Indiana residential care facility license: the state route to assisted living

The license Indiana uses instead of “assisted living”

Indiana’s licensing rules never use the words assisted living. Indiana licenses health facilities, and the tier for most assisted living buildings is the residential care facility. Rule 410 IAC 16.2-1.1-62 defines it as “a health care facility that provides residential nursing care”.⁠¹ Residential nursing care covers identifying residents’ responses to health conditions, making a nursing diagnosis, carrying out minor regimens that a nurse or prescriber has set, and administering, supervising and delegating that nursing work.⁠¹

The licensing test is in 410 IAC 16.2-5-0.5. A health facility that provides residential nursing care, or that administers medications prescribed by a physician, must be licensed as a residential care facility.⁠¹ A facility already licensed as a comprehensive care facility (a nursing home) does not need a second license to provide residential nursing care.⁠¹ Neither the rule nor the IDOH packet sets a minimum or maximum number of beds. The fee schedule simply starts at the first bed.⁠¹⁠³

Operating a facility that needs this license without one is classed as an “offense”, the most serious category in the rule.⁠¹ For an offense, the commissioner orders immediate correction and imposes a fine of up to $10,000, a suspension of new admissions for up to 45 days, or both.⁠¹

When you do not need the license

Subsection (c) of the same rule sets out Indiana’s main exemption. A facility that provides room, meals, laundry, activities, housekeeping and limited help with activities of daily living, but does not administer medication or provide residential nursing care, is not required to be licensed.⁠¹

A second sentence lets you go further. A licensed home health agency may administer medication or provide residential nursing care inside that unlicensed building, and the building still needs no license, “regardless of whether the facility and the home health agency have common ownership”. The condition is that each resident can contract with other home health agencies at any time during their stay.⁠¹ Some founders split the business this way: an unlicensed housing company plus a separately licensed agency. The agency side needs its own IDOH license; see the Indiana home health agency guide. Non-medical attendant and homemaker services fall under the personal services agency license, which does not cover nursing or medication administration.

Other setups get confused with this license:

• Comprehensive care facility (nursing home). This is a separate health facility license. New comprehensive care beds fall under Indiana’s certificate of need law, IC 16-29-7, which covers beds in facilities that provide nursing care at that level.⁠⁷ The statute is written around comprehensive care beds, and no certificate of need for residential care beds appears in it.⁠⁷
• Adult Family Care. This is a Medicaid waiver service in which up to 4 participants live with an unrelated caregiver. FSSA lists state licensure for it as not required; only waiver certification applies.⁠⁹ A home that gives private-pay residents medication administration or residential nursing care is a different case: if it is a health facility, 410 IAC 16.2-5-0.5(a) applies.⁠¹
• Medicaid “assisted living” providers. These are residential care facility licensees that FSSA has also approved. Approval does not replace the license (covered below).⁠⁵

Decide your service level first

Under 410 IAC 16.2-5-4(c), each facility must choose whether it administers medication, provides residential nursing care, or both.⁠¹ That choice drives your staffing plan, your pharmacy arrangements and how many residents you can keep as they decline.

If you administer medication, it must be given by licensed nurses or by qualified medication aides (QMAs) under the supervision of a licensed nurse. A QMA may give an as-needed (PRN) dose only after a licensed nurse or physician authorizes that specific dose.⁠¹ The QMA credential is governed by 412 IAC 2, which IDOH links from its residential care page.⁠² A licensed nurse must be on the premises or on call at all times.⁠¹ A consultant pharmacist must review the drug regimen of each resident who receives medication services at least every 60 days.⁠¹

The rule also sets limits on who can stay. A resident must be discharged if the resident:⁠¹

• is a danger to self or others;
• needs 24-hour comprehensive nursing care or comprehensive nursing oversight;
• needs less than 24-hour comprehensive nursing care, nursing oversight or rehabilitative therapy, and has not contracted with a licensed provider of their choice for it;
• is not medically stable; or
• needs total assistance with at least two of eating, toileting and transferring, unless the resident is medically stable and the facility can meet their needs.

There are two exceptions. Residents receiving hospice from a licensed provider of their choice do not have to leave, and a facility that keeps appropriate professional staff may give comprehensive nursing care for a self-limiting condition.⁠¹

The building: plans review and fire safety come before the application decision

The first step in the IDOH sequence is to send plans and specifications to the Health Care Engineering program. You do this whether you build new or convert an existing building.⁠³ The rule requires detailed architectural and operational plans before construction starts, stating the licensure classification you seek. Projects under 30,000 cubic feet need suitable detailed plans and sketches. Larger projects need certification by an architect or engineer registered in Indiana. A plan of operation covering functional areas such as the kitchen and laundry must go with the plans.⁠¹ IDOH assigns your six-digit state facility number when the plans are filed.⁠³

The building must comply with the fire and building rules of the Fire Prevention and Building Safety Commission (675 IAC). Your license file needs a state fire marshal report and verification from the building official.⁠¹ The physical plant section, 410 IAC 16.2-5-1.6, adds these specifics:⁠¹

For newly licensed facilities, subsection (j)(1) requires a private toilet, lavatory and tub or shower in each unit. The rule text gives the cutoff as “initially licensed after (effective date)” and never states the date, so the published rule does not settle whether it reaches a facility licensed today. Ask Health Care Engineering in writing, before you finalize plans, whether every new residential care facility must have a private bath in each unit.

The kitchen, food supplies, waste disposal and pest control program must each comply with 410 IAC 7-24.⁠¹ The facility must provide, arrange or make available three meals a day, seven days a week, on menus approved by a registered dietitian.⁠¹

If you also plan to serve Medicaid residents, design for the stricter waiver unit standard now. It is covered under Medicaid below.

What goes in the application packet

The IDOH packet for a new residential care facility (dated November 2024) lists these items:⁠³

1. State Form 8200,

   Application for License to Operate a Health Facility, with attachments. The rule requires you to disclose every direct or indirect owner with 5% or more, plus officers, directors and partners.⁠¹

2. State Form 19733,

   Implementing Indiana Code 16-28-2-6.

3. Secretary of State registration

   for the applicant entity.

4. An IRS document showing the entity’s legal name and EIN

   It must be a document the IRS sent you, not a form you completed and sent to the IRS.

5. State Form 51996,

   Independent Verification of Assets and Liabilities. The rule requires a certified public accountant to prepare it and to show working capital adequate to operate the facility.⁠¹

6. The licensure fee

7. State Form 4332,

   Bed Inventory.

8. A floor plan on 8½ x 11 paper

   showing room numbers and beds per room.

9. State Form 55282,

   Proposed Staffing Structure.

10. State Form 55283,

    Contract and Service Agreement Checklist.

The rule also asks for your corporate or partnership structure, a list of every facility your officers, directors, agents and managing employees have owned or operated, copies of agreements and contracts, a staffing plan, and a disaster plan.⁠¹ The packet goes to Long Term Care – Provider Services, Indiana Department of Health, 2 N. Meridian St., Section 4-B, Indianapolis, IN 46204. Questions go to [email protected].⁠³

Fees as published by IDOH

The November 2024 packet sets the licensure fee at $200 for the first 50 beds and $10 for each additional bed.⁠³ Under that schedule, a 16-bed building pays $200 and an 80-bed building pays $500. The packet says you pay a renewal application and fee every time the license expires, whatever its length.⁠³ A probationary license requires a new fee even if you already paid for the full year.⁠¹

From plans to first residents: the IDOH order

1. Plans review

   Submit plans and specifications to Health Care Engineering and get approval.⁠³

2. Application

   Send the packet. IDOH must receive and approve it before any inspection takes place.⁠³

3. Substantial completion

   Notify Provider Services in writing when construction or remodeling is substantially complete.⁠¹⁠³

4. Fire safety inspections

   Send a written request for the State Fire Code inspections to the Program Director – Provider Services, Division of Long Term Care.⁠³

5. Authorization to Occupy and provisional license

   Once the fire inspections are done and released, the division issues both. You may admit residents from that point.⁠³

6. Initial licensure survey

   IDOH surveys the facility before the provisional license expires and sends the results through its Survey Report System.⁠³ Neither the rule nor the packet states how long the first provisional license lasts; the rule only says it is issued under IC 16-28-2-4(2).⁠¹⁠³ Ask Provider Services for the expiry date on your provisional license and the survey window.

The bed inventory and floor plan approved at opening stay your licensed configuration. You need IDOH approval before you relocate or change beds.⁠³ You may not house more residents than your licensed number, except with temporary permission in an emergency.⁠¹

The administrator

The licensee must appoint an administrator who holds either a comprehensive care (health facility administrator, HFA) license or a residential care facility administrator license, and delegate day-to-day operations to that person.⁠¹ One administrator can serve only one health facility at a time. You must notify IDOH within 3 working days of a vacancy and give the replacement’s name and license number.⁠¹ The administrator must report unusual occurrences that threaten residents to the division within 24 hours.⁠¹

The Professional Licensing Agency lists these requirements for the residential care administrator (RCA) license:⁠⁴

• age 21 or older and a high school diploma or equivalent;
• a national criminal history background check;
• a passing score on Indiana’s jurisprudence exam (the national NAB exam is not required);
• one qualifying route: being a licensed HFA or a health care practitioner registered, certified or licensed under IC 16 or IC 25; one year of management experience in health care, housing, hospitality or similar services to the elderly; an associate’s degree in gerontology or health care; a bachelor’s degree or higher; or a 100-hour board-approved course in residential care facility administration;
• a $100 application fee.

As published on 2026-10-12, RCA licenses expire on August 31 of even-numbered years, renewal costs $100, and RCAs must complete at least 20 hours of continuing education in each two-year licensing period.⁠⁴ The board can issue a provisional RCA license for a specific facility to someone with at least 2 years of administrative experience in a residential care facility.⁠⁴

Staffing, aides and training

Indiana sets no resident-to-staff ratio for small buildings. Staffing must meet the 24-hour scheduled and unscheduled needs of residents, with these fixed floors:⁠¹

• At least one awake staff person with current CPR and first aid certificates on site at all times.
• At least one nursing staff person on site at all times once 50 or more residents regularly receive residential nursing services or medication administration.
• Above 100 such residents, one more awake nursing staff person on duty for every additional 50 residents.

Unlicensed staff who give more than limited help with daily activities must be certified nurse aides or home health aides.⁠¹ Every employee gets an orientation before working independently. The orientation covers first aid, emergency procedures and evacuation, and each resident’s particular needs for direct care staff.⁠¹ Annual in-service training is at least 8 hours for nursing staff and 4 hours for other staff. Staff with resident contact also need 6 hours of dementia-specific training within 6 months and 3 hours a year after that.⁠¹

Employees and volunteers are screened for tuberculosis at hire (or within one month before) and every year after. The first skin test must be read before the person starts work, and a two-step test is used for anyone without a documented negative test in the previous 12 months.⁠¹

Admission evaluations and service plans

You must start an evaluation of each resident before admission and update it at least every six months and whenever the resident’s condition changes substantially. A licensed nurse evaluates nursing needs.⁠¹ At a minimum, the evaluation covers physical, cognitive and mental status, independence in daily activities, weight (on admission and every six months), and, where relevant, the ability to self-administer medication.⁠¹ From it you write a service plan, which the resident signs and dates.⁠¹ Residents who self-medicate may keep their medications in their unit under the conditions the rule sets.⁠¹

Alzheimer’s and dementia special care units

A facility that must file an Alzheimer’s and dementia special care unit disclosure under IC 12-10-5.5 must designate a director for the unit.⁠¹ The director needs a degree in a health care, mental health or social service profession, or a health facility administrator license. They also need at least one year of work experience with dementia or Alzheimer’s residents within the past five years.⁠¹ The rule also sets hours of dementia-specific training for the director: an initial block within 3 months of starting, then 6 hours a year.⁠¹ Adding a special unit later goes through IDOH’s bed change, remodeling and special unit request process.⁠²

Medicaid: the waiver layer and the 2026 split

Indiana Medicaid does not license assisted living. It pays licensed residential care facilities that FSSA has approved as waiver providers. Under 460 IAC 19 (formerly 455 IAC 3), a provider must hold the 410 IAC 16.2-5 license for each facility and must register each facility as a housing with services establishment under IC 12-10-15.⁠⁵ Each facility is certified and enrolled with the Indiana Health Coverage Programs separately.⁠⁹

Units for waiver recipients have to meet extra standards:⁠⁵

• New facilities: a bedroom, a private bath, a living area and a kitchenette with a refrigerator, a food preparation area and a microwave or stovetop. Each unit needs at least 220 sq ft of livable space excluding the bathroom, a wheelchair-accessible bath and an individual thermostat, and half of the units offered to recipients must have a roll-in shower.
• Facilities already licensed before the rule took effect: at least 160 sq ft, a sleeping area that need not be a separate bedroom, a semiprivate bath, and access to a stovetop or oven in a common area.
• All facilities: units are single unless the recipient chooses to share. Recipients may lock their units unless a physician or mental health professional certifies in writing that the recipient is cognitively impaired enough to be a danger to self or others, or the fire code conflicts.

Service plans for waiver residents must be reviewed at least every 90 days.⁠⁵ Recipients pay room and board themselves, and you may not charge more than the current SSI rate minus the personal needs allowance.⁠⁵ Waiver assisted living providers must also provide help with daily activities, instrumental activities and medication oversight. Integrated health care coordination must be delivered by an Indiana-licensed RN or LPN, or a licensed social worker with a master’s degree in social work and at least two years of experience providing health care coordination.⁠⁸

The program is changing. HEA 1277, enacted in 2026, directed FSSA to apply for a separate 1915(c) waiver for assisted living for people aged 60 and older who meet nursing facility level of care. The waiver would pay for assisted living, integrated health care coordination and transportation.⁠⁶ FSSA’s June 2026 draft application lists a proposed effective date of July 1, 2026 and 6,500 participants a year. It transfers slots from the Indiana PathWays for Aging waiver and phases assisted living out of PathWays.⁠⁶ Under PathWays, members receive long-term services and supports through managed care entities.⁠⁶ The only FSSA document found as of 2026-10-12 is that draft, which was in public comment through August 14, 2026; no CMS approval or provider-enrollment instructions for the new waiver were found. If you plan to serve Medicaid residents, ask FSSA whether the waiver is approved, which provider approval process applies, and whether 460 IAC 19 approval still governs new assisted living providers.

Renewal, surveys and enforcement

IDOH may issue a full renewal license for any period up to one year. File the renewal application at least 45 days before the license expires.⁠¹ IDOH program staff run health and life safety code surveys and investigate complaints.⁠² Findings are classified by severity:⁠¹

A probationary license lasts 3 months, and IDOH may issue no more than three in any 12-month period.⁠¹ You must report in writing any change of 5% or more in direct or indirect ownership at the time it happens. Changes in officers, directors, managing employees or the management company must be reported the same way.⁠¹ A buyer must notify the director in writing before taking over a licensed facility, or IDOH cannot issue a full license.⁠¹ IDOH publishes separate change-of-ownership, name-change and closure packets on its residential care page.⁠²

The rule article was last readopted on November 13, 2019.⁠¹ This guide did not find a pending rulemaking on 410 IAC 16.2-5 in the sources checked on 2026-10-12. Check the Indiana Register and IDOH’s residential care page for changes before you file plans.

Sources

1. 1
   Indiana Department of Health, 410 IAC 16.2, Health Facilities; Licensing and Operational Standards (including Rule 5, Residential Care Facilities) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Indiana Department of Health, Long-Term Care / Nursing Homes: Residential Care Checked 12 Oct 2026 · Back to text ↑
3. 3
   Indiana Department of Health, Long Term Care, Application for a New Residential Care Facility (November 2024) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Indiana Professional Licensing Agency, Health Facility Administrators: Licensing Information Checked 12 Oct 2026 · Back to text ↑
5. 5
   Indiana Administrative Rules and Policies, 460 IAC 19, Assisted Living Medicaid Waiver Services Checked 12 Oct 2026 · Back to text ↑
6. 6
   Indiana Family and Social Services Administration, Application for a 1915(c) HCBS Waiver: PathWays Assisted Living Waiver (public comment draft, June 2026) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Indiana Department of Health, IC 16-29-7, Certificate of Need for Comprehensive Care Health Facilities Checked 12 Oct 2026 · Back to text ↑
8. 8
   Indiana Health Coverage Programs, IHCP Bulletin BT2025148: Guidance for HCBS providers that provide IHCC (October 21, 2025) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Indiana Health Coverage Programs, Office of Medicaid Policy and Planning Home- and Community-Based Services provider module Checked 12 Oct 2026 · Back to text ↑

Was this information accurate? Report an errorPrint or save as PDF