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Adult day care licensing by state

Daytime care and activities for adults who live at home

Adult day care is the least uniform care license. In 33 states it is a licensed facility, in 15 states and DC there is no license and the state only certifies programs that want Medicaid or other public funding, and Alabama and Michigan regulate it not at all.

States that only certify for public funding

Connecticut, Oregon and Wisconsin say a private-pay adult day program can open without a state license, and Colorado, Illinois, Indiana, Ohio and others have no adult day license on the books. Certification comes in when you want to be paid by a Medicaid waiver or state program: Colorado’s CDPHE surveys and certifies programs for Medicaid billing, Ohio’s Department of Aging certifies providers for programs such as PASSPORT, and Wisconsin certification is voluntary unless you serve county waiver clients. Mississippi waiver enrollment requires a year in business. Vermont certification also requires a new center to show unmet need. In Colorado, Idaho, Illinois, Indiana and Washington, no official source says outright that a private-pay center is exempt, so confirm with the agency before you open.

The participant count that triggers a license

Where a license exists, the trigger is usually a small headcount of unrelated adults. South Carolina and Iowa license from 2 or more, while Florida, Georgia, New Hampshire, New Mexico and Utah start at 3. Arkansas, Delaware, Nebraska, North Carolina, Pennsylvania, Texas, Virginia and Wyoming start at 4, and Arizona, Missouri and Tennessee at 5. Kansas, Montana, Nevada, Oklahoma and Rhode Island set no minimum, so even one participant can require a license. Hours matter too: Missouri and Arkansas count programs open over 2 hours a day, Tennessee over 3.

Social model or medical model

Many states license only the medical model, with nursing and therapy. West Virginia’s rule excludes mainly social and recreational programs, Maryland’s OHCQ does not license social-model programs, and New Jersey’s licensed facility list covers adult day health only. Other states split the two into separate licenses. California issues an Adult Day Program license from CDSS and a separate Adult Day Health Care license from CDPH, and Louisiana licenses social adult day care for 10 or more as a module of its home and community-based services license. In New York, medical adult day health care can run only as an approved program of a licensed nursing home.

Different names for the same license

Texas licenses Day Activity and Health Services facilities, Pennsylvania Older Adult Daily Living Centers, Maryland Adult Medical Day Care Centers and Nevada a Facility for the Care of Adults During the Day. Some mandatory credentials are not called licenses: North Carolina and Iowa issue a required certification, and Hawaii a certificate of approval. Minnesota offers a Family Adult Day Services license for up to 8 adults in the provider’s own home, and New Mexico licenses an adult day care home for 3 to 5 participants.

Certificates of need and moratoriums

Hawaii (freestanding adult day health centers) and DC (programs billing Medicaid) require a certificate of need, while New Jersey exempts adult day health care facilities by statute (N.J.S.A. 26:2H-7a), and Kentucky withholds its statutory exemptions from adult day health care (KRS 216B.020(4)). West Virginia will not issue an initial license for a project reviewable under its certificate of need law until the Health Care Authority finds it conforms. Minnesota has accepted no new adult day center applications since February 1, 2026, and expects the moratorium to last until January 31, 2028. In Massachusetts, a six-month MassHealth enrollment moratorium for Adult Day Health took effect May 19, 2026; DPH still issues initial licenses, but MassHealth provider enrollment is paused meanwhile.

Across the 50 states and DC

What each state requires to operate, at our last review

33 of 51
License required
16 of 51
Medicaid/Medicare certification only
2 of 51
No state license
Guides
33 below

Adult day care rules in every state

All states
Adult day care licensing in each state: requirement, official license name, agency and size threshold
Alabama No state license None (adult day care programs are not state-licensed) No licensing agency No state license; funding agencies approve centers
Alaska Medicaid/Medicare certification only Adult day services provider certification (Medicaid waiver) Alaska Department of Health, Division of Senior and Disabilities Services No state license; certification only to bill Medicaid
Arizona License required Adult Day Health Care Facility license Arizona Department of Health Services (ADHS), Bureau of Assisted Living Facilities Licensing Day services to 5 or more unrelated adults
Arkansas License required Adult Day Care (ADC) or Adult Day Health Care (ADHC) license Arkansas Department of Human Services, Division of Provider Services and Quality Assurance (DPSQA) 4+ functionally impaired adults, 2 to 24 hours a day, outside their homes
California License required Adult Day Program license (CDSS); Adult Day Health Care center license (CDPH) CDSS Community Care Licensing Division, Adult Care Licensing Program (Adult Day Programs) Day care for adults 18+; Adult Day Health Care is separate
Colorado Medicaid/Medicare certification only Adult Day Services certification (specialty code 601) for Medicaid billing Colorado Department of Public Health and Environment (CDPHE), Health Facilities and Emergency Medical Services Division, for the Department of Health Care Policy and Financing (HCPF) No state license; CDPHE certification only to bill Medicaid waivers
Connecticut Medicaid/Medicare certification only Adult day health care facility certification (no state license) Department of Social Services (DSS) sets certification rules No state license; certification only to be paid by state programs
Delaware License required Adult Day Care Facility license Delaware Department of Health and Social Services (DHSS), Division of Health Care Quality (DHCQ) Day services for 4 or more impaired adults, under 12 hours a day
District of Columbia Medicaid/Medicare certification only Adult Day Health Program (Medicaid provider enrollment) Department of Health Care Finance (DHCF) No facility license; Medicaid provider agreement and CON to bill DC Medicaid
Florida License required Adult Day Care Center license Agency for Health Care Administration (AHCA) Day services to 3 or more unrelated adults
Georgia License required Adult Day Center license Department of Community Health, Healthcare Facility Regulation Division (HFRD) 3 or more adults; serving 1 or 2 is exempt
Hawaii License required Adult Day Care Center certificate of approval Department of Health (DOH), Office of Health Care Assurance (OHCA) Supportive day care for 4 or more disabled adults
Idaho Medicaid/Medicare certification only Adult Day Health (Medicaid Aged and Disabled Waiver service) Idaho Department of Health and Welfare, Division of Medicaid, Bureau of Long Term Care No state license; Medicaid provider enrollment only
Illinois Medicaid/Medicare certification only Adult Day Service provider certification (Community Care Program) Illinois Department on Aging, Community Care Program No state license; Dept. on Aging certification for state-funded programs
Indiana Medicaid/Medicare certification only Adult Day Services (Medicaid waiver service) Indiana FSSA, Office of Medicaid Policy and Planning (HCBS certification) No state license found; FSSA waiver certification for each location
Iowa License required Adult day services program certification Iowa Department of Inspections, Appeals, and Licensing (DIAL), Health Facilities Division Day services to 2 or more adults with a functional impairment
Kansas License required Adult Day Care (adult care home license) Kansas Department for Aging and Disability Services (KDADS), Adult Care Home Licensure Day care for any number of unrelated adults needing daily-living help
Kentucky License required Adult Day Health Care Program License Cabinet for Health and Family Services (CHFS), Office of Inspector General, Division of Health Care Daytime health care program for clients of any age; license required
Louisiana License required Adult Day Health Care (ADHC) License; Adult Day Care module of the HCBS Provider License Louisiana Department of Health (LDH), Health Standards Section ADHC: 2+ impaired adults; HCBS day care module: 10+
Maine License required Adult Day Services Program License Maine DHHS, Division of Licensing and Certification (DLC), Assisted Housing Program A group program for more than 2 unrelated adults, 2+ hours a day
Maryland License required Adult Medical Day Care Center License Maryland Department of Health (MDH), Office of Health Care Quality (OHCQ) Day care for 4+ elderly adults, or 2 or 3 in a family home
Massachusetts License required Adult Day Health Program license Department of Public Health (DPH), Division of Health Care Facility Licensure and Certification Group nursing and health day program for adults 18+ with impairments
Michigan No state license None (no state adult day license) No state licensing agency No state license; funded programs follow service standards
Minnesota License required Adult Day Care Center license (adult day services); Family Adult Day Services license Minnesota Department of Human Services (DHS), Licensing Division Day services for impaired adults; home-based limit 8 adults
Mississippi Medicaid/Medicare certification only Adult Day Care provider, Elderly & Disabled Waiver Mississippi Division of Medicaid, Office of Long-Term Care No state license; Medicaid waiver enrollment only
Missouri License required Adult Day Care Program license Missouri Department of Health and Senior Services (DHSS), Division of Regulation and Licensure Group program for 5 or more impaired adults, 2 to 24 hours a day
Montana License required Adult Day-Care Center license Montana DPHHS, Office of Inspector General, Licensure Bureau Scheduled daily-living care for adults, no overnight; no minimum count
Nebraska License required Adult Day Service (ADS) license Nebraska DHHS, Licensure Unit, Office of Outpatient and In-Home Care Services Group day program for 4 or more people needing age or disability support
Nevada License required Facility for the Care of Adults During the Day (adult day care) license Nevada Health Authority, Health Care Purchasing and Compliance Division (HCQC) Any daytime care for aged or infirm adults; fees tier at 50 clients
New Hampshire License required Adult Day Program (ADP) license Department of Health and Human Services (DHHS), Health Facilities Administration, Health Facilities Licensing Unit Adult day services (under 12 hours a day) to 3 or more people
New Jersey License required Adult Day Health Services Facility license Department of Health (DOH), Certificate of Need and Licensing Division Medical day care for adults, licensed by slots, up to 12 hours a day
New Mexico License required Adult Day Care Facility license New Mexico Health Care Authority (HCA), Division of Health Improvement 3 or more non-resident adults, under 24 hours a day; home model 3 to 5
New York Medicaid/Medicare certification only Social adult day care (no license; annual certification to contract with Medicaid managed long term care plans); adult day health care (approved program of a licensed nursing home) Department of Health and Office for the Aging standards Social programs unlicensed; medical model only via nursing homes
North Carolina License required Adult Day Care Program certification NC DHHS, Division of Aging and Adult Services, with the county department of social services Group day care for adults; exempt if 3 or fewer people or all relatives
North Dakota Medicaid/Medicare certification only Adult day care (Qualified Service Provider enrollment) North Dakota HHS, Adults and Aging Services (Qualified Service Provider program) No state license; QSP enrollment needed for state-funded clients
Ohio Medicaid/Medicare certification only Adult Day Service (ADS) provider certification (enhanced or intensive) Ohio Department of Aging (ODA) No state license; ODA certification to serve publicly funded clients
Oklahoma License required Adult Day Care Center license Oklahoma State Department of Health (OSDH), Protective Health Services, Health Facility Systems Day care for unrelated impaired adults over 4 hours a day
Oregon Medicaid/Medicare certification only Adult Day Services (ADS) program certification (voluntary registry listing) Oregon Department of Human Services (ODHS), Aging and People with Disabilities (APD) No license; certification only for Medicaid-enrolled programs
Pennsylvania License required Older Adult Daily Living Center license Department of Aging Daytime care for 4 or more unrelated adults
Rhode Island License required Adult Day Care Program license Rhode Island Department of Health (RIDOH), Center for Health Facilities Regulation Non-residential adult day program with care plans; no set minimum count
South Carolina License required Day Care Facility for Adults license South Carolina Department of Public Health (DPH), Healthcare Quality Group day program for 2 or more unrelated adults, open 4 to 14 hours a day
South Dakota Medicaid/Medicare certification only Adult Day Services (DHS provider enrollment) Department of Human Services (DHS), Long Term Services and Supports No state license; DHS provider rules apply to waiver-paid programs
Tennessee License required Adult Day Services Center license Tennessee Department of Human Services (TDHS), Adult Day Services Day services to 5+ unrelated adults, 3 to 24 hours a day
Texas License required Day Activity and Health Services (DAHS) facility license Texas Health and Human Services Commission (HHSC), Long-term Care Regulation Daytime services for 4 or more unrelated adults
Utah License required Adult Day Care license (human services program license) Utah Department of Health and Human Services (DHHS), Division of Licensing and Background Checks, Office of Licensing Day care for 3 or more impaired adults, 4 to under 24 hours a day
Vermont Medicaid/Medicare certification only Adult Day Center certification (Certification Standards for Adult Day Services in Vermont) Vermont DAIL, Adult Services Division No license; DAIL certification needed for state and Medicaid-funded services
Virginia License required Adult Day Center License Virginia Department of Social Services (VDSS), Division of Licensing Programs Part-day care for 4+ adults; for-profit or voluntarily licensed
Washington Medicaid/Medicare certification only Adult day care and adult day health (DSHS/Area Agency on Aging contracted services) Department of Social and Health Services (DSHS), Aging and Long-Term Support Administration, with Area Agencies on Aging No state license; DSHS contract standards for Medicaid-funded centers
West Virginia License required Medical Adult Day Care Center license West Virginia Office of Inspector General, Office of Health Facility Licensure and Certification (OHFLAC) Medical day program for impaired adults; social-only exempt
Wisconsin Medicaid/Medicare certification only Adult Day Care Center (ADCC) certification Department of Health Services (DHS), Division of Quality Assurance No license; certification only to serve Medicaid waiver clients
Wyoming License required Adult day care facility license Wyoming Department of Health, Healthcare Licensing and Surveys (HLS) Social-model day program for 4 or more adults 18+ with disabilities

License names link to our guide where we have one, otherwise to the agency’s own page. Agency names and size thresholds are shortened here; state hubs give them in full.

Adult day care guides

All guides

  1. Arizona adult day health care facility license: ADHS rules, plan review and fees

    Licensing an Arizona adult day health care facility under A.R.S. 36-401 and R9-10 Article 11: 5-adult threshold, plan review, 40 sq ft rule, staffing, fees, ALTCS.

    Arizona · Adult day careUpdated

  2. Rhode Island adult day care program license: RIDOH rules, staffing and the no-fee application

    Licensing an adult day care program in Rhode Island under 216-RICR-40-10-7: who needs it, staffing, space, fire sign-offs, the no-fee application and Medicaid.

    Rhode Island · Adult day careUpdated

  3. Arkansas adult day care license: DPSQA rules, slots, staffing and the Act 905 question

    How to license an adult day care in Arkansas under 20 CAR Part 408: the 4-adult threshold, $5 per slot fee, 2-staff minimum, 40 sq ft rule, fire rules and ARChoices.

    Arkansas · Adult day careReviewed

  4. California adult day program license: CDSS rules, plus the separate ADHC path

    How to license a non-medical adult day program with CDSS in California, and how the medical Adult Day Health Care license (CDPH) and CBAS certification differ.

    California · Adult day careReviewed

  5. Delaware adult day care facility license: DHCQ rule 3360, space, staffing and fees

    Licensing an adult day care facility in Delaware under 16 DE Admin. Code 3360: the four-participant threshold, space formula, 1:8 staffing and the $100 fee.

    Delaware · Adult day careReviewed

  6. Florida adult day care center license: AHCA rules, ratios and the Alzheimer's designation

    How to license an adult day care center in Florida under Chapter 429 Part III and rule 59A-16: who needs it, 45 sq ft rule, 1:6 ratio, fees, inspection and Medicaid LTC.

    Florida · Adult day careReviewed

  7. Georgia adult day center license: social vs medical model, the 1:8 ratio and GAHLES filing

    How to license an adult day center in Georgia under rule 111-8-1: the 3-participant threshold, social vs medical model, 35 sq ft rule, 1:8 ratio, fees and CCSP.

    Georgia · Adult day careReviewed

  8. Hawaii adult day care center certificate of approval: rules, fees and the OHCA process

    How to get a certificate of approval for an adult day care center in Hawaii under HAR 17-1424: who needs it, 1:6 ratio, 50 sq ft rule, $1,000 fee, 60-day decision.

    Hawaii · Adult day careReviewed

  9. Iowa adult day services program certification: DIAL rules, fees and the CARF route

    How to certify an adult day services program in Iowa under Iowa Code 231D and 481 IAC 70: who needs it, fees, CARF accreditation, staffing, dementia rules and Medicaid.

    Iowa · Adult day careReviewed

  10. Kansas adult day care license: KDADS rules, space, fees and the fire marshal track

    How KDADS licenses adult day care in Kansas: no minimum headcount, a registered operator, 60 sq ft per participant, $100 + $30 per slot and fire marshal review.

    Kansas · Adult day careReviewed

  11. Kentucky adult day health care program license: certificate of need, 902 KAR 20:066 and waiver rules

    How to open an adult day health care program in Kentucky: certificate of need, OIG licensure under 902 KAR 20:066, the $170 fee, nursing rooms and waiver rates.

    Kentucky · Adult day careReviewed

  12. Louisiana adult day health care license: LDH rules, staffing and the 1,500-foot rule

    How to license an adult day health care center in Louisiana under LAC 48:I Chapter 42: fire marshal plan review, the $600 fee, staffing, space and the ADHC Waiver.

    Louisiana · Adult day careReviewed

  13. Maine adult day services program license: Chapter 117, the 1:6 ratio and the fire marshal sign-off

    How to license an adult day program in Maine under 10-144 CMR Ch. 117: who needs it, social vs. health programs, 50 sq ft rule, 1:6 ratio, fees and fire inspection.

    Maine · Adult day careReviewed

  14. Maryland adult medical day care license: the OHCQ letter of interest, staffing and space rules

    How to license an adult medical day care center in Maryland under COMAR 10.12.04: letter of interest, plans review, RN and director rules, square footage and Medicaid.

    Maryland · Adult day careReviewed

  15. Massachusetts Adult Day Health program license: DPH rules under 105 CMR 158.000

    Licensing an Adult Day Health program in Massachusetts: who needs it, the 50 sq ft rule, staffing, the mailed DPH application and the 2026 MassHealth moratorium.

    Massachusetts · Adult day careReviewed

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

    How Minnesota licenses adult day centers and family adult day services: the DHS moratorium through Jan. 2028, Rule 223 ratios, 40 sq ft rule, fees and Medicaid screening.

    Minnesota · Adult day careReviewed

  17. Missouri adult day care program license: DHSS rules, space, staffing and Medicaid

    How to license an adult day care program in Missouri under RSMo 192.2200 and 19 CSR 30-90: the five-participant trigger, 80 sq ft rule, staffing, fees and MO HealthNet.

    Missouri · Adult day careReviewed

  18. Montana adult day care center license: DPHHS rules, application packet and inspections

    Licensing an adult day care center in Montana under MCA 50-5 and ARM 37.106: who needs it, the application packet, staffing, meals, inspections and Medicaid.

    Montana · Adult day careReviewed

  19. Nebraska adult day service license: 175 NAC 5, fees, building sign-offs and Medicaid waiver work

    How to license an adult day service in Nebraska: the 4-person threshold, $200-$300 fees, Fire Marshal and zoning papers, the 2024 rules, inspection and AD Waiver billing.

    Nebraska · Adult day careReviewed

  20. Nevada adult day care license: the facility for the care of adults during the day

    How to license an adult day care in Nevada under NRS and NAC 449: no client minimum, plan review, 40 sq ft per client, $1,164 or $1,753 fees, renewal, Medicaid 1915(i).

    Nevada · Adult day careReviewed

  21. Opening an adult day program in New Hampshire: the He-P 818 license, staffing and the 2026 rewrite

    Licensing an adult day program in New Hampshire under He-P 818: the 3-person threshold, administrator and nurse rules, ratios, local sign-offs, the $200 fee and CFI.

    New Hampshire · Adult day careReviewed

  22. Opening a medical adult day center in New Jersey: the DOH adult day health services license

    How New Jersey licenses medical adult day care under N.J.A.C. 8:43F: the CN-6 project application, $1,500 + $10 per slot fee, surveys, staffing and Medicaid rules.

    New Jersey · Adult day careReviewed

  23. New Mexico adult day care facility license: center vs. home, HCA rules and fees

    How to license an adult day care center or adult day care home in New Mexico under 8.370.20 NMAC: thresholds, 40 sq ft rule, 1:5 ratio, $300 fee, HCA steps.

    New Mexico · Adult day careReviewed

  24. North Carolina adult day care certification: county DSS study, DAAS rules and day health

    How to certify an adult day care or adult day health program in North Carolina under G.S. 131D-6 and 10A NCAC 06R/06S: exemptions, ratios, space, package and renewal.

    North Carolina · Adult day careReviewed

  25. Oklahoma adult day care center license: OSDH rules, the 180-day first license and the 1:8 ratio

    How to license an adult day care center in Oklahoma under the Adult Day Care Act and OAC 310:605: who needs it, ODH Form 712, fees, the 40 sq ft rule and the 1:8 ratio.

    Oklahoma · Adult day careReviewed

  26. Pennsylvania adult day center license: Older Adult Daily Living Center rules and steps

    How to license an adult day center in Pennsylvania: the four-client threshold, I-4 occupancy, 1:7 ratio, 50 sq ft rule, $10-$40 fee, interim license and CHC Medicaid.

    Pennsylvania · Adult day careReviewed

  27. South Carolina day care facility for adults license: R.60-75 rules, fees and Medicaid

    How to license adult day care in South Carolina under Regulation 60-75: the two-person threshold, 50 sq ft rule, 1:8 ratio, fees, plan review and Medicaid ADHC.

    South Carolina · Adult day careReviewed

  28. Tennessee adult day services center license: the TDHS process and the September 2026 rule changes

    How to license an adult day center in Tennessee under rule 1240-07-10: the 5-participant threshold, TDHS pre-licensure steps, 40 sq ft, 1:8 ratio, fees and 2026 changes.

    Tennessee · Adult day careReviewed

  29. Texas Day Activity and Health Services (DAHS) license: building, staffing and Medicaid

    How to license a Day Activity and Health Services facility in Texas: the 4-person threshold, 40 sq ft rule, 1:8 ratio, $75 fee, TULIP steps, Medicaid and ISS.

    Texas · Adult day careReviewed

  30. Utah adult day care license: a human services program under R501-13

    Licensing adult day care in Utah: the 3-adult, 4-hour threshold, R501-13 staffing ratios, the 50 sq ft rule, FY2027 fees and New Choices Waiver billing.

    Utah · Adult day careReviewed

  31. Virginia adult day center license: VDSS rules, the 1:6 ratio and a fee that starts at $14

    Licensing an adult day center in Virginia under 22VAC40-61: who needs it, director rules, 50 sq ft per participant, 1:6 staffing, VELA filing, fees, inspections.

    Virginia · Adult day careReviewed

  32. West Virginia medical adult day care center license: OHFLAC rules, space, nursing and Medicaid

    Licensing a medical adult day care center in West Virginia under 71CSR20: who needs it, $100 fee, 90-day filing, RN and 1:6 staffing, space rules, CON, ADW Medicaid.

    West Virginia · Adult day careReviewed

  33. Wyoming adult day care facility license: HLS rules, the 1:6 ratio and the $250 fee

    How to license an adult day care facility in Wyoming: the 4-adult threshold, HLS checklist, 40 sq ft rule, 1:6 ratio, $250 fee and Community Choices Waiver.

    Wyoming · Adult day careReviewed

Beyond the state licenseEntity and EIN, caregiver pay rules, NPI, Medicaid or Medicare enrollment, EVV and background checks.Certificate of need by stateWhich states make home health, assisted living or adult day founders prove need before licensing.

Other care business types

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