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New Jersey assisted living residence license: certificate of need first, then DOH licensure

New Jersey will not license a new assisted living residence until the Department of Health (DOH) has approved a certificate of need for it. After that comes a license under N.J.A.C. 8:36, renewed every year. The project must also commit to filling 10% of its beds with Medicaid-eligible residents within three years of licensure, and 20% of resident days with people who need nursing home level of care within 36 months.

Written by Editorial team Checked against 47 official sources Last reviewed How we review
Contents13 sections

Key takeaways

  • A new assisted living residence (ALR) needs an expedited-review certificate of need (form CN-19) before DOH will take a license application. The CN-19 fee is $7,500, or $7,500 plus 0.25% of total project cost for projects over $1,000,000.⁠3⁠9⁠10
  • Expedited CON filings are accepted only on the first business day of a month, and the rule sets a 90-day decision deadline. One 2024 approval came about 18 months after filing.⁠5⁠7
  • Every ALR licensed on or after September 1, 2001 must reach 10% Medicaid occupancy within three years and keep it there. Facilities with fewer than 10 beds must hold at least one bed for Medicaid.⁠19
  • Each apartment needs at least 150 square feet of clear floor space for one person, plus its own bathroom, a kitchenette and a lockable door. No more than two people may share a unit.⁠8⁠29⁠30⁠31
  • The administrator must be at least 21 and either a licensed NJ nursing home administrator or a Certified Assisted Living Administrator. A registered nurse must be available at all times.⁠17⁠22

Quick facts

AgencyNJ Department of Health, Division of Certificate of Need and Licensing
RuleN.J.A.C. 8:36 (readopted 2021, expires Nov. 29, 2028)
Certificate of needRequired: expedited review on form CN-19
CON fee$7,500; over $1M project cost: $7,500 + 0.25% of total cost
License fee$1,500 + $15 per bed, every year, plus a $1,500 inspection fee every two years
License termOne year or less
Medicaid set-aside10% of beds within 3 years of licensure

Fees as published in N.J.A.C. 8:36-2.2 and on form CN-19 (rev. January 2024), checked on 2026-10-12.

Three licenses under one rule, and which one you can actually start

N.J.A.C. 8:36 licenses three different kinds of business. The building you plan decides which one you need.⁠1⁠8

Licenses under N.J.A.C. 8:36 (definitions at N.J.A.C. 8:36-1.3)
License What it is Unit standard
Assisted living residence (ALR) Apartment-style housing and congregate dining, with assisted living services available when needed, for four or more unrelated adults At least one unfurnished room, a private bathroom, a kitchenette and a lockable door
Comprehensive personal care home (CPCH) Room and board, with assisted living services available when needed, for four or more unrelated adults No more than two residents per unit, with a lockable door
Assisted living program (ALP) Meals and assisted living services delivered to tenants of publicly subsidized housing that cannot be licensed as an ALR Services go to the tenants (residents) of the subsidized housing

The ALR is the license for a new building. A new CPCH is limited to a narrow set of projects:⁠34

  • conversions of licensed long-term care beds, or of residential health care facilities, residential health care beds, or Class “C” boarding homes that were licensed or approved on or before December 20, 1993
  • additions of no more than 20 beds in any five-year period to an existing or converting CPCH
  • hospice programs that have been Medicare-certified for at least 12 consecutive months

A CPCH that wants to add more than 20 beds has to apply as an ALR instead.⁠34 CPCHs also carry an extra duty. Each year, at least 5% of resident days must go to people receiving Supplemental Security Income (SSI), and at least half of those residents must be former psychiatric patients. The home reports the figure to DOH by April 15. Exceptions apply, including a one-year grace period after conversion and homes built exclusively for hospice residents.⁠36

“Assisted living” in New Jersey is a protected term. Only licensed ALRs and CPCHs may describe themselves to the public as providing assisted living services. DOH treats any other use of the term as operating a health care facility without a license.⁠15 The definition reaches residents who need nursing home level of care: assisted living means personal and health services available 24 hours a day, including to people who require that level of care.⁠8

Neighboring licenses

  • A home with three or fewer residents. In the caregiver’s own home, this is adult family care, licensed to the individual caregiver, who works through a sponsor agency.⁠1 See /guides/new-jersey-adult-family-care-caregiver-license/.
  • Dementia care homes. These have their own DOH licensing chapter, N.J.A.C. 8:37, under the Dementia Care Home Act (N.J.S.A. 26:2H-148 et seq.).⁠42 The chapter defines a resident as a person with Alzheimer’s disease or another form of dementia who is 18 or older and ambulatory.⁠46 An applicant may ask DOH for a functional review of the project before submitting plans.⁠47 The rule text this guide checked sets no certificate of need step or resident cap that it could confirm, so ask DOH’s Certificate of Need and Healthcare Facility Licensure Program whether a dementia care home project needs a certificate of need and what resident limit applies.⁠42
  • Existing facilities adding assisted living. A nursing home, residential health care facility or Class “C” boarding home needs DOH licensing approval before it starts providing assisted living services.⁠10
  • Ventilator care and severe behavior problems. DOH calls this “specialized long-term care.” Residents who need it cannot stay in an ALR or CPCH and must move to a long-term care facility that provides it.⁠8⁠19

Step one is the certificate of need

N.J.A.C. 8:36-2.1 is plain about it: a health care facility may not be “instituted, constructed, expanded, licensed to operate, or closed” without a certificate of need (CON) issued under N.J.A.C. 8:33.⁠9 The license application comes only “following receipt of a certificate of need.”⁠10

Opening or enlarging an ALR goes through expedited review, not full review. The same track covers new or larger CPCHs and new ALPs.⁠4 DOH says full reviews go to the State Health Planning Board, while expedited reviews are conducted by the Deputy Commissioner of Health Systems.⁠2

Filing the CN-19

  • Filing day. DOH accepts CN-19 applications only on the first business day of each month. Anything filed later waits for the next month’s cycle, and the form says requests for exceptions “will not be entertained.”⁠3
  • Decision deadline. N.J.A.C. 8:33-5.2 requires a decision no later than 90 days after DOH accepts the application for processing.⁠5 Acceptance is a separate gate. An application that is unsigned, incomplete, missing the fee or missing out-of-state track record reports is not accepted. You must refile in a later cycle.⁠3⁠5
  • What to send. One electronic copy and ten paper copies go to the Office of Certificate of Need and Healthcare Facility Licensure, P.O. Box 358, Trenton, NJ 08625-0358. The payment is a certified check, cashier’s check or money order payable to “Treasurer, State of New Jersey.”⁠3
  • What the form asks for:⁠3
    • every owner of a for-profit applicant, with addresses and ownership percentages
    • every licensed facility owned or run by you or a related entity, with 12 months of track record reports from other states
    • total project cost and funding sources
    • projected operating costs, revenues and utilization for the first 12 months after licensure
    • present and projected population data, including growth of the 65-and-over population
    • how the medically underserved will have access, why the project is justified, and which existing services it may affect
    • financial statements
  • Equity. DOH’s approval letters for new ALRs apply N.J.A.C. 8:33H-1.16.⁠7 That rule asks for proof that at least 10% of total project cost, including financing and carrying costs, is available as equity. It also requires financial projections showing the facility can afford its Medicaid share.⁠6
  • Floor plans. If the building needs no construction or renovation, a dimensioned floor plan goes in with the CN-19. It must show room uses, door swings, corridor widths, exits, toilets, ADA accessibility, fire alarm pull stations and extinguishers.⁠3
  • Waivers. If you want a waiver of the physical plant rules in N.J.A.C. 8:36-16 or 8:36-22, it must be explained, justified and filed as part of the CON application.⁠14 Requests to count an alcove, foyer or vestibule as usable floor space also belong in the CON.⁠29

The 90 days are not the whole wait

One public example: DOH approved a 101-bed ALR in Cherry Hill on April 19, 2024. The application had been filed on October 31, 2022. The approval expires April 19, 2029.⁠7

That letter also shows conditions DOH attaches to approvals:⁠7

  • Double-bedded rooms may be occupied only by couples, relatives, or residents who agreed to share in writing in the admission agreement.
  • The CON does not override local land-use authority.
  • Services may not begin until a license is issued, and a DOH survey must come first.

If final project cost runs more than $1,000,000 over the approved amount, you owe 0.25% of the excess before the license is issued.⁠3⁠7

Two commitments you make before you build

Medicaid occupancy (10%). Under N.J.S.A. 26:2H-12.16 and N.J.A.C. 8:36-5.1(h), a new ALR or CPCH licensed on or after September 1, 2001 must reach Medicaid occupancy of at least 10% of its total beds within three years of licensure. It must then keep that level for as long as it is licensed.⁠19 The rules work like this:⁠19

  • Small facilities. If the facility has fewer than 10 beds, at least one bed is reserved for a Medicaid-eligible person.
  • Who counts. Residents count whether they were admitted directly on Medicaid or started as private payers and later qualified. Each must be financially eligible, assessed as needing nursing home level of care, and approved for the state’s federally approved waiver program for assisted living.
  • Exemption. The requirement does not apply to an ALR run by a continuing care retirement community.
  • Waivers. DOH may waive or reduce it by region if Medicaid capacity is sufficient, and must waive it when funding is limited. A facility can also request a waiver.

CON approval letters repeat the condition and say DOH will monitor it for the life of the license.⁠7

Nursing home level of care (20%). The license application must include a statement committing that, within 36 months after licensure, at least 20% of residents will be people who need nursing home level of care. The share is measured in resident days per calendar year.⁠10

The building: apartments, not bedrooms

New Jersey’s unit standard is what separates an ALR from a group home. Plan the building around these minimums from N.J.A.C. 8:36-16:

ALR residential unit and building minimums (N.J.A.C. 8:36-16)
Item Requirement
Unit size, one occupant 150 sq ft of clear, usable floor area. Closets, bathroom, kitchenette, hallways and corridors do not count; alcoves, foyers and vestibules count only if DOH agrees in writing⁠29
Second occupant 80 additional sq ft; no unit may house more than two people⁠29
Door Lockable by the resident, opens from inside with a simple operation, and staff have a master key⁠29
Windows Glazed area equal to at least 8% of the clear floor area⁠29
Bathroom Toilet, tub or shower, and handwashing sink in every unit, plus additional toilets outside the units for residents, staff and visitors⁠30
Kitchenette Small refrigerator, wall cabinet, bar-type sink, and a counter with outlets for small appliances. The facility offers a cooking appliance unless the resident’s assessment shows it is unsafe⁠31
Community space 30 sq ft per resident for dining and recreation⁠32
Fire protection Fire suppression system under the Uniform Construction Code (N.J.A.C. 5:23). Smoke detectors in every bedroom, living room and studio, installed to NFPA 72 (1999)⁠27⁠28
Mixed use Not allowed in buildings classified High Hazard (H), Factory (F) or Assembly (A-2)⁠26

For comparison, a CPCH unit needs only 80 square feet for one resident plus 50 square feet for a second. CPCHs must also meet Use Group I-2 of the construction code.⁠35

Plan review. Any construction program goes to the Department of Community Affairs’ Health Care Plan Review Unit before work starts. This applies whether or not the project needed a CON.⁠11 Your license application must include the Unit’s written final release of the plans.⁠11 Before residents move in, the municipality’s certificate of occupancy goes to the Plan Review Unit. DOH licensing gets both of these:⁠11

  • a copy of the certificate of occupancy
  • DCA’s letter recommending approval of the completed work

Location. When plans are required, the license application must explain how the location connects residents to “a neighborhood, center or other area with existing services or amenities.” It must also explain how the design supports privacy, independence and dignity, and how it accommodates reduced mobility, incontinence and dementia.⁠10

Administrator: certification comes before the license

Every ALR administrator must meet three requirements:⁠17

  • be at least 21
  • have a high school diploma or equivalent
  • hold either a New Jersey nursing home administrator license or New Jersey certification as an assisted living administrator

An owner who qualifies may serve as administrator.⁠17

To become a Certified Assisted Living Administrator, you:⁠17⁠18

  1. complete a DOH-recognized assisted living training course
  2. sit for the Assisted Living Competency Examination within two years of finishing the course
  3. clear a criminal background check under N.J.A.C. 8:43I

After a second failed exam, you must retake the course.⁠17 Candidates who have finished the course and passed the exam can get a conditional certification.⁠17 The certificate lasts three years. Renewal requires at least 30 hours of continuing education and a new background check.⁠17⁠18

On-site time. The administrator or a designated alternate must be on site full time if the facility has 60 or more licensed beds, and half time if it has fewer.⁠16

Ownership. Owners and the property must be disclosed to DOH. No one convicted of a crime that “relat[es] adversely” to running the facility may own or operate it.⁠44

Staffing and training minimums

N.J.A.C. 8:36 sets floors, not ratios. The rule says staffing must also match the acuity of residents’ needs.⁠20⁠25

  • Nursing. At least one registered professional nurse must be available at all times.⁠22
  • Round-the-clock coverage. At least one awake personal care assistant and one additional employee must be on the premises at all times. If residents live in more than one freestanding building, each building needs a personal care assistant, and both must be awake.⁠25
  • Personal care assistants. Each must hold one of three credentials: New Jersey certified nurse aide, Board of Nursing-certified homemaker-home health aide, or DOH-certified personal care assistant. PCA certification lasts two years and requires 20 hours of continuing education per cycle.⁠23
  • Medications. Certified medication aides must already hold one of the aide credentials above and complete a DOH medication course. They must take the state exam within six months of the course, and renewal every two years requires 10 hours of continuing education.⁠24
  • Orientation and yearly training. All staff get orientation and yearly in-service training on seven topics:⁠20
    • assisted living concepts
    • emergency plans
    • infection control
    • resident rights
    • abuse and neglect
    • pain management
    • dementia care
  • Dementia programs. If you advertise an Alzheimer’s or dementia program, all direct care staff need the specialized training required by N.J.S.A. 26:2M-7.2.⁠33
  • Services you must be able to provide. The facility must be able to provide personal care, nursing, pharmacy, dining, activities, recreation and social work.⁠19 It must also be able to keep residents who reach nursing home level of care. Your admission agreement must say which higher-need conditions you will and will not retain residents with, and at what cost. The rule lists those conditions, among them 24-hour nursing supervision and being bedridden for more than 14 days.⁠19
  • Transfer agreements. You need written referral or transfer agreements with at least one New Jersey acute care hospital, one psychiatric hospital and one long-term care facility. An acute care hospital with licensed adult psychiatric beds covers the psychiatric requirement.⁠21

From CON approval to opening day

  1. Get the CON. File the CN-19 on the first business day of a month and wait for the expedited-review decision.⁠3⁠5
  2. Clear plan review. Get final release of construction plans from DCA Health Care Plan Review before building or renovating.⁠3⁠11
  3. Request a preliminary conference (optional). Any applicant may book one with DOH’s Certificate of Need and Licensing Program.⁠10 A preliminary conference on licensing conditions must take place before the license is issued.⁠12
  4. File the license application. Use DOH’s prescribed forms.⁠10 N.J.A.C. 8:36-2.2(a) says the forms come from the Certificate of Need and Licensing Program. DOH’s public forms page, checked on 2026-10-12, lists CN-19 and the AAS-24 affidavit but no separate ALR license application form, so ask the Program which form and delivery method it wants after CON approval.⁠43 Include the admission agreement for DOH review, the final project cost certification, the license fee, and the 20% nursing-home-level commitment.⁠7⁠10 The admission agreement must cover:
    • charges for every level of service
    • how residents are told about rate changes
    • the right to appeal an involuntary discharge
    • discharge criteria
  5. Assemble local approvals. Before DOH issues the license, it needs:⁠12
    • approvals from the local zoning, fire, health and building authorities
    • the certificate of occupancy
    • written local approval of any private water or sewage system
  6. Staff up and pass the survey. Once the application is approved and the building is ready, DOH surveyors inspect. Deficiencies must be corrected and re-surveyed before occupancy. The license is issued once the survey finds substantial compliance and staff are hired to the rule’s levels.⁠12 DOH publishes an Affidavit of Compliance for assisted living residences (form AAS-24), the Assisted Living Assessment and Survey (AAS-80) and the Assisted Living Entrance Guide (AAS-81).⁠43
  7. Admit nobody before the license. Admitting residents before DOH’s written approval or license is penalized as unlicensed operation.⁠12

Fees as published on 2026-10-12

State fees for a new ALR (N.J.A.C. 8:36-2.2; form CN-19, rev. January 2024)
Fee Amount
CON application, total project cost of $1,000,000 or less $7,500⁠3
CON application, total project cost over $1,000,000 $7,500 + 0.25% of total project cost⁠3
CON extension of time $7,500⁠3
Cost overrun of $1,000,000+ above approved cost 0.25% of the excess, paid before licensure⁠3
License application, and each annual renewal $1,500 + $15 per licensed bed (nonrefundable)⁠10
Inspection fee, every other year $1,500, added to the initial fee for a new facility⁠10
Add bed or non-bed services $750⁠10
Reduce services; relocate $375 each⁠10
Transfer of ownership $1,500⁠10

As an example, apply the published schedule to the $26,576,439 Cherry Hill project.⁠7 The CON fee works out to $7,500 plus $66,441.10. A 60-bed residence would pay $2,400 for its first license plus the $1,500 inspection fee. You must license every bed your units can hold.⁠10

Renewal, inspections and deemed status

  • License term. A license runs one year or less. It renews on the original licensure date once the fee is paid, and DOH sends the fee request 30 days ahead.⁠13
  • Ownership changes. The license cannot be transferred and becomes void when ownership changes. A new owner files a transfer of ownership application ($1,500).⁠10⁠13
  • Local requirements. DOH can refuse renewal if local requirements are not met.⁠13
  • Inspections. Licensure inspections are biennial.⁠10⁠12 Since April 21, 2025, an ALR can ask for deemed status at its biennial inspection. It submits accreditation from a DOH-recognized accrediting organization issued within the previous two years, plus that organization’s report and any remediation plan. DOH’s rulemaking record describes this as an alternative to DOH staff performing the licensure inspection, with DOH licensure compliance visits every three years.⁠12⁠38⁠39 DOH can still survey any facility at any time, including for complaints.⁠12

Getting paid through Medicaid

Your 10% Medicaid residents are paid for through NJ FamilyCare Managed Long Term Services and Supports (MLTSS). MLTSS uses NJ FamilyCare managed care organizations to coordinate services, including care in an assisted living facility.⁠37

Clinical eligibility for adults age 21 and older means needing hands-on help with three or more activities of daily living. Cognitive deficits that require supervision and cueing with three or more activities also qualify.⁠37 Your CON financial projections must show the facility can afford its Medicaid share.⁠6

A CON approval “does not imply acceptance by a reimbursing entity,” so contracts with the managed care plans are a separate step.⁠7

Rule changes in 2025 and 2026

  • January 16, 2025. DOH readopted the social isolation prevention rules at N.J.A.C. 8:36-13A, first adopted under P.L. 2020, c. 113, along with related definitions.⁠40
  • April 21, 2025. Deemed status became available to ALRs. It replaced the “advanced standing” pilot, which ran from 2012 to 2023 and used inspections by the Health Care Association of New Jersey.⁠38⁠39
  • Pending. Proposal PRN 2026-003, published January 5, 2026, would extend deemed status to comprehensive personal care homes. Comments closed March 6, 2026, and DOH’s proposal notices page still listed an 8:36-1.3 and 2.4 proposal, with no adoption, when checked on 2026-10-12.⁠39⁠45
  • Expiration. The chapter itself was readopted effective November 29, 2021, and expires November 29, 2028 unless readopted again.⁠41

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New Jersey and neighboring states

Compare all 51
Assisted living facility licensing in New Jersey and neighboring states: license, size threshold and state fee
StateLicenseWho needs itState fee
New Jersey (this guide) Assisted Living Residence license Apartment-style housing, meals and care; certificate of need required $7,500; over $1M project cost: $7,500 + 0.25% of total cost
New York Adult care facility operating certificate (adult home, enriched housing program or residence for adults), plus an assisted living residence license to call it assisted living 5+ unrelated adults; "assisted living" name needs an ALR license $500 + $50 per resident above 400% FPL, max $5,000 per 2 years
Pennsylvania Personal Care Home license or Assisted Living Residence license 4+ unrelated adults; personal care home or ALR license $15 (0-20 beds) to $50 (101+ beds)
Delaware Assisted Living Facility license Any facility holding itself out as assisted living; licensed per bed $400 under 100 beds; $550 at 100+ beds; plus up to $500 background fee on initial applications

Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.