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Arkansas - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Arkansas Department of Human Services (DHS) Division of Provider Services and Quality Assurance (DPSQA) licenses Assisted Living Facilities under Level I and Level II designations, with Level II required to deliver services through the Medicaid 1915(c) Living Choices Assisted Living Waiver. Facilities combine housing, personal care, and supervision for individuals medically eligible for nursing home level of care.

Applicants must secure a Permit of Approval (P-o-A) from the Health Services Permit Commission or Health Services Permit Agency before submitting an initial licensure application. Medicaid enrollment requires the Level II license and registration of all personal care aides in the state's Electronic Visit Verification (EVV) system.

1. Service Definition and Scope

Arkansas defines assisted living through two distinct licensure levels. Level II facilities provide housing, personal care, and nursing services to individuals meeting nursing facility level of care, funded primarily through the Living Choices Assisted Living Waiver.

Waiver services include personal care, homemaker, chore, attendant care, companion, transportation, and medication oversight. Room and board costs are excluded from Medicaid reimbursement and must be paid directly by the resident.

2. Regulatory and Oversight Agencies

Multiple divisions within the Arkansas Department of Human Services (DHS) oversee the licensure, certification, and Medicaid enrollment of assisted living facilities.

The Health Services Permit Agency controls market entry through need-based approvals, while the Division of Medical Services manages the Medicaid waiver rules.

3. Gatekeeping Prerequisites: Who Can Even Apply

Arkansas strictly controls the expansion of assisted living facilities through a formal need-review process. An applicant cannot submit a licensure application to DPSQA without first obtaining this specific approval.

The state requires a Permit of Approval (P-o-A) to dictate the exact number of beds a facility is authorized to operate.

4. Licensure and Certification Requirements

DPSQA issues separate licenses for Level I and Level II beds, even if housed in the same facility. The grant of a Level II license automatically grants Level I authority, but separate licenses reflecting specific bed counts are issued.

Initial licensure requires the submission of building plans and a distinctive facility name that cannot be changed without prior written approval.

5. Medicaid Provider Enrollment

Facilities enroll as Medicaid providers through the Arkansas Medicaid Provider Portal (MMIS). Providers must hold a valid Level II license to enroll for the Living Choices waiver.

Additionally, individual personal care aides employed by the facility must enroll to obtain a Practitioner Identification Number (PIN) for EVV compliance.

6. Staffing, Training and Background Checks

Facilities must maintain sufficient staff to meet the 24-hour scheduled and unscheduled needs of residents. Staffing ratios and qualifications are dictated by the Level II licensure rules.

Arkansas mandates that all aides providing personal care components enroll individually in Medicaid to utilize the Electronic Visit Verification (EVV) system.

7. Documentation, Policies and Records

Facilities must maintain comprehensive records of resident care, medication administration, and staff credentials. Bed capacity must be strictly monitored to ensure it never exceeds the licensed limit.

EVV documentation is strictly enforced for the personal care components of the waiver service.

8. Billing, Rates and Claims

Claims are processed through the Arkansas MMIS. Medicaid covers the care component of the assisted living service, while residents are responsible for room and board.

Claims for personal care components will deny if the services are not properly logged in the EVV system by an enrolled aide.

9. Approval Sequence and Timeline

The approval process is strictly sequential, beginning with the Health Services Permit Agency before moving to DPSQA for licensure.

Medicaid enrollment is the final step and cannot be initiated without the Level II license and EVV registration for staff.

10. Common Denials and Survey Findings

Applications are routinely rejected at the outset if they lack the prerequisite Permit of Approval from the Health Services Permit Agency.

Surveyors frequently cite facilities for exceeding licensed bed capacity or failing to comply with EVV mandates for personal care staff.

11. Key Contacts and Resources

Primary contacts for prospective providers include the Health Services Permit Agency for initial bed approvals and DPSQA for licensure.

The Arkansas Medicaid Provider Enrollment Unit handles all MMIS and EVV registration inquiries.

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