Rates are the property taxes paid by households and businesses in Northern Ireland.
The Department of Finance has launched a review of business rates and various exemptions offered to sectors.
The review also raises the possibility that a derelict land tax could be levied on development sites.
Rates are the only significant tax that is controlled and spent locally in Northern Ireland.
Business rates in 2014/15 raised £592m and a further £221m was forgone through various exemptions and reliefs.
Part of the review examines the "continued relevance and affordability" of those exemptions.
The exemption for residential homes costs just over £8m a year.
The consultation states that while there may be merit in providing rate relief in relation to the care of the elderly, it is "perhaps less clear who actually benefits from this exemption".
Charities benefit from £87m in rate relief, but the review states it is arguable that it is "both appropriate and affordable" for larger charities to make some contribution towards their rates.
The review states that bringing derelict or "brownfield" sites into the tax base would encourage land owners to makes sites available for development.
It could also discourage "land banking", whereby speculators retain land holdings in the expectation that values would rise.
The review adds that it would be technically difficult to bring derelict land into the rates system, but that it could still be taxed.
Residential homes and some large charities may have to begin paying rates, a Stormont consultation has suggested.