New Mexico assisted living facility license: HCA rules, fees and the temporary-license path

Who needs the license, and who does not

New Mexico draws the line low. The assisted living rule applies to “any facility which is operated for the maintenance or care of two or more adults who need or desire assistance with one or more activities of daily living.”⁠¹ The rule defines activities of daily living as eating, dressing, oral hygiene, bathing, grooming, mobility and toileting.⁠¹ If you help a second unrelated adult with even one of those, you need the license.

There is one exclusion. The rule “does not apply to the residence of an individual who maintains or cares for a maximum of two relatives.”⁠¹ Caring for your own parents at home is outside it. Caring for one parent and one paying neighbor is not.

There is also no small-home tier. A two-resident house is an assisted living facility and holds the same license, under the same rule, as a large campus. The rule does relax some building requirements below certain resident counts, which matters when you size a house (see the building section).⁠¹

Assisted living or boarding home?

New Mexico’s other residential license for adults is the boarding home under 8.370.15 NMAC. A boarding home gives help with instrumental activities of daily living, or coordinates community services, for residents who do not need the services of an assisted living facility, nursing facility or hospital.⁠⁹ Once residents need hands-on help with bathing, dressing, toileting or the other ADLs, a boarding home license does not fit. The annual fee is the same $300 for both.⁠²

Who you cannot serve

An assisted living facility must not admit or keep anyone who needs 24-hour continuous nursing care. The one exception is hospice residents who have elected the hospice benefit. The rule names the conditions that usually mean continuous nursing care: ventilator dependency, stage III or IV pressure sores, IV therapy or injections, any physical or chemical restraint, nasogastric tubes, tracheostomy care, isolation, a Hoyer lift, and an ostomy the resident cannot manage themselves.⁠¹ You may not admit anyone under 18.⁠¹

A resident whose needs grow can sometimes stay. The administrator, the resident or their surrogate, and the hospice or home health clinician must agree in writing on an individual service plan (ISP) that shows how the needs will be met. If the facility is licensed for more than eight residents and is not fully sprinklered, it must keep a fire safety evacuation rating of “prompt.”⁠¹ If you plan to rely on outside skilled care, see the New Mexico home health agency guide.

A pending rewrite of the rule

The rule now in force, 8.370.14 NMAC, was issued by the Health Care Authority and took effect July 1, 2024.⁠¹ HCA’s Division of Health Improvement is also “finalizing repeal and replacement” of that rule. It held a public hearing on April 16, 2025.⁠⁴ The hearing summary (file version dated August 18, 2025) says several industry recommendations were included “in the final rule.” In its redline, the effective date is still blank (“xx, xx, 2025”).⁠⁵ On 2026-10-12 the State Records Center still published the July 1, 2024 text, so that text governs this guide. HCA’s DHI regulations page still described the replacement as being finalized, and none of the sources checked gave an effective date.⁠⁴ Ask the Division of Health Improvement which version applies on the date you file.

The proposed text keeps most numbers in this guide, including the 650 credit score, the six-month funding test, the 16- and 12-hour training rules and the staffing ratios.⁠⁶ Two proposed changes matter to founders:

• Administrator route. A current nursing home administrator license would be an alternative to the state-approved assisted living administrator certification.⁠⁶
• Change of ownership. A buyer would file a full initial application and, at least 60 days before closing, add a continuity-of-care transition plan. They would also have to show that residents, families and the state long-term care ombudsman were notified. All waivers held by the seller would become void.⁠⁵

The owner’s tests: money, credit and disclosure

New Mexico screens the applicant’s finances more closely than most states. The initial application must include evidence of “sufficient financial assets to permit operation of the facility for a period of six months.” That evidence must include a credit report from one of the three national credit bureaus showing a score of 650 or above.⁠¹

You must also disclose the following:⁠¹

• every person or entity with at least 5% ownership, direct or indirect, in the profits, the land or the building. That includes the owners of any company that owns the land or building.
• every creditor with a security interest in the land or building.
• any later change in ownership or management, which must be reported within 30 days.

HCA will not issue a new license to an applicant who has had a health facility license revoked or a renewal denied, or who surrendered a license under threat of either. It may also refuse applicants with repeated class A or B deficiencies or a record of ignoring plans of correction.⁠¹ A license cannot be sold or transferred, and it expires automatically when the facility is sold or leased or the licensee changes.⁠¹ Under the fee rule, a change of ownership goes through the initial application and fee process again.⁠²

The administrator

Every facility must be supervised by a full-time administrator. One administrator can cover several facilities within a 40-mile radius. The administrator must:⁠¹

• be at least 21 and have a high school diploma or equivalent;
• complete a state-approved certification program for assisted living administrators;
• show education and experience directly related to the facility’s services;
• give three notarized letters of reference from people who are not related to them;
• clear the caregivers criminal history screening (8.370.5 NMAC) and the employee abuse registry check (8.370.8 NMAC);
• be able to speak the language used by most residents.

The rule does not name the approved certification programs, and no official HCA list was found in the sources checked. Ask HCA which programs it approves before you pay for one. Changing administrators requires an amended license application within 10 business days of the change, and the fee is $300.⁠¹⁠²

Building, zoning and fire safety

The application cannot be completed without local sign-offs. It must include the following:⁠¹

• building plans approved under 8.370.14.41 NMAC
• fire authority approval
• a letter of approval or exemption from the local health authority for food service and the kitchen
• a liquid waste (septic or sewer) permit
• zoning approval
• a certificate of occupancy

HCA tells applicants to call its Program Operations Bureau in Santa Fe (505-476-9093) early in planning and before any construction.⁠³

Plan review comes first

You must submit preliminary plans and final construction drawings to HCA and get them approved before building. This applies to new construction, to any building not previously licensed as a facility, to any renovation that adds beds, to any addition, and to any renovation of any size.⁠¹ If you are converting a house that has never been licensed, it therefore goes through plan review. Above 15 residents, a New Mexico-registered architect must stamp the drawings. Construction must start within 180 days of approval, and the codes in force at submittal apply until the project ends.⁠¹

Thresholds that decide which building works

Source: 8.370.14.40, .41, .55, .61 and .62 NMAC.⁠¹

Any facility without sprinklers must run the fire safety equivalency system (FSES) at least once a year and keep a “prompt” evacuation rating.⁠¹ Every facility needs the following:⁠¹

• hard-wired smoke detectors with battery backup on each floor and in assembly areas
• heat detectors in kitchens
• at least two 2A10BC extinguishers, no more than 50 feet apart
• one fire drill a month, with at least one drill on each eight-hour shift every quarter

Room and space standards

• Bedrooms: private rooms at least 100 sq ft. Semi-private rooms at least 80 sq ft per bed, with no more than two residents and beds 3 feet apart. Closets do not count toward the area. No bedroom can be narrower than 7 feet.⁠¹
• Windows: each bedroom needs an operable, screened window with at least 5.7 sq ft of clear opening, at least 20 inches wide and 24 inches high, with the sill no higher than 44 inches. Window area must be at least one-tenth of the floor area.⁠¹
• Bathrooms: one toilet, one sink and one bathing unit for every eight residents. The facility must have at least one tub and one shower or a combination unit. Facilities with four or more residents need one accessible bathroom for every 30 residents.⁠¹
• Common space: at least 40 sq ft per resident for living, dining and social space. With 60 or fewer residents, everyone must be able to eat at one sitting.⁠¹
• Accessibility: at least one bedroom and one bathroom per eight residents must have 36-inch doors, and the bathroom must have a 60-inch turning circle.⁠¹

You must get a fire clearance from the State Fire Marshal or the local fire authority before the initial license. After that, you must request a fire inspection every year, and a copy of the annual fire inspection report goes with each renewal.⁠¹

Pharmacy permit and medication rules

If you have two or more residents and you assist with self-administration of medication or keep residents’ medication, you need a custodial drug permit from the New Mexico Board of Pharmacy.⁠¹ HCA says Board of Pharmacy approval is required before licensure and lists the Board at 505-841-9102.⁠³ The Board’s fee rule lists a drug room permit for “adult shelter care or custodial care facility” at $100 every two years for 10 or fewer beds and $200 for 11 or more, plus $150 for an initial inspection.⁠¹⁰ The assisted living rule calls the permit a “custodial drug permit,” and the fee rule does not use that exact name, so ask the Board of Pharmacy which fee line and inspection fee apply to you.

The permit brings these duties:⁠¹

• Pharmacist review. A consulting pharmacist reviews the medication regimen at least every three months, and the administrator must resolve any problems found within 72 hours.
• Storage. All medicine goes in locked storage, with a separate locked refrigerator.
• Staff who assist. They must complete a state-approved assistance-with-self-administration course or hold a nursing license or certification.
• Nurse-only routes. Only an RN or LPN may give medication by IV, subcutaneous, intramuscular, vaginal or rectal routes, or give non-premixed nebulizer treatments.

Staffing and training

New Mexico sets overnight staffing by size and requires awake staff even in the smallest homes.⁠¹

A small home cannot rely on a caregiver who sleeps on site. Someone must be awake all night. On request, HCA can ask for 30 days of staffing records.⁠¹

Direct care staff must be at least 16. Each new employee or volunteer who gives direct care needs at least 16 hours of supervised training before working unsupervised, and everyone needs at least 12 hours of training a year.⁠¹ The required topics include:⁠¹

• fire safety and evacuation
• first aid
• food handling
• infection control
• resident rights
• abuse and neglect reporting
• medication assistance
• carrying out the ISP

Facilities that provide or coordinate hospice add six hours a year of palliative care training. Memory care units add 12 hours a year of dementia training.⁠¹

All caregivers, including administrators and operators who are routinely on site, need nationwide and statewide fingerprint-based criminal history screening. The facility submits the fees, and a new hire can work under supervision until the results arrive.⁠⁸

Policies and the program narrative

The application must include a program narrative. It describes your service area, the population you will serve and its special needs, the services and professional services you will provide, and how you will work with other providers nearby.⁠¹ You must also submit policies and procedures “annotated to this rule.” HCA asks for a crosswalk from each policy to the rule section it satisfies.⁠³ The personnel policies must cover the following:⁠¹

• qualifications, conduct and training for staff, private duty attendants and volunteers
• criminal history screening
• emergency procedures
• medication administration
• personnel records

The admission agreement must state the facility’s staffing ratio, costs and refund terms, and bed-hold policy. Residents must get 15 days’ written notice before a non-emergency discharge and 30 days’ notice of changes in cost or services.⁠¹

From letter of intent to annual license

1. Send a letter of intent

   Email it to [email protected]. Give the proposed address, the population you will serve, a summary of services, and a contact person and email.⁠¹⁠³

2. Receive the application packet

   HCA emails it after approving the letter. It contains the application form, the fee schedule and the rule.⁠¹⁠³

3. Get plans approved and build

   Submit drawings for HCA plan review before construction. Then get the certificate of occupancy, the local fire inspection and, if applicable, the New Mexico Environment Department inspection.⁠¹⁠³

4. File the notarized application with the $300 fee

   Include the narrative, the annotated policies, the financial evidence and credit report, the ownership disclosures, and the local approvals.⁠¹⁠²

5. Get Board of Pharmacy approval

   if you will handle medications.⁠³

6. Pass the life safety code inspection

   HCA schedules it once the packet, policies and narrative are approved and construction is finished. It must be passed before HCA issues a temporary license.⁠³

7. Operate on a temporary license

   You may admit up to three residents. A temporary license lasts no more than 120 days, and HCA issues no more than two in a row. A second one costs another fee, and if you are not compliant within 240 days you must reapply.⁠¹⁠²

8. Request the initial health survey

   in writing to the district office. Have tuberculosis test (PPD) or chest X-ray results for all staff with resident contact, plus copies of staff licenses.⁠¹⁠³

9. Receive the annual license

   It runs one year, and the renewal date is set by the date of your first temporary license.⁠¹

HCA’s licensing page says the application, policies and plan review are good for one year from the day it receives the application fee. If no license has been issued by then, you may have to start again, and your survey moves to the end of the schedule.⁠³

Fees as published on 2026-10-12

HCA accepts checks, money orders or its approved electronic payment, and all fees are non-refundable.⁠² The licensing fee rule took effect January 28, 2025.⁠² Fingerprinting fees for staff come on top of these amounts. They are set by the FBI, the Department of Public Safety and HCA, and the screening rule does not list the amounts.⁠⁸

Surveys, renewal and penalties

HCA inspects every assisted living facility on site, and the latest survey report must be posted in public view.⁠¹ After a survey, the statement of deficiencies arrives within 10 business days. You then have 10 calendar days to request an informal dispute review or file a plan of correction. Deficiencies must be corrected within 30 days of the survey unless HCA extends the deadline.⁠¹ Incidents must be reported to HCA’s complaint hotline within 24 hours, or by the next business day, and investigated within five business days.⁠¹

HCA sets the initial base civil monetary penalty within a range of $500 to $5,000 for a class A deficiency, $300 to $3,000 for class B, and $100 to $500 for class C. Daily penalties are capped at $5,000.⁠⁷ If you operate without a license and do not comply within 10 days of notice, you face up to $5,000 a day, a cease-and-desist order and possible criminal penalties.⁠¹

Apply for renewal within 30 business days before the license expires. Send the application and fee, an updated narrative if your program changed, and the annual fire inspection report.⁠¹ You need an amended license before you change location, name or capacity, or modify the building; for an administrator change, file within 10 business days of the change. Capacity increases need building plans, and you cannot raise your census until the new license is issued.⁠¹

Memory care units

A facility that runs a secured memory care unit must meet 8.370.14.69 NMAC on top of the general rules. Before admission, a registered nurse or physician extender must assess the resident within 15 days, or within five days after an emergency placement. The resident’s primary care practitioner must document a dementia diagnosis and the need for a secured unit. Residents are re-evaluated every six months.⁠¹ The unit needs a secure outdoor area that residents can reach on their own year-round. At least one trained staff member must be awake and present in the unit at all times. Before admission, you must tell residents and their legal representatives that the facility operates a secured environment, and what diagnoses, behaviors and services it covers.⁠¹

Getting paid through Medicaid

Medicaid pays for assisted living in New Mexico through the Turquoise Care Agency-Based Community Benefit (ABCB). It is a home and community-based Medicaid program run by four managed care organizations: Blue Cross Blue Shield, Molina, Presbyterian and UnitedHealthcare. Members must meet nursing facility level of care.⁠¹¹ Assisted living is a covered ABCB service, and providers need a full annual assisted living license. A temporary license does not qualify, and HCA says the license requirement cannot be waived.⁠¹¹

Enrollment happens in this order:⁠¹¹

1. Program approval

   Email HCA’s Medical Assistance Division the ABCB checklist and forms at [email protected].

2. Medicaid application

   Once approved, file the MAD 335 Medicaid provider application on YES New Mexico.

3. MCO contracts

   After you receive a Provider Type 363 Medicaid number, contract with each MCO yourself.

HCA does not set ABCB rates. You negotiate them with each MCO, and Letter of Direction #59 lists recommended rates. An HCA approval letter does not guarantee that any MCO will contract with you.⁠¹¹ Because ABCB providers need a full annual license, a facility operating only on a temporary license cannot enroll, so residents admitted during that period (up to three) would not be ABCB-billable.⁠¹⁠¹¹

For a daytime program in the same building, see the New Mexico adult day care facility guide.

Sources

1. 1
   New Mexico State Records Center and Archives, 8.370.14 NMAC, Requirements for Assisted Living Facilities for Adults Checked 12 Oct 2026 · Back to text ↑
2. 2
   New Mexico State Records Center and Archives, 8.370.3 NMAC, Health Facility Licensure Fees and Procedures Checked 12 Oct 2026 · Back to text ↑
3. 3
   New Mexico Health Care Authority, Division of Health Improvement, Licensing a Healthcare Facility Checked 12 Oct 2026 · Back to text ↑
4. 4
   New Mexico Health Care Authority, Division of Health Improvement, DHI Regulations Checked 12 Oct 2026 · Back to text ↑
5. 5
   New Mexico Health Care Authority, Division of Health Improvement, Public Hearing Summary, 8.370.14 NMAC Assisted Living Facilities for Adults (with redline) Checked 12 Oct 2026 · Back to text ↑
6. 6
   New Mexico Health Care Authority, Division of Health Improvement, Notice of Public Hearing and proposed repeal and replacement of 8.370.14 NMAC Checked 12 Oct 2026 · Back to text ↑
7. 7
   New Mexico State Records Center and Archives, 8.370.4 NMAC, Health Facility Sanctions and Civil Monetary Penalties Checked 12 Oct 2026 · Back to text ↑
8. 8
   New Mexico State Records Center and Archives, 8.370.5 NMAC, Caregivers Criminal History Screening Requirements Checked 12 Oct 2026 · Back to text ↑
9. 9
   New Mexico State Records Center and Archives, 8.370.15 NMAC, Boarding Homes Checked 12 Oct 2026 · Back to text ↑
10. 10
    New Mexico State Records Center and Archives, 16.19.12 NMAC, Pharmacists: Fees Checked 12 Oct 2026 · Back to text ↑
11. 11
    New Mexico Health Care Authority, Medical Assistance Division, Turquoise Care Agency-Based Community Benefit (ABCB) Program Provider Enrollment FAQs (updated 02/05/2026) Checked 12 Oct 2026 · Back to text ↑

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