Minnesota adult day services license: Rule 223 centers, the 2026 moratorium and the home option

The moratorium comes first

If you plan to open an adult day center in Minnesota between now and early 2028, check this before anything else. DHS’s Licensing Division announced on December 16, 2025 that it would stop accepting new adult day care license applications and cancel every application already in its queue ⁠⁸. The moratorium took effect February 1, 2026, and DHS expects it to end January 31, 2028 ⁠¹.

DHS gave its reason in numbers. Licensed adult day capacity grew 43%, while the yearly average number of Medicaid adult day participants grew only 7% ⁠⁸. DHS concluded that existing capacity “substantially exceeds current or expected need over the next two years,” and said it would spend the pause investigating fraud allegations and reviewing licensed centers on a two-year cycle ⁠⁸.

Applicants caught in the cancellation had to apply for a refund. DHS emailed the refund process to the authorized agent or controlling individual on September 10, 2026 ⁠⁹.

How the exception process works

There is no path for a provider to request an exception directly. Each county, managed care organization (MCO) and Tribal Nation names one adult day care moratorium liaison, and DHS accepts exception requests only from those liaisons ⁠¹⁠⁹. DHS accepts a request in two situations ⁠¹:

• A lead agency or Tribal Nation finds that one person’s service need cannot be met by existing licensed capacity in the county, reservation or region where the person wants services.
• One or more lead agencies or Tribal Nations jointly identify a regional need for new capacity based on the needs of several people.

The request must name a provider able to meet the need. DHS then contacts that provider to file a standard application, and the provider still has to meet every licensing requirement ⁠¹. A lead agency does not have to support anyone who asks. DHS may deny a request if more providers are not needed in the area, if other ways to meet the person’s needs have not been explored, or if the lead agency has not determined that the provider can meet them ⁠⁹. Neither the lead agency’s decision nor DHS’s decision can be appealed. If DHS lets you apply and then denies the license itself, you have the usual appeal rights under section 245A.05 ⁠⁹.

DHS expects the exception step to take no more than 60 days, and the license application review afterward to take no more than 45 days, depending on how quickly the applicant supplies documents ⁠⁹. An existing center does not need a needs determination to change its capacity; it asks HCBS Licensing directly ⁠⁹.

Buying an existing center during the pause

A 2026 law, effective July 1, 2026, says a change of ownership is not subject to a licensing moratorium as long as it does not increase licensed capacity or service scope ⁠¹⁰. That makes acquisition the most direct way into center-based adult day in Minnesota before 2028. Two rules shape the deal:

• Selling or transferring 100% of a licensed program’s property, stock or assets makes the buyer apply for their own license ⁠¹⁰.
• Effective October 1, 2026, the legislature removed the old change-of-ownership exception, which had let a license continue if at least one controlling individual had been on it for the previous 12 months. Selling 100% of the property, stock or assets, or replacing every controlling individual, now always requires the new owner to apply ⁠¹⁰.

On October 12, 2026 the Revisor’s page for section 245A.10 still printed the subdivision 3a change-of-ownership fee text, but flagged it as repealed by Laws 2026, chapter 121, article 4, section 37, as DHS’s implementation plan also lists ⁠⁴⁠¹⁰. Ask DHS what a buyer’s application fee is before you budget.

Two licenses, two licensing offices

Minnesota uses one statutory definition for three terms, “adult day care,” “adult day services” and “family adult day services”: a program operating less than 24 hours a day that gives functionally impaired adults an individualized, coordinated set of health, social and nutritional services aimed at maintaining or improving their capacity for self-care ⁠⁵. Two license types sit under that definition.

DHS’s moratorium materials refer only to adult day care centers and “adult day centers”, and they do not say whether the pause reaches county-licensed family adult day services ⁠¹⁠⁸. Before you rely on the family route as a way around the moratorium, ask your county licensing unit whether it is accepting family adult day services applications.

What does not need a license

The definition leaves out programs where adults gather mainly for socialization, education, supervision, caregiver respite, religious expression, exercise or meals ⁠⁵. A senior center lunch program or a faith-based social day is therefore outside the license. Section 245A.03 also excludes care given by a related individual, care given by an unrelated individual to people from a single related family, programs for adults who have no functional impairment, disability, mental illness or substance use disorder, and recreation programs run or approved by a park and recreation board ⁠⁶.

Under a 2026 law, “individual who is related” now includes people related through marriage. DHS will no longer issue a license to someone who seeks it in order to serve an in-law ⁠¹⁰.

A center’s licensing obligation starts when it serves people “regularly,” meaning more than 30 days in any 12-month period. Any part of a calendar day counts as a full day ⁠². Hospitals, nursing homes and boarding care homes licensed by the Minnesota Department of Health need a separate adult day center license for any identifiable unit that regularly serves six or more non-resident functionally impaired adults at a time ⁠².

If your participants need overnight care, look at adult foster care (also DHS) or an assisted living facility license (MDH). An adult foster care license holder can provide family adult day services under the foster care license by meeting section 245A.143, and the eight-person cap counts residents and day participants together ⁠³.

Building and space for a center

Rule 223 ties occupancy classification to the Minnesota State Fire Code, chapter 7511 ⁠². Licensed capacity is limited by usable indoor space. You need at least 40 square feet for each participant and each staff member present ⁠². The following do not count toward that space ⁠²:

• Hallways, stairways, closets, offices, restrooms, and utility and storage areas.
• More than 25% of the space occupied by furniture or equipment used by participants or staff.
• In a multifunctional organization such as a nursing home, space occupied by the organization’s other people while participants are using shared space.

The rule also requires ⁠²:

• A room or area that can be used privately for personal hygiene or social services.
• A call signal (light or sound) in participant restrooms.
• A sturdy, nonfolding chair for each participant who does not use a wheelchair, plus stable tables.
• One cot, couch or recliner for every eight participants.
• An indoor temperature of at least 70°F, and screens on any doors or windows opened for ventilation in summer.

DHS also notes that an adult day center may need its own Food, Beverage and Lodging license from the Department of Health, and certified food protection manager coverage, depending on how meals are handled ⁠¹. Rule 223 requires food handling to follow the state food code (chapter 4626) and local ordinances, including when meals are prepared off-site under contract ⁠².

Who runs the center and how many staff you need

Center director. The director must meet one of two routes ⁠²:

• A Minnesota LPN license or at least two years of accredited postsecondary education, plus two years of paid or volunteer experience planning or delivering health or social services, including supervision and administration.
• Four years of such experience, including two years of supervision and administration.

Ratios. Rule 223 ties staffing to whether each participant is “capable of taking appropriate action for self-preservation under emergency conditions.” In practice, that means someone who can walk or move independently, recognize an alarm, evacuate with no more than occasional help, choose another exit if needed, and wait at the meeting point ⁠². The ratios are ⁠²:

For example, 10 participants who can evacuate on their own and 4 who cannot score 125 + 80 = 205 points, which requires three staff. Only employees whose main job duties are direct care count toward the ratio. Participants never count. A volunteer counts only by meeting the same standards as paid staff ⁠². If the 1-to-8 ratio (all participants able to evacuate) requires only one staff member and six or more participants attend, a second adult who is not a participant must be present ⁠².

A person trained in basic first aid and certified in CPR and obstructed-airway treatment must be present at the center whenever participants are, in any vehicle transporting them, and on every field trip ⁠².

Training. Every employee gets 20 hours of orientation within their first 40 hours on the job, including at least four supervised hours before working directly with participants. The orientation covers participants’ impairments, vulnerable adult protection and the center’s safety procedures. After that, the center must provide at least eight hours of in-service training a year ⁠². If you market services for people with Alzheimer’s disease or related disorders, direct-care staff and their supervisors must be trained in dementia care (disease basics, help with daily living activities, problem-solving with challenging behaviors, and communication), and you must give consumers a written description of that training ⁠⁷.

Medication. Staff other than physicians, pharmacists, RNs and LPNs who assist with medication need a certificate from a Department of Health-approved trained medication aide program, or must be trained by an RN ⁠².

The service program Rule 223 requires

Minnesota’s center rule is more clinical than many states’. It requires three outside or in-house professionals on a fixed schedule ⁠²:

• Registered nurse. Health services must be developed with an RN, who reviews them at least monthly. The RN also sets the policies for self-administered medication and for training unlicensed staff.
• Registered physical therapist. A daily structured exercise program, for participants whose physicians have cleared them, must be developed with a registered physical therapist, who reviews it at least quarterly.
• Registered dietitian. All meal and snack menus need a registered dietitian’s approval.

DHS publishes sample personnel-file templates for the consultant RN, dietitian and physical therapist ⁠¹. The rule requires a signed contract and proof of licensure in each consultant’s file ⁠².

Meals and transport have their own figures ⁠²:

• A participant at the center more than 4½ hours gets a meal meeting one-third of the recommended dietary allowances.
• Every center offers a midmorning and a midafternoon snack, keeps refrigeration at 40°F or below, and keeps menu records for six months.
• No participant may ride a center vehicle more than 90 minutes one way.

The rule also requires a monthly plan of activities (social, personal interest, and awareness and language skills), help with activities of daily living, and social services that include a family and social history updated every year ⁠².

Admission and care-planning clock

The rule sets these deadlines for each participant ⁠²:

1. Intake screening

   Tell the person whether you can serve them within five working days of starting the screening.

2. Medical report

   Get it dated within three months before or 30 days after admission. It must be signed by a physician (or by a PA or RN and cosigned by a physician), include an exercise release, and document freedom from communicable disease. The physical exam is updated every year.

3. Needs assessment and preliminary service plan

   Complete within 30 days of admission.

4. Individual plan of care

   Complete within 90 days, with measurable objectives, then review and revise it quarterly.

Each record also holds monthly progress notes, the signed rights statement and the individual abuse prevention plan required by the Vulnerable Adults Act ⁠². If you bill a government program, section 245A.14 also requires same-day attendance records showing each person’s full name, drop-off time and pick-up time. A program designated for remote adult day services must document actual participation instead ⁠¹².

Policies and safety plans to have ready

At admission, every participant and caregiver gets written information on 14 points (items A to N of part 9555.9640). These include the populations and conditions you will not accept, transportation and meal policies, fees, insurance carried, pets, smoking, the grievance procedure with the DHS licensing division’s contact details, a summary of the Vulnerable Adults Act, and a statement of compliance with the Minnesota Human Rights Act ⁠². The bill of rights must cover participation in care planning, the right to refuse, physical privacy, confidentiality and grievances ⁠².

Safety rules are Minnesota-specific. Written emergency plans must cover fire, blizzards and tornadoes, be posted, and be rehearsed at least four times a year with recorded dates. You also need a flashlight and a radio or television that works without electricity, a stocked first aid kit that goes on field trips, and incident records ⁠². DHS posts sample policies for each of these, from the grievance policy to the program abuse prevention plan, along with a self-monitoring checklist for adult day centers ⁠¹.

Under a 2026 law effective July 1, 2026, applicants and license holders that receive public funds must file a notarized attestation saying whether an unaffiliated business or consultant helped prepare the application, documentation or written policies. DHS will not issue a license without it, and a license holder that updates a policy after a licensing review must file a new attestation ⁠¹⁰.

Applying, if you have an exception

Center applications go to DHS. Once an exception clears you to apply, the sequence runs:

1. Get exception approval

   DHS contacts the provider named in an approved lead-agency or Tribal request ⁠¹.

2. Pay the application fee

   The initial fee is $2,100. It is nonrefundable and not prorated, replaces the annual fee for the year ending December 31, and DHS will not process an application until it is paid ⁠⁴. Each license covers one specific location ⁠⁴.

3. Submit background studies and the attestation

   Background studies follow chapter 245C ⁠¹, and the 2026 consultant attestation must be notarized ⁠¹⁰.

4. Meet the location rule

   An applicant headquartered outside Minnesota needs a program office within 30 miles of the state border ⁠⁷.

5. Wait for the decision

   By statute, DHS acts within 90 working days of a complete application, and an application is not complete while an applicant or controlling individual is under a pending investigation ⁠⁷. For exception applicants, DHS’s FAQ estimates up to 45 days ⁠⁹.

6. Expect early visits

   A 2026 law created an HCBS “early and often” licensing team to help applicants and visit programs several times during their first 18 months ⁠¹⁰.

Source: ⁠⁴. The $2,100 initial application fee replaces the first year’s annual fee ⁠⁴.

Family adult day services in your home

The family license under section 245A.143 lets the license holder serve up to eight adults at one time in their own primary residence, with the license holder as the primary caregiver ⁠³. Counties handle licensing, so contact your county social services or human services department ⁠¹. The statutory fee is $2,100 a year for county evaluation and inspection ⁠⁴. These licenses can be issued for up to two years until DHS’s provider licensing and reporting hub is running, and you must apply for and receive a new license before the old one expires ⁠⁷⁠¹³.

What the statute requires ⁠³:

• Fire safety. The home is classified as R-3 residential occupancy. No building code inspection is required, but the state or local fire marshal must inspect it. Local ordinances still apply.
• Space. At least 35 square feet of usable indoor space for each participant, the license holder and each staff member present, not counting hallways, stairways, closets, offices, restrooms, and utility and storage areas, plus a private area for hygiene or social services.
• Staffing. Whenever participants are present, someone trained in first aid and certified in CPR and obstructed-airway treatment must be there. A second staff person is required when six, seven or eight participants are present.
• Training. 12 hours a year, dropping to six once you have six or more years licensed under this section or as an adult foster care provider. Training must cover vulnerable adult maltreatment reporting, and medical equipment if you serve people who rely on it.
• Medication. Unless licensed to give medication, the person responsible needs a certificate from a Department of Health-approved medication aide program or must show competency to an RN, physician or PA every two years. Medications stay in original containers in secure storage, with a record of every dose.
• Plans. Screen each person before admission. Before services begin, build a service delivery plan with the person, their caregiver and any case manager, and revise it on any change or at least every year. Have written policies on 14 points, including a disaster evacuation plan with a quarterly fire drill schedule and the county licensing department’s contact details for complaints.

Getting paid: Medicaid screening tightened in 2026

If you plan to bill Minnesota Health Care Programs, enrollment is now a second gate after licensing. In January 2026, DHS designated Adult Day Care as one of 13 high-risk Minnesota Health Care Programs (MHCP) services ⁠¹¹. In coordination with CMS, it also froze new provider enrollment in all 13 categories effective January 27, 2026, a freeze initially slated to last six months ⁠¹¹. DHS said the freeze was initially slated to last six months, and the sources checked on October 12, 2026 do not say whether it was extended or lifted; ask DHS Provider Eligibility before you plan on enrolling.

For high-risk providers, DHS requires ⁠¹¹:

• Fingerprint-based criminal background studies through NETStudy 2.0 for every direct and indirect owner with 5% or more ownership, with an “eligible” or “set-aside” result. Each study costs $44, plus a fingerprint fee that varies by location.
• Possible unannounced site visits.
• An off-cycle revalidation for already enrolled adult day providers, due May 31, 2026.

This guide does not cover how Medicaid waiver programs (Elderly Waiver, Alternative Care, CADI, Brain Injury) pay for adult day services, or their rates, because the DHS pages checked do not set them out for center applicants. Ask DHS and your county or managed care organization which programs authorize adult day services and what enrollment steps apply.

What may change next

• End of the moratorium. DHS plans to use the pause to “consider methods” for bringing in new applicants after January 31, 2028 that better match statewide need, so the post-moratorium application process may differ from the one described here ⁠⁸.
• Rule 223 rewrite. DHS’s Adult Day Services Standards Improvement Project, run by its Aging and Adult Services, Disability Services and Licensing divisions, worked on a legislative proposal for new adult day licensing standards. DHS’s page describes a 20-member stakeholder group scheduled to meet about every other month from September 2019 through November 2020; it names no adopted new standards, so Rule 223 remains the rule ⁠¹⁴.
• Enforcement. 2026 laws expanded DHS’s authority to withhold payments and to suspend licenses during fraud investigations, effective July 1, 2026 ⁠¹⁰.

For other Minnesota care licenses, see the basic home care license or the Minnesota state overview.

Sources

1. 1
   Minnesota Department of Human Services, Licensing help for adult day providers Checked 12 Oct 2026 · Back to text ↑
2. 2
   Minnesota Office of the Revisor of Statutes, Minnesota Rules, parts 9555.9600 to 9555.9730 (Rule 223): Adult day care centers Checked 12 Oct 2026 · Back to text ↑
3. 3
   Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 245A.143: Family adult day services Checked 12 Oct 2026 · Back to text ↑
4. 4
   Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 245A.10: Fees Checked 12 Oct 2026 · Back to text ↑
5. 5
   Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 245A.02: Definitions Checked 12 Oct 2026 · Back to text ↑
6. 6
   Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 245A.03: Who must be licensed Checked 12 Oct 2026 · Back to text ↑
7. 7
   Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 245A.04: Application procedures Checked 12 Oct 2026 · Back to text ↑
8. 8
   Minnesota Department of Human Services, Office of Inspector General, Licensing Division, Temporary Licensing Moratorium for Adult Day Care (December 16, 2025) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Minnesota Department of Human Services, Frequently asked questions: Temporary Adult Day Care moratorium exceptions Checked 12 Oct 2026 · Back to text ↑
10. 10
    Minnesota Department of Human Services, Adult day care centers: Implementation plan for 2026 legislative changes (September 2026) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Minnesota Department of Human Services, MHCP Provider News, February 10, 2026 Checked 12 Oct 2026 · Back to text ↑
12. 12
    Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 245A.14: Special conditions for nonresidential programs Checked 12 Oct 2026 · Back to text ↑
13. 13
    Minnesota Office of the Revisor of Statutes, Minnesota Statutes, section 245A.16: Standards and procedures for county agencies Checked 12 Oct 2026 · Back to text ↑
14. 14
    Minnesota Department of Human Services, Adult Day Standards Improvement Project Checked 12 Oct 2026 · Back to text ↑

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