How to start a group home in New York: full 2026 guide

Last updated 2026-07-25

What is a group home, exactly?

A group home in New York is a licensed residence, usually serving 4 to 14 people, where staff provide supervision, personal care, and sometimes treatment services to people who can't safely or fully live alone. It's not a single license type. It's a category that covers several very different state programs. New York regulates group homes through three main agencies depending on who lives there. The Office for People With Developmental Disabilities (OPWDD) certifies Individualized Residential Alternatives (IRAs) and community residences for people with intellectual and developmental disabilities under 14 NYCRR Part 686 ^[1]. The Office of Mental Health (OMH) certifies community residences and family-based treatment homes for adults with serious mental illness under 14 NYCRR Part 595 ^[2]. The Department of Health (DOH) licenses adult care facilities, including assisted living programs, under Public Health Law Article 46 and 18 NYCRR Part 487 ^[3]. Each path has its own application, staffing rules, and inspection cycle. If you're not sure which population you want to serve, that decision comes before anything else, because it determines which agency you'll be dealing with for the life of the business. For background on how assisted living fits into the broader group home landscape, see our guide to assisted living.

What is assisted living?

Assisted living in New York is a licensed level of care for adults who need help with daily activities like bathing, dressing, medication management, and meals, but who don't need the 24-hour skilled nursing care a nursing home provides. New York calls its licensed model the Assisted Living Program (ALP), authorized under Public Health Law Article 46-B ^[4]. An ALP operates inside an adult care facility (an enriched housing program or adult home) that has an additional ALP certification from DOH. The program serves people who are eligible for nursing home level of care but who can be safely served in a less medical, more home-like setting, according to DOH's ALP program description ^[4]. Assisted living is different from an OPWDD or OMH group home in one big way: it's built around aging and chronic care needs, not developmental or psychiatric disability. If your target resident is an older adult who needs help with ADLs but not a hospital bed, ALP is the license type to research first with DOH.

What is an assisted living facility (and how is it different from an adult home)?

An assisted living facility is the physical adult care facility (adult home or enriched housing program) that has been additionally certified to operate an Assisted Living Program. In New York, you can't get an ALP certification standing alone. You first need to be licensed as an adult home or enriched housing program under 18 NYCRR Part 485 or 488, and then apply to add ALP certification under Part 487 ^[3][4]. That two-step structure trips up a lot of first-time applicants. People search "how do I license an assisted living facility" expecting one application, but New York requires the underlying adult care facility license first. DOH's Adult Care Facility/Assisted Living Surveillance unit reviews both the base facility application and the ALP add-on, and both go through separate certificate-of-need-style review and inspection ^[3]. Budget extra time, and extra paperwork, if you're planning to open a new adult home and add ALP certification rather than converting an existing licensed home. For a side-by-side look at facility types, our assisted living facility and assisted living facilities guides break down the certification layers in more detail.

What's the difference between assisted living and a nursing home?

Licensing law	Public Health Law Article 46-B [4]	Public Health Law Article 28 [5]
Staffing	Personal care aides, some nursing oversight	24/7 licensed nursing staff
Medical acuity	Stable, chronic conditions	Skilled/complex medical needs
Setting	Residential, apartment-style common	Clinical, hospital-adjacent
Medicaid coverage	Limited (see below)	Yes, through Medicaid nursing facility benefit	The short version: if a resident needs a ventilator, wound vac management, or round-the-clock nursing judgment, that's nursing home territory. If they need reminders, supervision, and help with 2 to 3 ADLs, assisted living or a group home level of care usually fits.

Assisted living provides help with daily living activities and some health monitoring in a residential, non-medical setting. A nursing home provides 24-hour skilled nursing care for people with serious medical needs, ordered and supervised by physicians, under Public Health Law Article 28 ^[5]. Here's the practical breakdown: | Feature | Assisted Living Program (NY) | Nursing Home (NY) |

What does assisted living provide, day to day?

Assisted living in New York provides help with activities of daily living (bathing, dressing, toileting, transferring, eating), medication administration or supervision, three meals a day, housekeeping, laundry, social and recreational activities, and 24-hour on-site staff availability, per DOH's adult care facility regulations at 18 NYCRR Part 487 ^[3]. ALP-certified facilities must also provide case management, and must arrange for home health or hospice services when a resident's needs increase, rather than automatically discharging them, under the ALP regulations ^[4]. What assisted living does not typically provide: ongoing IV therapy, ventilator care, or the kind of intensive rehab you'd get after a hospital stay. Those trigger a nursing home level of care determination, and DOH requires facilities to have a discharge plan for residents whose needs exceed what ALP can safely provide ^[4].

Does Medicare cover assisted living facilities?

No. Medicare does not cover the room-and-board or personal care costs of assisted living. CMS is direct about this: Medicare Part A and Part B do not pay for long-term custodial care, including assisted living, because assisted living is considered residential and personal care, not skilled medical care ^[6]. Medicare may still pay for medically necessary services a resident receives while living in assisted living, like a doctor visit, physical therapy ordered after a fall, or durable medical equipment. But the facility's monthly rate itself is a private-pay or Medicaid (in limited cases) expense, not a Medicare-covered service ^[6]. Medicaid coverage of assisted living in New York is limited and program-specific. Some ALP slots participate in Medicaid managed long-term care, and New York's Assisted Living Program regulations allow a portion of ALP beds to serve Medicaid recipients, but availability varies by facility and region ^[4]. If Medicaid funding is central to your business model, confirm current ALP Medicaid slot rules and reimbursement rates directly with your regional DOH office before writing a business plan around them. Nursing home care, by contrast, is a core Medicaid benefit nationally under federal Medicaid law ^[7].

How do I start a group home in New York, step by step?

Starting a group home in New York generally follows this sequence, though the exact steps and forms depend on whether you're going through OPWDD, OMH, or DOH. 1. Choose your population and license type. Decide between OPWDD (I/DD), OMH (mental health), or DOH (adult care/assisted living/senior). This decision drives every regulation that follows. 2. Form your legal entity. Most OPWDD and OMH providers operate as nonprofit corporations under New York's Not-for-Profit Corporation Law, though some adult care facilities operate as for-profit LLCs or corporations. Check current entity requirements with your target agency, since OPWDD and OMH have historically required not-for-profit sponsorship for most certified programs ^[1][2]. 3. Submit a Certificate of Need or Prior Approval Review (PAR) application. OPWDD requires prior approval before you can develop a new residential program, reviewed against the state's Statewide Plan under 14 NYCRR Part 620 ^[1]. DOH requires certificate-of-need style review for adult care facilities and ALPs under Public Health Law Article 46 ^[3]. 4. Secure and prepare your site. This includes local zoning review, fire marshal sign-off, and a building code compliance check tied to the New York State Uniform Fire Prevention and Building Code. See our zoning and property considerations below. 5. Write your policy and procedure manual. Every licensing agency wants written policies covering resident rights, medication management, incident reporting, staffing plans, emergency procedures, and abuse/neglect prevention before they'll schedule a licensing survey. 6. Hire and train staff to the required ratios (see the staffing section below), and complete required background checks through the Statewide Central Register and criminal history checks under Social Services Law. 7. Pass your pre-operational inspection/survey. OPWDD, OMH, and DOH each conduct an on-site survey before issuing an operating certificate, checking physical plant, staffing, records, and policy implementation. 8. Receive your operating certificate and open. Certificates are typically time-limited and subject to renewal inspections, complaint investigations, and periodic recertification surveys. Realistically, this whole process runs 9 to 18 months from entity formation to opening day, and longer if you're building or renovating a site rather than converting an existing residential property. Agencies don't publish a guaranteed timeline, and delays in site approval or staffing are the most common holdups reported by providers working through OPWDD and DOH review processes.

What license and application steps does OPWDD require?

OPWDD certifies group homes (IRAs and community residences) under 14 NYCRR Part 686, and new residential development goes through a Prior Approval Review tied to the state's needs-based planning process ^[1]. That means OPWDD doesn't just check whether your paperwork is in order. It also checks whether there's an identified regional need for the beds you want to open, funded through the state's Statewide Plan. Applicants typically work with an OPWDD Developmental Disabilities Regional Office (DDRO) starting with a concept paper or proposal, then move into site-specific plans once conceptual approval is granted. Required components include a program description, staffing plan, budget, and evidence of sponsor capacity (financial and programmatic) to operate the home ^[1]. OPWDD-certified homes must also meet staffing and supervision levels tied to each resident's individualized service plan, not a flat ratio, which means your staffing costs can vary a lot from home to home depending on resident acuity.

What license and application steps does OMH require?

OMH certifies community residences and family-based treatment programs for adults with serious mental illness under 14 NYCRR Part 595 ^[2]. Like OPWDD, new OMH-funded residential programs typically originate through a regional needs assessment and are usually developed in partnership with, or contracted through, the local Single Point of Access or county mental health system, since most beds are tied to state or county funding streams. Applicants submit program descriptions, a staffing plan appropriate to the certified capacity, a fire safety and physical plant review, and policies covering medication management, treatment planning, and incident reporting consistent with OMH's Part 595 standards ^[2]. OMH-licensed community residences commonly serve 6 to 14 residents, with staffing intensity tied to the specific residence type (community residence vs. more supervised community residence-single room occupancy models). Confirm current capacity limits and staffing ratios for your specific residence type with your OMH field office, since these details are set at the regulation and local-contract level and can vary.

What zoning and property rules apply to a New York group home?

New York has a strong fair housing protection for small group homes: under New York's Padavan Law (Mental Hygiene Law Section 41.34), a community residence for people with disabilities serving up to 14 residents is generally treated as a permitted single-family or multi-family residential use, and local governments cannot exclude it through zoning simply because it's a group home ^[8]. Municipalities do get formal notice-and-comment rights before certain new homes open, but they can't zone them out entirely. That protection applies specifically to OPWDD, OMH, and OASAS-certified community residences under Mental Hygiene Law. It does not automatically extend to every DOH-licensed adult care facility or private assisted living conversion, so if you're pursuing an ALP or private-pay assisted living license, check local zoning code and any conditional use permit requirements separately with your municipality. Regardless of program type, you'll also need a fire safety inspection tied to the New York State Uniform Fire Prevention and Building Code, and an occupancy classification appropriate to a residential care use (not a straight single-family dwelling classification), which usually means sprinkler, egress, and fire alarm requirements beyond a typical house. Get your local fire marshal and building department involved early, before you sign a lease or purchase agreement, because retrofitting an older house for a residential care occupancy classification can be the single biggest unplanned cost in a project like this.

What staffing does a New York group home need?

Staffing requirements vary significantly by license type, resident acuity, and certified capacity, so there's no single ratio that applies across OPWDD, OMH, and DOH programs. Here's what generally holds true across models: - 24-hour on-site staff presence is standard for certified residential programs serving people who need supervision, whether that's an OPWDD IRA, an OMH community residence, or a DOH-licensed adult care facility.

• OPWDD staffing is tied to each resident's individualized service plan and behavioral/medical support needs, so a home serving residents with high medical needs will require more direct support professionals per shift than a home serving more independent residents ^[1].
• OMH community residences require staff trained in mental health rehabilitation approaches, medication oversight, and crisis intervention, with staffing patterns set out in each program's certification and approved by the local field office ^[2].
• DOH-licensed adult care facilities and ALPs require an administrator, and staff levels tied to resident census and acuity, with additional requirements for medication administration personnel under Public Health Law and DOH regulations ^[3][4]. Across all three systems, staff must clear a criminal background check and a check against the Statewide Central Register of Child Abuse and Maltreatment where applicable, and most direct care staff must complete agency-specific training (medication administration, abuse prevention, CPR/first aid, and program-specific curricula) before working unsupervised.

What does a New York group home inspection actually check?

Inspections (called surveys by DOH, and certification reviews by OPWDD and OMH) check three broad things: the physical environment, the paper trail, and what staff actually do in front of the surveyor. Physical environment checks cover fire safety systems, exits and egress, resident living space (bedroom size and occupancy limits), kitchen and food storage sanitation, and accessibility features required for the certified population. Record checks cover individualized service or treatment plans, medication administration records, staff training files and background check documentation, incident and injury reports, and required policy manuals (resident rights, grievance procedures, emergency evacuation plans, abuse and neglect reporting). Operational observation covers whether staff actually follow the written plans: are medications given on schedule and documented correctly, is supervision matching the level called for in each resident's plan, are meals nutritionally appropriate and served on schedule. A pre-opening survey has to be passed before your operating certificate is issued. After opening, expect periodic recertification surveys (frequency varies by agency and program type) plus complaint-driven inspections that can happen with little or no notice. Keep your policy manual current and your staff training documentation audit-ready year-round. This is one area where a documented, agency-aligned Group Home Licensing Kit from GroupHomePath ($299 one-time, at /licensing-kit-builder) can save real time, since it gives you a starting policy manual structure built around what OPWDD, OMH, and DOH surveyors actually check, rather than building every form from a blank page.

How much does it cost and how long does it take to open?

New York doesn't publish a single statewide fee schedule that covers every group home type, because fees and review timelines depend on which agency licenses your program and how it's funded. What you can plan around: - Entity formation and legal setup: a few hundred to a few thousand dollars depending on whether you use an attorney for nonprofit incorporation and bylaws.

• Site acquisition or lease-up plus any building/fire code retrofit: this is usually the largest and most variable cost, and depends entirely on the condition of the property relative to residential care occupancy standards.
• Staffing and training costs before you have paying residents: several months of payroll if you're required to have trained staff in place before your pre-opening survey.
• Application and review timelines: OPWDD's prior approval and certificate process, and DOH's certificate-of-need review for adult care facilities, both commonly run many months once you include site-specific plan review and survey scheduling; 9 to 18 months from entity formation to opening is a reasonable planning range, and complex builds or first-time applicants often run longer. Because fee amounts and processing timelines change and vary by program and region, confirm current application fees, per-bed certificate costs, and expected review timelines directly with OPWDD, OMH, or DOH before finalizing your budget.

Which agency should I apply to first?

Start with the agency that matches your intended resident population, not the license that seems fastest or cheapest, because trying to retrofit a home built for one population into another agency's rules later is far more expensive than choosing correctly up front. If your residents will have intellectual or developmental disabilities, start with your regional OPWDD Developmental Disabilities Regional Office ^[1]. If your residents are adults with serious mental illness needing residential rehabilitation, start with your regional OMH field office ^[2]. If your residents are older adults or people who need help with ADLs but not psychiatric or I/DD-specific programming, start with DOH's Adult Care Facility/Assisted Living program ^[3][4]. Substance use recovery residences in New York are generally overseen by the Office of Addiction Services and Supports (OASAS) rather than OPWDD, OMH, or DOH, and have their own certification track under OASAS regulations, so confirm that separately if recovery housing is your target population. If you're still comparing populations, our guides on assisted living at home and senior assisted living facilities near me cover how senior-focused models differ operationally from I/DD or mental health group homes.

Frequently asked questions

What is assisted living?

Assisted living is a licensed care setting for adults who need help with daily activities like bathing, dressing, and medication management, but not full-time skilled nursing care. In New York, the licensed version is the Assisted Living Program (ALP) under Public Health Law Article 46-B, operated inside a certified adult home or enriched housing program ^[4].

What is a group home?

A group home is a licensed residence, usually housing 4 to 14 people, where staff provide supervision and support to residents who can't fully live independently. In New York, group homes are certified by OPWDD (I/DD), OMH (mental illness), or DOH (adult care/assisted living), each with its own regulations and application process ^[1][2][3].

What is an assisted living facility?

An assisted living facility is a DOH-licensed adult home or enriched housing program that has received additional certification to operate an Assisted Living Program. New York requires the base adult care facility license first, then a separate ALP certification application under 18 NYCRR Part 487 ^[3][4].

What is the difference between assisted living and a nursing home?

Assisted living provides help with daily activities in a residential setting for people with stable, chronic conditions. A nursing home provides 24-hour skilled nursing care for people with complex medical needs, licensed under Public Health Law Article 28 ^[5]. Nursing homes have on-site licensed nursing staff around the clock; assisted living generally does not.

Does Medicare cover assisted living facilities?

No. CMS confirms Medicare does not cover the room-and-board or custodial care costs of assisted living, since it's considered residential and personal care rather than skilled medical care ^[6]. Medicare can still cover medically necessary services, like doctor visits or therapy, that a resident receives while living there.

How do I start a group home in New York?

Pick your population and matching agency (OPWDD, OMH, or DOH), form a legal entity, apply for prior approval or certificate of need, secure a site that passes zoning and fire code review, write your policy manual, hire and train staff to required ratios, then pass a pre-opening survey before your operating certificate is issued. Plan for 9 to 18 months.

Does Medicaid cover assisted living in New York?

Coverage is limited. Some Assisted Living Program beds are designated for Medicaid managed long-term care recipients, but availability varies by facility and region, and it's not a universal benefit the way nursing home care is under Medicaid ^[4][7]. Confirm current ALP Medicaid slot rules with your regional DOH office.

Do I need to be a nonprofit to open a group home in New York?

For most OPWDD- and OMH-certified group homes, yes, sponsorship is typically structured through a not-for-profit corporation. DOH-licensed adult care facilities and ALPs can operate under for-profit structures in many cases. Confirm current entity requirements with your target licensing agency before incorporating ^[1][2][3].

Can a town block a group home through zoning in New York?

Generally no, for certified community residences serving up to 14 people. New York's Padavan Law (Mental Hygiene Law Section 41.34) treats these homes as a permitted residential use and limits a municipality's ability to exclude them through zoning, though towns do get formal notice before certain new homes open ^[8].

How many residents can a New York group home have?

It depends on the license type and program model. Many OPWDD and OMH community residences are sized for 6 to 14 residents under the Padavan Law framework, while ALP-certified adult care facilities can vary more widely based on the underlying adult home's licensed capacity. Confirm capacity limits for your specific program type with the licensing agency ^[1][2][8].

What kind of inspection does a group home go through before opening?

A pre-opening survey checks physical plant and fire safety, resident living space, required written policies (medication management, resident rights, emergency procedures), staff training and background check files, and whether staff practice matches what's written down. All three agencies (OPWDD, OMH, DOH) require this before issuing an operating certificate.

What's the difference between OPWDD, OMH, and DOH group homes?

OPWDD certifies homes for people with intellectual and developmental disabilities under 14 NYCRR Part 686. OMH certifies homes for adults with serious mental illness under 14 NYCRR Part 595. DOH licenses adult care facilities and assisted living programs for older adults and people needing ADL support under Public Health Law Article 46 ^[1][2][3].

How long does it take to get a group home license in New York?

There's no guaranteed timeline published by any agency. Realistically, from entity formation through prior approval or certificate-of-need review, site preparation, staffing, and a pre-opening survey, most applicants should plan for 9 to 18 months, and longer for new construction or major renovations.

Sources

1. New York Codes, Rules and Regulations: OPWDD certifies IRAs and community residences under 14 NYCRR Part 686 and requires prior approval review for new residential development
2. New York Codes, Rules and Regulations: OMH certifies community residences and family-based treatment homes under 14 NYCRR Part 595
3. New York State Department of Health, Adult Care Facilities: DOH licenses adult care facilities including assisted living programs under Public Health Law Article 46 and 18 NYCRR Part 487
4. New York State Department of Health, Assisted Living Program: New York's Assisted Living Program is authorized under Public Health Law Article 46-B and operates within certified adult care facilities
5. New York Public Health Law Article 28: Nursing homes in New York are licensed under Public Health Law Article 28 and provide 24-hour skilled nursing care
6. Medicare.gov, Long-term care coverage: Medicare does not cover long-term custodial care including assisted living room and board costs
7. Medicaid.gov, Nursing Facilities: Nursing facility care is a core mandatory Medicaid benefit nationally
8. New York Mental Hygiene Law Section 41.34: The Padavan Law treats certified community residences serving up to 14 people as a permitted residential use and limits municipal zoning exclusion