Minnesota assisted living facility license: MDH rules, fees and steps

One license for any size, in two categories

Minnesota replaced its old housing-with-services registration (chapter 144D) with a single assisted living license on August 1, 2021. Since then, “no assisted living facility may operate in Minnesota unless it is licensed under this chapter.”⁠¹ The trigger is functional. An assisted living facility is “a facility that provides sleeping accommodations and assisted living services to one or more adults.”⁠¹ A converted single-family house with two residents and a 120-unit building fall under the same statute and the same MDH unit.

“Assisted living services” is a defined list. It includes help with dressing, self-feeding, grooming, toileting and bathing; standby assistance; medication and treatment reminders; specialized diets ordered by a health professional; nursing and therapy services; tasks an RN delegates to unlicensed staff; medication management; hands-on help with transfers and mobility; and help with eating for residents who have complicated eating problems.⁠¹ Supportive services such as housekeeping or transportation count only “in addition to the provision of at least one” of the listed services.⁠¹ If you rent rooms and offer only meals and housekeeping, you are not an assisted living facility. Add standby help with bathing and you are.

The license comes in two categories:⁠¹

• Assisted living facility. For facilities that provide only assisted living services.
• Assisted living facility with dementia care. Required if you advertise, market or promote “specialized care for individuals with Alzheimer’s disease or other dementias,” and required for any facility with a secured dementia care unit, meaning an area locked or secured to prevent or limit residents from leaving.

MDH issues one license for each building at a separate address. A licensee running several buildings on one campus may hold a single campus license that lists each building’s address and capacity.⁠¹ If part of a licensed building is used by an unlicensed entity or another license type, you need at least a vertical two-hour fire barrier between them.⁠¹ The licensee stays legally responsible for the facility even if a management company runs it day to day.⁠¹

Operating without a license is a misdemeanor for the facility and for any controlling individual with authority over operations, and MDH may also fine you.⁠¹ A 144G license replaces the chapter 157 lodging and food licenses. You do not need a separate hotel, boarding or restaurant license.⁠¹

Assisted living, adult foster care or home care?

Founders who want a small home often weigh three Minnesota licenses run by two agencies:

• Adult foster care is a Department of Human Services (DHS) license under chapter 245A. The 144G definition expressly excludes settings licensed under chapter 245A, “including adult foster care.”⁠¹ Under a licensing moratorium, DHS may not issue an initial adult foster care license for a location that will not be the license holder’s primary residence for the whole licensed period, with listed exceptions.⁠¹⁵
• Home care (basic or comprehensive, MDH, chapter 144A) is for services delivered in a client’s own home. A home care licensee “must not provide sleeping accommodations as a provision of home care services,” and housing plus assisted living services “requires assisted living facility licensure.”⁠¹⁴ See the basic home care guide for the home care side.
• Adult day services (DHS) cover care for less than 24 hours with no overnight stay.

Chapter 144G also lists settings that are not assisted living facilities even if residents get help: nursing homes, hospitals and boarding care homes; private homes where residents are related to the provider “by kinship, law, or affinity”; owner-occupied condominiums and cooperatives (at least 80% of units owner-occupied); temporary family health care dwellings; homeless and domestic violence shelters; and certain HUD and tax-credit rental housing.⁠¹ The tax-credit and Minnesota Housing exclusion does not cover developments “that market or hold themselves out as assisted living facilities and provide assisted living services.”⁠¹

Six residents or fewer: the 2026 siting rules

The 2026 Legislature tightened licensing for small facilities. If you plan a house-sized facility, these rules decide whether your address can be licensed at all.

DHS must clear the location first. Laws 2026, chapter 121, amended section 144G.15. MDH “must not grant a provisional license for an assisted living facility with a licensed resident capacity of six or fewer” until DHS determines that the site meets the colocation standard in section 245A.042.⁠⁸ This applies whatever services you plan and whether or not any resident is publicly funded.⁠⁸ Under the standard, effective July 1, 2026, a newly licensed small setting cannot sit “on the same property or on an adjoining property” of any existing community residential setting, adult foster care home, small customized living setting, or 144G facility of six or fewer, “regardless of who owns or controls the existing setting.”⁠⁸ The definition of adjoining is broad. Lots that touch only at a corner count. So do lots separated by a street, alley, bike path or other right-of-way that would otherwise share a boundary or corner.⁠⁸ MDH’s July 1, 2026 application for six or fewer residents says MDH “cannot issue a license until DHS has completed its review.”⁠⁵

MDH weighs the community. Before issuing a small-facility provisional license, MDH must also consider “the population, size, land use plan, availability of community services, and the number and size of existing licensed assisted living facilities” in the town, city or county.⁠⁸ The small-facility application therefore asks you to name the jurisdiction and give a contact for the city administrator, township clerk or county administrator. It also asks for the jurisdiction’s population and a description of the community and its services, and you attach the local land use plan. There is a box to tick if no plan can be found.⁠⁵⁠⁶

Your city is told. For provisional licenses issued on or after July 1, 2026, MDH must notify the affected municipality within five business days. The notice gives your business name, street address, license category, capacity, and the contact for your authorized agent.⁠⁸

Some local rules do not apply. A facility of six or fewer is exempt from local rental licensing ordinances. It must still meet local fire, building and zoning codes.⁠¹ Starting January 1, 2027, MDH may delegate inspections of existing six-or-fewer facilities, for physical plant requirements and zoning, to a county or city that asks for that authority.⁠⁸

The same chapter tells MDH to convene stakeholders and draft a new license category for facilities of five or fewer residents, especially those serving waiver participants. The draft legislation is due to the Legislature by January 1, 2028.⁠⁸ Nothing has been enacted yet.

The building: plan review, fire code and design standards

MDH Engineering reviews every proposed building before licensure. The provisional application requires an Assisted Living Plan Submittal Form as its physical environment addendum.⁠⁶ MDH’s application says its engineers “will review the proposed assisted living facility building plans and conduct an inspection.”⁠⁵ What you submit depends on size:⁠⁷

• Five or fewer residents: a PDF of clear, legible, dimensioned final construction plans.
• Six or more residents: a writable PDF of final plans certified by a licensed architect under Minn. R. 1800.4200.

A plan review that involves construction carries a nonrefundable fee under section 144.554. The fee is tiered by project cost and starts at $45 for projects up to $10,000. A submittal without construction has no fee.⁠⁷⁠¹¹ For new construction, Minnesota-registered architects and engineers must sign the plans, construction must start within one year of approval or the plans must be resubmitted, and you must notify MDH within 30 days before completion so it can schedule a final inspection.⁠¹

Section 144G.45 sets the baseline for every facility, including small homes:⁠¹

• Site: public utilities or approved water and septic systems; access for fire and EMS; drainage that does not flood; all-weather roads and walks to the entrances and parking; outdoor activity space for residents.
• Fire: compliance with the State Fire Code (Minn. R. ch. 7511); smoke alarms in every sleeping room, outside sleeping areas and on every story, interconnected where more than one is required; and in Group R-3 occupancies, extinguishers rated at least 2-A:10-B:C within 75 feet of travel.
• Plans and drills: written fire safety and evacuation plans; staff training at hire and at least twice a year; evacuation drills twice a year per shift, with at least one drill every other month.

Facilities with six or more residents also have to meet two national standards for new licenses or new construction. One is the 2018 Facility Guidelines Institute Guidelines for Design and Construction of Residential Health, Care and Support Facilities. The other is the 2018 NFPA 101 Life Safety Code chapter on residential board and care occupancies. These facilities must also offer every resident the option of a bath as well as a shower.⁠¹ You can request a written variance or waiver from section 144G.45 requirements.⁠¹

People you need before you open

A licensed assisted living director. Each facility must employ an assisted living director “licensed or permitted by the Board of Executives for Long Term Services and Supports” (BELTSS) and affiliated with the board as director of record.⁠¹ To qualify, a director either completes a BELTSS-approved training course and passes an exam that covers Minnesota assisted living law, or holds a Minnesota nursing home administrator license (or national health services executive validation) and has core knowledge of assisted living law.⁠¹⁰ The director must apply for licensure within 30 days of hire and complete 30 hours of continuing education every two years.⁠¹⁰ Under BELTSS fee caps as amended in 2026, the application costs at most $200, the state exam $125, the initial license $250 and a permit $400.⁠⁸

A clinical nurse supervisor. Every facility needs a clinical nurse supervisor “who is a registered nurse licensed in Minnesota.”⁠¹ That nurse writes the staffing plan and the posted 24-hour daily staffing schedule required by rule.⁠³

Awake, reachable staff around the clock. At least one person must be available 24 hours a day, seven days a week, to respond to residents’ requests for help. That person must be awake and must be located in the same building, an attached building or a contiguous campus. Staff must also have access to an on-call RN at all times.⁠¹ When a resident’s assessment calls for two-person help, two direct-care staff must be scheduled and available.⁠³

Clean background studies. Before MDH issues a provisional license, every managerial official and every natural person with a direct ownership interest must pass a background study under section 144.057. MDH will not license you if a controlling individual has a disqualification that was not set aside.⁠¹ Employees, contractors and regularly scheduled volunteers need the same study.⁠¹

What MDH wants in the application

You download the provisional application from MDH, one version for six or fewer residents and one for seven or more, and upload it with its addenda to MDH’s Facility and Provider Licensing System.⁠⁴ By statute the application must show:⁠¹

• business and legal entity names, and the facility’s street and mailing addresses;
• names and contact details for all owners, controlling individuals, managerial officials and the assisted living director;
• licensed resident capacity and license category;
• background study documentation, for a new license covering every person with 5% or more direct or indirect ownership;
• proof of workers’ compensation coverage and of liability coverage;
• the executed lease, management agreement and operations transfer agreement, if any;
• an organizational chart of every owner with a 5% or greater interest;
• disclosure of felony-level offenses in the past ten years, plus any health care fraud or patient abuse convictions, license revocations and program exclusions;
• any default in paying money collected for others, including discharge through bankruptcy, in the past three years;
• every state where the applicant or a 5% owner had a care license or certification denied, suspended, revoked or placed in receivership; and
• one or more authorized agents who can accept legal service for the licensee.

MDH’s checklist adds documents that founders often lack on day one. You need your IRS SS-4 (the letter assigning your federal EIN) and your entity’s Minnesota Secretary of State filings: articles and a member list with ownership percentages for an LLC, or the certificate of incorporation for a corporation. You also need a copy of the Uniform Disclosure of Assisted Living Services and Amenities (UDALSA) you will give prospective residents, with no signatures or resident information. Small facilities attach the local land use plan.⁠⁶ MDH acknowledges receipt and sends back incomplete or inaccurate applications.⁠⁴

Fees as published

Scroll the table sideways to see every column.

Sources: ⁠²⁠⁵

The fee is calculated on the licensed resident capacity in your application. MDH asks for payment only after it finds the application complete. Only online payments are accepted, and a payment rejected for insufficient funds costs another $30.⁠⁵ All fees are nonrefundable, “including if an application is denied or withdrawn.”⁠¹⁠⁵ At renewal, MDH may lower the fee by up to 10% if waiver recipients made up more than 50% of your capacity in the prior calendar year, or raise it by up to 10% if they made up less than 50%.⁠²

Other fees you may meet are the construction plan review fee, the BELTSS director fees, a $3,905 relocation fee (see below), a $200 late-renewal penalty and $250 a day for operating on an expired license.⁠¹⁠⁸⁠¹¹

From application to full license

1. Confirm the site

   For six or fewer residents, check the adjoining-property rule and gather the land use plan before you sign a lease. Confirm local zoning and building requirements for any size.⁠¹⁠⁸

2. Hire or line up the director and clinical nurse supervisor

   MDH’s application asks for both, and dementia care applicants are judged partly on their experience.⁠¹⁠⁴

3. Submit plans to MDH Engineering

   with the Assisted Living Plan Submittal Form, and pay the plan review fee if there is construction.⁠⁶⁠⁷

4. Upload the provisional application

   and addenda to the Facility and Provider Licensing System.⁠⁴

5. Pay the license fee

   when MDH tells you the file is complete. MDH then reviews the application and may consult the Department of Labor and Industry, DHS and BELTSS.⁠⁵

6. Complete background studies

   The review ends with them. For six or fewer residents, DHS must also issue its location determination.⁠⁵

7. Receive the provisional license

   It is effective for up to one year. Post the certificate at the main public entrance.⁠¹⁠³ Within 30 days, send an unsigned copy of your assisted living contract to the Office of Ombudsman for Long-Term Care.⁠³

8. Admit your first resident and notify MDH within two days

   by email. If you serve no one during the provisional year, the license expires and you must reapply.⁠¹

9. Pass the unannounced initial survey

   Substantial compliance earns the full license. Otherwise MDH either ends the provisional license or extends it for up to 90 days with conditions. If you notify MDH of your first resident within 45 days of expiry, MDH may extend the provisional license up to 60 days to finish the survey.⁠¹

If MDH denies the license after the survey, you have 15 calendar days to request reconsideration in writing. The owners and managerial officials of a denied provisional licensee cannot apply for another assisted living license for one year after the facility closes.⁠¹ MDH’s application materials state no processing time, so ask MDH for its current review timeline before you sign a lease.

Dementia care: the extra license category

Choose the dementia care category if you will market dementia care or lock any unit. MDH weighs the dementia and long-term care experience of your director, managerial official and clinical nurse supervisor, plus your compliance history.⁠¹ If neither the director nor the clinical nurse supervisor has managed residents with dementia, you must employ a consultant for at least the first six months of operation. The consultant needs two years of work experience related to dementia, health care, gerontology or a related field and the minimum core training in section 144G.64.⁠¹⁠⁵ MDH inspects the physical environment on site before it issues a dementia care license.⁠¹

Additional requirements:⁠¹

• a documented safety-risk assessment of the property, with each risk mitigated;
• an approved supervised automatic sprinkler system throughout the facility by August 1, 2029;
• for secured units, the 2018 NFPA 101 health care (limited care) chapter and an awake staff member physically present in the unit 24 hours a day;
• policies on wandering and elopement, behavioral symptoms and psychotropic medication;
• dementia-trained staff only for residents with dementia; and
• at least ten hours of the director’s annual continuing education devoted to dementia.

To drop the category later, you must give MDH, the ombudsman and residents 60 days’ written notice.⁠¹

Staff training MDH checks

Sources: ⁠¹

Proof of the required training completed within the past 18 months satisfies the initial requirement. Until direct-care staff finish their initial dementia training, they may give direct care only when a trained staff member is on site to help.⁠¹ Unlicensed staff need a training and competency evaluation. Staff who perform delegated nursing tasks must also pass a written or oral test and a practical skills test, or meet the federal home health aide or nursing assistant standard.⁠¹ Temporary agency staff are held to the same rules as your employees.⁠¹

Operating rules that shape your service model

Chapter 144G includes resident-rights rules that affect how you design the building and the contract. Every facility must:⁠¹

• give residents access to food at any time, a choice of visitors and visiting times, a choice of roommate, and a lockable unit door (you supply the lock);
• offer three nutritious meals a day plus snacks, following USDA guidelines, with menus planned a week ahead;
• offer weekly housekeeping and laundry, help arranging transportation, and a daily activity program; and
• evaluate staffing levels at least twice a year.

Facilities of ten or fewer residents get relief from parts of the food code. For example, they may share a certified food protection manager with one other commonly managed facility within 60 miles.⁠¹

Required written policies cover maltreatment reporting, background studies, training, complaints, RN assessments, infection control consistent with CDC guidance, tuberculosis screening, medication and treatment management, and delegation and supervision.⁠¹ By rule, you must follow the federal emergency preparedness standard for long-term care facilities (42 CFR 483.73) and keep a missing-resident plan for residents who cannot evacuate on their own or are assessed as at risk of wandering.⁠³ An RN must assess each prospective resident who will receive services and propose a temporary service plan before the contract is signed or the resident moves in, whichever is earlier. The RN reassesses within 14 days after services start.⁠¹ You may not admit or keep a resident whose needs you cannot meet, and anyone you turn down must be told why.⁠³ Since August 1, 2026, you may not require a resident to have a guardian or conservator as a condition of admission or continued residence.⁠⁹

Getting paid through Minnesota’s waivers

Minnesota’s waivers pay for assisted living as “customized living” services: under the Elderly Waiver (chapter 256S) and under the Brain Injury (BI) and Community Access for Disability Inclusion (CADI) waivers (section 256B.49).⁠¹²⁠¹³ For customized living under chapter 256S, a provider must be licensed under chapter 144G. The exception is a comprehensive home care licensee delivering services in certain exempt subsidized or federally financed housing.⁠¹² If you plan to serve BI or CADI residents in a house, two limits matter:

• DHS will not enroll new customized living settings “serving four or fewer people in a single-family home” under the BI or CADI waivers. Settings operating by June 30, 2021 are exempt, and an existing setting that changes ownership at the same address may get an exception.⁠¹³
• A new facility that is adjoined to, or on the same property as, an institution such as a nursing home cannot receive disability waiver services.⁠¹

Renewal, surveys, ownership changes and relocation

Renewal. A full license runs for up to one year. File the renewal at least 60 days before expiration, and show that you served at least one resident at the licensed address during the year.⁠¹ Filing less than 30 days before expiration costs a $200 penalty, and operating after expiration costs $250 a day.⁠¹

Surveys. MDH surveys each facility at least once every two years, without advance notice, and may survey more often based on license category, compliance history or size.⁠¹

Ownership changes. A license cannot be transferred. A buyer must apply for a new (non-provisional) license, give MDH at least 60 days’ written notice and expect a survey within six months.⁠¹ Under a 2026 amendment, the new licensee inherits outstanding fines and existing correction orders.⁠⁹

Relocation. A facility licensed for five or fewer residents may move under its current license with MDH approval. The move costs a $3,905 nonrefundable fee and needs plan review and a certificate of occupancy for the new building. You may relocate only once in any three-year period unless MDH approves another move for an extenuating circumstance, and the new location goes through the same DHS colocation review.⁠⁸ Since the 2026 amendment, a facility in the seven-county Twin Cities metro area may not relocate outside it.⁠⁸

Changes taking effect in 2026 and 2027

• July 1, 2026: DHS colocation review and municipal notice for provisional licenses of six or fewer.⁠⁸
• August 1, 2026: ban on requiring guardianship or conservatorship for admission.⁠⁹
• January 1, 2027: only licensed facilities may use “assisted living” in advertising, and a licensee’s name may not include “home care” or “nursing home.”⁠¹ A new section 144G.85 bans restraints except emergency manual restraint, prohibits prone restraint and requires a report to MDH and the ombudsman within seven days of any use.⁠⁹ Staff authorized to use emergency manual restraint need four hours of training first and two hours of refresher training each year.⁠⁹ Counties and cities may take over inspections of small facilities.⁠⁸
• August 1, 2027: the 24-hour responder must be trained in the 144G.61 topics. New training topics cover airway, breathing and circulation emergencies, bleeding, emergency movement, log roll and spinal precautions. Facilities need written procedures for falls, heart events, breathing difficulty and choking, and for non-emergency lift assistance after a fall, and must give the emergency procedures to prospective residents before they sign.⁠⁹
• January 1, 2028: MDH’s draft of a new license category for facilities of five or fewer residents is due to the Legislature.⁠⁸

Sources

1. 1
   Minnesota Office of the Revisor of Statutes, Minnesota Statutes, chapter 144G (Assisted Living Facilities) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 144.122 (License, permit, and survey fees) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Minnesota Office of the Revisor of Statutes, Minnesota Rules, chapter 4659 (Assisted Living Facility Licensing) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Minnesota Department of Health, Assisted Living Licensure Application Materials Checked 12 Oct 2026 · Back to text ↑
5. 5
   Minnesota Department of Health, Provisional Assisted Living Licensure Information and Application (6 or Fewer Residents), July 1, 2026 Checked 12 Oct 2026 · Back to text ↑
6. 6
   Minnesota Department of Health, Provisional Assisted Living Licensure Application Checklist Checked 12 Oct 2026 · Back to text ↑
7. 7
   Minnesota Department of Health, Engineering Services for Assisted Living Facilities Checked 12 Oct 2026 · Back to text ↑
8. 8
   Minnesota Office of the Revisor of Statutes, Laws of Minnesota 2026, chapter 121 (S.F. 4476) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Minnesota Office of the Revisor of Statutes, Laws of Minnesota 2026, chapter 95 (S.F. 476) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 144A.20 (Administrator and director qualifications) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 144.554 (Health facilities construction plan submittal and fees) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 256S.20 (Customized living services; policy) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 256B.49 (Home and community-based service waivers for persons with disabilities) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 144A.471 (Home care provider and home care services) Checked 12 Oct 2026 · Back to text ↑
15. 15
    Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 245A.03 (Who must be licensed) Checked 12 Oct 2026 · Back to text ↑

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