Certificate of need for senior housing, by state
Most states still control nursing home beds through a certificate of need, a moratorium or a bed cap; few control assisted living. NCSL lists no nursing home CON in 13 states, and a moratorium or bed cap in 8 more (Arkansas, Louisiana, Minnesota, Mississippi, Nebraska, Ohio, West Virginia, Wisconsin).
| State | Nursing home beds | Assisted living | Notes |
|---|---|---|---|
| Alabama | Yes | Not listed | Ala. Code § 22-21-260. Covers SNF, ICF and "Long-term care" |
| Alaska | Yes | Not listed | Capital expenditures over $1M, including "Converting a building ... to a nursing home" |
| Arizona | No | No | No CON program (ambulance only) |
| Arkansas | Yes (moratorium on residential care) | Yes | Lists "Assisted living facilities." Moratorium covers "Constructing a new residential care facility". Called a Permit of Approval. |
| California | No | No | |
| Colorado | No | No | |
| Connecticut | Yes | Not listed | Conn. Gen. Stat. 17b-352 covers nursing homes, rest homes and residential care homes. Residential care homes are not CT's assisted living license AL not named |
| Delaware | Yes | Not listed | Covers nursing homes and "Continual care community" (CCRC). Capital threshold $5.8M |
| District of Columbia | Yes | Not listed | D.C. Code § 44-401. Covers SNF and ICF |
| Florida | Yes | No | 2026 HB 693 would have repealed nursing home CON. It passed the House 79–30 but the Senate record reads "3/13/2026 Senate - Died in Rules". NH CON stays in force. |
| Georgia | Yes | Listed (personal care homes) | NCSL lists "Personal care homes". confirm with GA DCH Office of Health Planning |
| Hawaii | Yes | Not listed | 2026 SB2289 (exemptions) was pending per HFMA, 2026-05-05 |
| Idaho | No | No | |
| Illinois | Yes | Not listed | NCSL: "Illinois' CON law is scheduled to be repealed December 2029" |
| Indiana | Yes (comprehensive care beds) | Not listed | IDOH runs an annual review cycle and posts a "Bed Need Analysis, July 1, 2026", so the program is active. |
| Iowa | Yes | Not listed | Covers nursing and "Residential care facilities". 2026 HF2635 raises thresholds |
| Kansas | No | No | |
| Kentucky | Yes | Not listed | |
| Louisiana | Yes (Facility Need Review) plus moratorium | Not listed | Moratorium on "Nursing facilities (until July 1, 2027)". LA calls its process FNR, not CON |
| Maine | Yes | Not listed | 2026 LD1890 raised the capital threshold to $7.5M (HFMA, 2026-05-05) |
| Maryland | Yes | Not listed | |
| Massachusetts | Yes (Determination of Need) | Not listed | NCSL: a prior LTC bed moratorium was eased the state now accepts some DoN applications |
| Michigan | Yes | Not listed | |
| Minnesota | Moratorium (no formal CON) | Not listed | "Nursing home beds ( Minn. Stat. § 144A.071 )" are under moratorium, with an exception process |
| Mississippi | Yes plus moratorium | Not listed | Moratorium covers SNF and ICF beds |
| Missouri | Yes | Yes | Lists "Residential care facilities. Assisted living facilities." Mo. Rev. Stat. § 197.300 |
| Montana | Yes (LTC only) | Not listed | 2021 HB 231 limited CON "to only include oversight of long-term care facilities and swing beds" |
| Nebraska | Yes plus moratorium | Not listed | Moratorium on LTC beds. 2026 LB437 enacted it extends CON validity "from one year to three years" |
| Nevada | Yes, rural counties only | UNVERIFIED | Covers capital expenditures "above $2 million for constructing a new health care facility in rural counties". Health facility is broadly defined |
| New Hampshire | No | No | Repealed 2016 |
| New Jersey | Yes | Yes | NJ DOH approved "a new 115-bed Assisted Living Residence" under N.J.A.C. 8:33-5.1(a)(4) expedited review. |
| New Mexico | No | No | |
| New York | Yes | Partial (adult care facilities) | NCSL: "Adult care facilities (process is different for ACFs compared to other facilities)" |
| North Carolina | Yes | Yes (adult care homes) | Lists "Adult care homes", NC's main licensed assisted living category |
| North Dakota | No | No | |
| Ohio | Yes plus moratorium | Not listed | LTC bed moratorium (2019 HB 166) with exceptions |
| Oklahoma | Yes | Not listed | |
| Oregon | Yes | Not listed | |
| Pennsylvania | No | No | |
| Rhode Island | Yes | Not listed | NCSL lists a nursing facility moratorium "(until July 1, 2022)". |
| South Carolina | Yes (nursing homes only) | No | 2023 law kept CON only for nursing homes and a few hospital items. 2026 H4799 (veterans' nursing homes exemption) passed the House and is pending |
| South Dakota | No | No | SD has historically had a nursing-facility bed moratorium outside CON. |
| Tennessee | Yes | Not listed | 2026 SB1369 phases out hospital CON by 2030. Nursing homes are not mentioned |
| Texas | No | No | Texas controls Medicaid nursing bed certification separately |
| Utah | No | No | |
| Vermont | Yes | Not listed | The moratorium is for home health, not nursing homes |
| Virginia | Yes (COPN) | Not listed | NCSL: nursing bed increases are "subject to the department issuing a request for applications" |
| Washington | Yes | Not listed | Nursing home capital expenditures over $2.83M |
| West Virginia | Yes plus moratorium | Not listed | Moratorium: "New intermediate care or skilled nursing beds" |
| Wisconsin | Bed cap / approval (no formal CON) | Not listed | "Nursing homes are subject to a statewide bed limit" |
| Wyoming | No (since 2026-07-01) | No | Sources conflict: NCSL lists "No" CON. Wyoming's HB0289 (Enrolled Act HEA 0049, Ch. 102) "repeals bed expansion limitations for nursing care facilities", effective 7/1/2026, so a nursing-bed limit was in force until then. |
"Not listed" means NCSL's table does not name assisted living for that state, not that the state exempts it. Several states regulate a related license, such as personal care homes in Georgia and Kentucky or adult care facilities in New York, and the line between that license and assisted living differs by state. Confirm with the state's health planning agency before buying land.
Source: NCSL, Certificate of Need State Laws, updated April 29, 2025, covering January 2025, with later changes checked on state legislature and health department sites on 2026-10-24. HUD Handbook 4232.1 REV-1, 2.5.EE. Absorption is not a law firm and this is not legal advice.