct standardized assessments.
Medicaid vs Private Pay:
A Medicaid Assisted Living Program (ALP) waiver requires an additional eligibility review.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 45-day discharge notice and appeal options.
North Carolina
Governing Agency & Regulations:
North Carolina’s assisted living facilities are regulated by the Division of Health Service Regulation.
Pre-Admission Requirements:
A physician evaluation must be completed within 30 days before admission.
Admission Criteria & Who Decides:
Residents requiring continuous nursing care or hospitalization are excluded.
Who Performs & Criteria:
Assessments are performed by RNs or administrators.
Medicaid vs Private Pay:
The Medicaid Special Assistance Program requires level-of-care screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeal process.
North Dakota
Governing Agency & Regulations:
North Dakota’s assisted living facilities are licensed by the Department of Health and Human Services under North Dakota Administrative Code (NDAC) Title 33-03-24.1.
Pre-Admission Requirements:
A physician’s medical exam must be conducted within 30 days before admission.
Admission Criteria & Who Decides:
Facilities exclude residents requiring continuous skilled nursing or those with severe unmanaged medical conditions.
Who Performs & Criteria:
Licensed nurses or administrators conduct ADL and cognitive assessments using standardized evaluation methods.
Medicaid vs Private Pay:
North Dakota’s Medicaid Waiver for Home and Community-Based Services (HCBS) requires an additional level-of-care review.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals via the ND Long-Term Care Ombudsman.
Ohio
Governing Agency & Regulations:
Ohio’s assisted living facilities are regulated by the Bureau of Long-Term Care Quality under OAC 3701-16.
Pre-Admission Requirements:
A physician’s exam must be completed within 90 days before admission.
Admission Criteria & Who Decides:
Facilities exclude residents needing 24/7 skilled nursing.
Who Performs & Criteria:
Assessments are conducted by RNs or administrators.
Medicaid vs Private Pay:
Ohio’s Medicaid ALF waiver requires an additional pre-admission screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice.
Oklahoma
Governing Agency & Regulations:
Oklahoma’s assisted living facilities are regulated by the Oklahoma State Department of Health under OAC 310:663.
Pre-Admission Requirements:
A physician’s exam within 30 days prior to admission is required, along with a facility assessment of ADLs, cognition, and health conditions.
Admission Criteria & Who Decides:
Residents requiring continuous skilled nursing or who have uncontrolled aggression are typically excluded.
Who Performs & Criteria:
Licensed nurses or administrators conduct assessments using state-approved evaluation tools.
Medicaid vs Private Pay:
Oklahoma offers the ADvantage Medicaid Waiver, requiring a level-of-care determination.
Reassessment, Appeal & Resident Rights:
Annual reassessments are mandatory, with a 30-day discharge notice and appeals via the OSDH Ombudsman.
Oregon
Governing Agency & Regulations:
Oregon’s assisted living facilities are licensed by the Oregon Department of Human Services, Aging and People with Disabilities (APD), under Oregon Administrative Rules (OAR) 411-054.
Pre-Admission Requirements:
A pre-admission assessment, including a functional and medical evaluation, must be completed before move-in.
Admission Criteria & Who Decides:
Residents requiring continuous skilled nursing care or those with significant behavioral health needs are typically excluded.
Who Performs & Criteria:
Assessments are conducted by registered nurses or trained facility staff using standardized state-approved tools.
Medicaid vs Private Pay:
Oregon offers Medicaid coverage through the K Plan, requiring a level-of-care determination for Medicaid-eligible residents.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals managed by the Long-Term Care Ombudsman Program.
Pennsylvania
Governing Agency & Regulations:
Pennsylvania’s assisted living facilities are regulated by the Department of Human Services under Title 55, Chapter 2800 of the Pennsylvania Code.
Pre-Admission Requirements:
A physician’s health evaluation must be completed within 30 days before admission.
Admission Criteria & Who Decides:
Facilities exclude residents requiring 24-hour skilled nursing or those with unmanaged medical needs.
Who Performs & Criteria:
Registered nurses or administrators conduct pre-admission assessments based on ADLs and cognitive status.
Medicaid vs Private Pay:
Pennsylvania’s Medicaid waiver, known as Community HealthChoices, requires an additional level-of-care screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are conducted, with a 30-day discharge notice and appeals through the Pennsylvania Long-Term Care Ombudsman.
Rhode Island
Governing Agency & Regulations:
Rhode Island’s assisted living facilities are licensed by the Department of Health under the Rhode Island Rules and Regulations for Licensing Assisted Living Residences (R23-17.4-ALR).
Pre-Admission Requirements:
A physician’s evaluation must be completed within 30 days prior to admission.
Admission Criteria & Who Decides:
Residents requiring full-time skilled nursing care or specialized behavioral treatment are typically not admitted.
Who Performs & Criteria:
Assessments are conducted by a registered nurse or administrator using state-approved functional evaluation tools.
Medicaid vs Private Pay:
Rhode Island offers Medicaid coverage for assisted living through the Global Consumer Choice Compact Waiver, requiring a level-of-care determination.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals available through the Rhode Island Long-Term Care Ombudsman.
South Carolina
Governing Agency & Regulations:
South Carolina’s assisted living facilities are regulated by the Department of Health and Environmental Control (DHEC) under Regulation 61-84.
Pre-Admission Requirements:
A physician’s exam within 30 days prior to admission is required, along with a pre-admission functional and cognitive assessment.
Admission Criteria & Who Decides:
Residents requiring 24/7 nursing care or severe psychiatric care are generally not admitted.
Who Performs & Criteria:
Registered nurses or administrators evaluate ADLs, cognition, and mobility.
Medicaid vs Private Pay:
The Medicaid Community Choices Waiver provides funding with an additional eligibility screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals via the Long-Term Care Ombudsman.
South Dakota
Governing Agency & Regulations:
South Dakota’s assisted living facilities are licensed by the Department of Health under ARSD 44:70.
Pre-Admission Requirements:
A physician’s exam within 30 days prior to admission is required.
Admission Criteria & Who Decides:
Residents requiring continuous skilled nursing or behavioral intervention services are excluded.
Who Performs & Criteria:
Registered nurses or administrators perform functional and cognitive assessments.
Medicaid vs Private Pay:
A Medicaid HCBS waiver is available with PAS screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are conducted, with a 30-day discharge notice and appeal options.
Tennessee
Governing Agency & Regulations:
Tennessee’s assisted living facilities are regulated by the Department of Health under Tenn. Code Title 68, Chapter 11.
Pre-Admission Requirements:
A physician’s exam within 30 days prior to admission is required.
Admission Criteria & Who Decides:
Facilities exclude residents requiring 24-hour skilled nursing or intensive behavioral care.
Who Performs & Criteria:
Assessments are conducted by RNs or administrators.
Medicaid vs Private Pay:
Tennessee’s CHOICES Medicaid Waiver requires a level-of-care screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeal rights.
Texas
Governing Agency & Regulations:
Texas’ assisted living facilities are licensed by the Health and Human Services Commission (HHSC) under Texas Administrative Code Title 26, Part 1, Chapter 553.
Pre-Admission Requirements:
A physician’s medical evaluation must be completed within 30 days prior to admission.
Admission Criteria & Who Decides:
Residents requiring full-time skilled nursing or severe cognitive/behavioral management are typically not admitted.
Who Performs & Criteria:
Assessments are performed by licensed nurses or administrators using standardized tools.
Medicaid vs Private Pay:
Texas offers the STAR+PLUS Medicaid Waiver, which requires an additional level-of-care determination.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals via HHSC and the Long-Term Care Ombudsman.
Utah
Governing Agency & Regulations:
Utah’s assisted living facilities are licensed by the Department of Health and Human Services (DHHS), Office of Licensing.
Pre-Admission Requirements:
A physician’s health assessment must be completed within 30 days before admission.
Admission Criteria & Who Decides:
Residents requiring 24-hour skilled nursing or intensive behavioral management are generally not admitted.
Who Performs & Criteria:
Registered nurses or administrators conduct ADL and cognitive assessments.
Medicaid vs Private Pay:
Utah’s Aging Waiver for Medicaid requires an additional level-of-care screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeal process.
Vermont
Governing Agency & Regulations:
Vermont’s assisted living facilities are regulated by the Department of Disabilities, Aging, and Independent Living (DAIL).
Pre-Admission Requirements:
A medical evaluation must be completed within 30 days before admission.
Admission Criteria & Who Decides:
Residents requiring continuous skilled nursing are excluded.
Who Performs & Criteria:
Licensed nurses or administrators conduct standardized evaluations.
Medicaid vs Private Pay:
The Choices for Care Medicaid Waiver is available with level-of-care screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals via DAIL.
Virginia
Governing Agency & Regulations:
Virginia’s assisted living facilities are licensed by the Department of Social Services.
Pre-Admission Requirements:
A physician’s exam within 30 days prior to admission is required.
Admission Criteria & Who Decides:
Facilities exclude residents requiring 24/7 skilled nursing or psychiatric hospitalization.
Who Performs & Criteria:
Assessments are conducted by RNs or administrators.
Medicaid vs Private Pay:
Virginia offers the Auxiliary Grant/Medicaid Waiver, requiring pre-admission screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals process.
Washington
Governing Agency & Regulations:
Washington’s assisted living facilities are regulated by the Department of Social and Health Services (DSHS).
Pre-Admission Requirements:
A physician’s exam within 30 days prior to admission is required.
Admission Criteria & Who Decides:
Residents requiring full-time nursing care are typically not admitted.
Who Performs & Criteria:
Registered nurses or administrators conduct standardized assessments.
Medicaid vs Private Pay:
A Medicaid waiver is available with level-of-care screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals via the state ombudsman.
West Virginia
Governing Agency & Regulations:
West Virginia’s assisted living facilities are regulated by the Department of Health and Human Resources.
Pre-Admission Requirements:
A physician’s exam within 30 days prior to admission is required.
Admission Criteria & Who Decides:
Residents requiring 24/7 skilled nursing are excluded.
Who Performs & Criteria:
Assessments are conducted by RNs or administrators.
Medicaid vs Private Pay:
A Medicaid waiver is available with level-of-care screening.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice.
Wisconsin
Governing Agency & Regulations:
Wisconsin’s assisted living facilities are licensed by the Department of Health Services (DHS) under Wisconsin Administrative Code Chapter DHS 83.
Pre-Admission Requirements:
A physician’s medical evaluation must be conducted within 30 days prior to admission.
Admission Criteria & Who Decides:
Facilities determine eligibility based on ADLs, medical conditions, and behavioral health status.
Who Performs & Criteria:
Assessments are conducted by registered nurses or facility administrators using state-mandated assessment tools.
Medicaid vs Private Pay:
Wisconsin’s Medicaid Family Care Program provides funding for eligible residents based on a level-of-care review.
Reassessment, Appeal & Resident Rights:
Annual reassessments are required, with a 30-day discharge notice and appeals handled through the Wisconsin Long-Term Care Ombudsman.
Wyoming
Governing Agency & Regulations
Wyoming’s assisted living facilities are regulated by the Wyoming Department of Health, Aging Division.
Pre-Admission Requirements
A physician’s exam is required within 30 days, and facilities conduct a comprehensive assessment covering ADLs, cognition, and medication needs.
Admission Criteria & Who Decides
Residents who require 24-hour nursing care are excluded; decisions are made by the facility based on licensed care limits.
Who Performs the Evaluations
Evaluations are conducted by licensed nurses or administrators using standardized assessments of functional status.
Medicaid vs. Private Pay
A Medicaid waiver is available with an additional level-of-care screening, while private-pay residents follow the standard facility process.
Reassessment, Appeal & Resident Rights
Facilities perform annual reassessments, require a 30-day discharge notice, and offer an appeals process through the state ombudsman.
Final Thoughts
Navigating the assisted living process can be daunting, but knowing what to expect can make the journey smoother. This guide provides you with state-specific insights to help you ask the right questions, understand the processes, and advocate for your loved ones. Whether you’re concerned about funding, resident rights, or the details of care assessments, this repository is designed to be your go-to resource.
Do you want to talk out this information with a group going through a similar experience? Join Primary Record’s, CEO, Jean Ross, RN, as she partners with Daughterhood to host an “Unpacking Senior Living” Circle each mother to guide daughters to ask the right questions, understand the options, and get organized before that first visit.
