All states: adult day services map
In short: No state license for adult day centers; DHR contracts set staffing and space rules, and Medicaid waivers pay adult day health per day.
| License or certification | No state license. Centers serving DHR or Medicaid waiver clients must meet that program's standards and be approved. |
|---|---|
| Who licenses or certifies | No licensing agency. DHR approves its contract centers; ADSS and Area Agencies on Aging approve Medicaid adult day health providers. |
| Adult day care vs adult day health | Yes, split by payer: adult day care is a DHR service, adult day health is a Medicaid waiver service. Neither is a license type. |
| Strictest staffing ratio | DHR contract: 1 direct care staff for 1 to 10 enrolled (plus a director), 2 for 11 to 25, then more by tier; at least 2 staff on site |
| Dementia ratio | No ratio specified |
| Medicaid programs | Elderly and Disabled (E&D) Waiver; Alabama Community Transition (ACT) Waiver |
| Medicaid billing unit | Per day (at least 4 hours) in the E&D Waiver, with a higher rate when the center provides transportation |
| Licensed centers | Not confirmed. No state agency licenses or counts adult day centers. |
Last verified against state sources: 2026-10-21.
Alabama does not license adult day centers. Instead, the rules come from the programs that pay for care: the Alabama Department of Human Resources (DHR) sets standards for the adult day care it buys, and the Alabama Medicaid Agency sets provider standards for adult day health in its home and community waivers. A center that serves only private-pay participants is not covered by either set of rules.
Important: No state license does not mean no rules. If you want to serve DHR or Medicaid waiver clients, you must meet that program's standards and be approved before you are paid. Medicaid also publishes a separate Adult Day Health scope of service that we could not open, so it may add rules not shown here. Ask the Alabama Department of Senior Services (ADSS) for the current version before you plan staffing or space.
Alabama uses two names, and the difference comes from who pays, not from a license type:
Here is who sets each layer:
The two layers are not stricter or looser as a whole. DHR is more detailed on staffing, space, hours and inspections. Medicaid requires health services, licensed nurses and more yearly training hours. We did not find a dementia-specific or social-model license category anywhere in Alabama's primary sources.
No. Alabama has no state license for adult day centers, and DHR's 2025 adult day RFP states that there are no licensure, certification or credential requirements. What you need instead depends on who will pay: DHR approval to serve DHR clients, or Medicaid waiver provider approval to serve E&D or ACT Waiver participants. Both come with inspections and annual checks.
To serve DHR clients. Under the 2025 RFP and the DHR Minimum Standards (section II.C.1):
To serve Medicaid waiver participants. Under the E&D Waiver's provider specifications, an adult day health provider must be an agency with an Alabama business license. Drivers need a valid driver's license and nurses a current Alabama Board of Nursing license. No certificate is required. ADSS and the Area Agencies on Aging check qualifications when the contract is signed and every year after. Rule 560-X-36-.04(4)(c) says the state agencies that contract for the service must determine that each facility meets the minimum standards for adult day health centers. The state also makes on-site visits to adult day health settings.
What we did not find. Because there is no license, there is no state application or license fee. We did not find a source saying whether adult day is subject to certificate of need review; ask the State Health Planning and Development Agency (SHPDA). We also did not find rules on per-site approval or change of ownership for DHR or Medicaid approval. If you are buying a center that serves DHR or waiver clients, ask DHR and ADSS early whether the seller's contract and approval can carry over. Local business, fire and health permits still apply.
Alabama's only staffing ratio for adult day comes from DHR's contract standards: one direct care staff member for 1 to 10 enrolled participants, plus a program director, with more staff added as enrollment grows. At least two staff must be at the center whenever participants are present. The Medicaid E&D Waiver sets no ratio, and we did not find a separate ratio for participants with dementia.
DHR tiers. The DHR Minimum Standards (section II.F) and the 2025 RFP (section 3.3.10) require, in addition to the program director, this many direct care staff during operating hours:
Note that the tiers are based on the number enrolled, not the number present on a given day.
Minimum staff on site. DHR requires at least one staff member present at all times who is CPR certified and trained in first aid.
Who counts toward the ratio. Under DHR rules the director is counted separately. Auxiliary staff such as kitchen, maintenance and bookkeeping workers do not count unless their job descriptions set times when they work only with participants. Volunteers who replace hired staff must meet the same requirements as staff.
Director. The E&D Waiver requires a director with a high school diploma or equivalent. We did not find director qualifications in the DHR standards or the 2025 RFP.
Nurses. DHR requires an LPN or RN to be available for monthly health screening of each participant. The E&D Waiver requires nurses licensed by the Alabama Board of Nursing, preferably with two years of RN or LPN experience in public health, a hospital or long-term care. Neither layer sets a number of nurse hours on site.
Training. DHR requires on-site orientation and supervised training for new staff without adult day experience, and in-service training at least every quarter, documented in writing, including Standard Precautions. The E&D Waiver requires at least 6 hours of in-service training per calendar year for every worker.
Background checks and health screening. Under the 2025 DHR contract, all staff and volunteers need a fingerprint criminal background check, an Alabama Elder in Need of Protective Services Abuse Registry clearance and a DHR Child Abuse/Neglect Central Registry clearance. Staff hired after October 1, 2025 must clear these before starting, and current staff had until January 1, 2026. Each employee also needs a physical exam within 3 months before employment and every two years. The E&D Waiver requires staff to follow Medicaid's TB testing policy.
What a center must provide depends on the program it serves. DHR contract centers must be open at least 8 hours a day, offer at least 5 hours of planned activities, serve meals and provide monthly health screening. Medicaid adult day health must include health education, self-care training, therapeutic activities and health screening, delivered for at least 4 hours a day.
Medicaid adult day health services. Under rule 560-X-36-.04(4), E&D adult day health includes health education, self-care training, therapeutic activities and health screening, and transportation may be part of the service. The ACT Waiver covers the same components plus community integration. When the center transports a participant, travel time counts toward the 4-hour daily minimum.
DHR hours and activities. Under the 2025 DHR contract, a center must be open at least 8 hours daily (7:30 a.m. to 3:30 p.m.), close for no more than 13 holidays a year, and give each participant the chance to take part in at least 5 hours of planned activities a day, not counting lunch, breaks or free time. The older 2007 Minimum Standards required 7 open hours. We did not find a minimum number of operating days for Medicaid.
Meals. DHR requires food that meets one-third of an adult's daily nutritional needs for full-time participants, plus snacks for those attending more than 4 hours. Weekly menus must be posted a week ahead, and special diets must be accommodated. Separately, the E&D home-delivered meals service provides one frozen meal on days a client attends an adult day health center.
Health and medications. DHR requires monthly health screening for each participant by an LPN or RN, and program staff must not administer medications. Medicines must be stored locked and away from toxic chemicals.
Transportation. Transportation is optional. When a DHR center provides it, drivers must be licensed, vehicles need seat belts, loading must be at the curb, and insurance certificates must be filed with DHR.
Space. Only DHR sets space rules (Minimum Standards, section II.C.2):
Written and posted policies. DHR centers must have posted evacuation procedures known to all staff, advance arrangements for medical situations, a holiday schedule given at admission and a week before each holiday, Standard Precautions with staff training, a process for reporting suspected abuse to the county DHR, and a written daily operating schedule. Fire Marshal and health inspection results, the food permit and weekly menus must be posted. For Medicaid, adult day health centers must meet the federal home and community-based settings rule (560-X-36-.01(5)), which the state checks through on-site visits. We did not find a required fire drill frequency or policy review schedule.
For DHR contract centers, each participant needs a written assessment within 30 days of enrollment, then quarterly assessments and six-month summaries, plus daily attendance records. Suspected abuse must be reported to the county DHR right away. Medicaid waiver participants must have a written plan of care before any paid service and get at least 10 days notice before waiver services are cut or ended.
Who can enroll. DHR clients are referred by the county DHR office. A center that turns down a referral must tell the referring county DHR social worker in writing. E&D Waiver participants must meet nursing facility level of care. Under rules 560-X-36-.02 and -.06, the case manager completes an initial assessment with the physician, a written plan of care is in place before any paid service, and eligibility is redetermined every year with certification by an Alabama-licensed physician. ADSS handles assessments and redeterminations.
Participant record (DHR). Each record must include:
Attendance. DHR contract centers must keep daily attendance records and a written weekly activity plan. Missing records can lead to a payment adjustment or loss of the contract.
Abuse reporting. Suspected abuse, neglect or exploitation must be reported immediately to the county DHR by phone or in person, with a written report within five days.
Notice and appeals. Under rule 560-X-36-.08(2), E&D participants get at least 10 days notice before waiver services are ended, suspended or reduced, and they may appeal. This is a program-level protection, not a center discharge rule.
Record retention. E&D providers must keep records that fully show the extent and cost of services for five years and make them available to Medicaid and state and federal officials (560-X-36-.07(1)).
What we did not find. We did not find center discharge reasons or notice periods, a required physician order or TB test for participants, required enrollment agreement contents, a DHR record retention period, or rules for reporting falls and other incidents beyond abuse. Families should ask the center for its written admission, discharge and fee policies, and operators should ask DHR or ADSS what they expect.
Alabama Medicaid pays for adult day health mainly through the Elderly and Disabled (E&D) Waiver, which pays by the day for at least 4 hours of service. There are two services with two rates, one when the center provides transportation and a lower one when it does not. Adult day health is also a covered service of the Alabama Community Transition (ACT) Waiver.
E&D Waiver. The E&D Waiver (AL.0068.R08.00) is a 1915(c) waiver overseen by the Alabama Medicaid Agency and operated by ADSS through the Area Agencies on Aging. Case management is provided through the Alabama Select Network under a separate 1915(b) waiver. ADSS describes the waiver on its Medicaid waiver programs page and notes that adult day services are available in some areas.
Transportation. Transportation is not billed separately. It is built into the higher with-transportation daily rate.
ACT Waiver. Rule 560-X-44-.04(10) lists adult day health as an ACT Waiver service, provided in facilities that meet the minimum standards for adult day health centers. We did not find the ACT billing unit or rate, so ask the Alabama Medicaid Agency.
Attendance documentation. For Medicaid billing, each day needs at least 4 hours of service and must match the care plan and service authorization. We did not find a Medicaid rule requiring an electronic sign-in or sign-out for adult day. DHR contract centers must keep daily attendance records as part of their contract documentation.
Yes. Because Alabama does not license adult day centers, a center that serves only private-pay participants has no state adult day license to get. DHR and Medicaid standards apply only to centers that serve those programs' clients. Local business, fire and health permits still apply.
What we did not find. We did not find a state rule limiting what a private-pay center may do, such as personal care, nursing tasks or giving medications. General nurse practice laws and local permits likely apply, but we did not confirm them. We also did not find consumer protections for private-pay participants, such as required contract terms or fee disclosure. Ask your city or county about permits and the Alabama Board of Nursing about nursing tasks before you open.
DHR-funded care. DHR buys adult day care for adults at risk of abuse, neglect, exploitation or institutionalization. Its 2025 RFP offered 340 full-time slots with transportation, 15 full-time without, 44 part-time with and 8 part-time without, for contracts from October 1, 2025 to September 30, 2028. The RFP does not publish a daily rate; vendors propose a budget rate. DHR programs must be available regardless of race, color, sex, national origin or disability.
Other funding. ADSS runs Alabama CARES, a caregiver support program that offers respite among its core services through local Area Agencies on Aging, but its page does not say whether respite can be provided at an adult day center. We did not confirm whether Older Americans Act funds pay for adult day in Alabama, and we did not find a primary source showing the U.S. Department of Veterans Affairs buying adult day health care from Alabama centers. Your local Area Agency on Aging, through AGE-LINE at 1-800-243-5463, or your local VA medical center can tell you what is available.
The market. We did not find a count of adult day centers in Alabama, because no state agency licenses them. We also did not find a statewide adult day association.
As of our last check on October 21, 2026, we did not find an announced change to Alabama's adult day rules or Medicaid adult day payment. One date is on the horizon: the current approval of the Elderly and Disabled Waiver ends September 30, 2027, so a renewal is due to take effect October 1, 2027. No renewal draft had been published.
Leave your email and we will let you know when Alabama changes its adult day licensing, staffing or Medicaid rules. No newsletter, only changes for this state.
Questions about Alabama adult day rules are best put to the state. Start with ADSS Medicaid waiver programs. The state lists this contact: ADSS AGE-LINE 1-800-243-5463, ageline@adss.alabama.gov.
Alaska, Colorado, Connecticut, District of Columbia, Idaho, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, New Jersey, New York, North Dakota, Ohio, Oregon, South Dakota, Vermont, Washington, West Virginia, Wisconsin. See every state on the adult day services map.
This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.
Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.
There's a lot to learn about Adult Day Care and the opportunity that it presents both for entrepreneurs, and for families. Below are some frequently asked questions, but you are also welcome to learn more by filling out the form on the right.
No. Adult day is not among the facility types the Alabama Department of Public Health licenses, and DHR's 2025 adult day RFP states there are no licensure requirements. To serve clients funded by DHR or the Medicaid waivers, you must meet that program's standards and be approved by the agency that contracts for the service.
The difference comes from who pays, not from a license. Adult day care is bought by the Department of Human Resources for adults at risk of abuse, neglect, exploitation or institutionalization. Adult day health is a Medicaid waiver service, delivered for at least four hours a day, that includes health education, self-care training, therapeutic activities and health screening.
The only ratio we found is in DHR's contract standards. Besides a program director, DHR requires one direct care staff for 1 to 10 enrolled participants, two for 11 to 25, three for 26 to 35, four for 36 to 43, and one more for each 8 additional participants, with at least two staff on site whenever participants are present. The Medicaid E&D Waiver sets no ratio.
The Elderly and Disabled Waiver pays adult day health by the day, and each billed day needs at least four hours of service. There is a higher rate when the center provides transportation and a lower one when it does not. Rates are set by the Alabama Department of Senior Services, and the days authorized must appear on the participant's care plan and service authorization.
The E&D Waiver requires an Alabama business license for the provider, a director with at least a high school diploma, nurses licensed by the Alabama Board of Nursing, and at least six hours of in-service training a year for every worker. Staff must follow Medicaid's TB testing policy, and ADSS and the Area Agencies on Aging check qualifications at contract signing and every year.
Yes. Alabama has no adult day license, so a private-pay center does not need one, and the DHR and Medicaid standards apply only to centers serving those programs. Local business, fire and health permits still apply, and we did not find state rules on what a private-pay center may or may not do.
We did not find any. No Alabama layer sets a separate staffing ratio for participants with dementia, and there is no dementia-specific adult day license. Families should ask a center how it staffs and plans activities for people with dementia.
Under DHR's adult day care standards, program staff must not administer medications. Medicines must be stored locked and away from toxic chemicals, and an LPN or RN must be available for monthly health screening of each participant.
