Adult Day Care in Arizona

All states: adult day services map

Arizona adult day services at a glance

Last verified against state sources: 2026-10-21.

How is adult day care regulated in Arizona?

Arizona has one licensed adult day model, the adult day health care facility, licensed by the Arizona Department of Health Services (ADHS). There is no separate adult day care license, and state law uses "adult day care" and "adult day health" as one defined service. AHCCCS, the state Medicaid agency, pays for adult day health through ALTCS and relies on the ADHS license.

Three layers of rules can apply to an Arizona center, and each comes from a different agency:

• Licensing (ADHS). State law defines the adult day health care facility in A.R.S. 36-401(A)(4) and (5), and ADHS sets the standards in the Health Care Institutions licensing rules, 9 A.A.C. 10, Article 11 (R9-10-1101 to R9-10-1117), plus the general rules in Article 1. These rules cover the license, staffing, space, services, records and incidents for every licensed center, whatever the payer. The adult day health care facility is its own license class under R9-10-102(A)(18).
• Medicaid (AHCCCS). The Arizona Health Care Cost Containment System pays for adult day health through the Arizona Long Term Care System (ALTCS). Its rules for centers are in the AHCCCS Medical Policy Manual, AMPM Policy 1240-B, Adult Day Health Facilities, which adds community setting and member choice duties on top of the license.
• Other funding (DES). The Arizona Department of Economic Security, Division of Aging and Adult Services, lists adult day care among its nonmedical home and community based services for older adults and people with disabilities (A.R.S. 46-191). DES does not license adult day programs. The U.S. Department of Veterans Affairs also pays for adult day health care for some veterans.

State law defines adult day health services as planned care supervision and activities, personal care, personal living skills training, meals and health monitoring, provided for part of a day, for pay, on a regular basis, to 5 or more adults not related to the owner. Services may also include preventive, therapeutic and restorative health-related care. We did not find a separate dementia or social model license type.

Where the layers overlap, the ADHS licensing rules are the stricter layer for how a center is staffed and run. AHCCCS adds location, community integration and choice requirements for centers that serve ALTCS members, and requires a center that shares a building with an assisted living facility or skilled nursing facility to hold its own separate license.

Do you need a license to open an adult day center in Arizona?

Yes, if you will provide adult day health services to 5 or more unrelated adults for pay. ADHS issues the adult day health care facility license whether participants pay privately, through ALTCS or some other way. You apply online 60 to 120 days before you plan to open, with an architect's attestation on your building plans.

How to apply. Under state law and the ADHS rules:

• File the application at least 60 but not more than 120 days before your planned opening date (A.R.S. 36-422).
• Include a notarized attestation from a registered architect that your plans meet ADHS standards, and follow local building codes and ordinances (A.R.S. 36-421).
• State the number of participants you want to serve. That number, once ADHS authorizes it, is your licensed capacity (R9-10-1102).
• Submit everything electronically through the ADHS Licensing Management System. ADHS says paper forms are no longer accepted (ADHS Residential Facilities Licensing).
• If you will serve more than 15 participants, hold a food establishment license or permit, or contract with a licensed food establishment (R9-10-1114(D)).

Fees. Under R9-10-106 (amended April 15, 2022), the application fee is $50. The annual license fee for adult day health care is $280 plus $70 per unit of licensed capacity for capacity of 1 to 59, with higher base fees at 60, 100 and 150 or more. A $250 late fee applies to a late annual payment.

Certificate of need. We did not find a certificate of need requirement or a moratorium for adult day health care in the licensing statutes and Article 11 sections reviewed. Confirm with ADHS before you sign a lease.

One license per site. State law ties the license to a named location, and a change of address for a facility that provides health-related services on site needs a new application (R9-10-109). AHCCCS policy says a center co-located with an assisted living facility or skilled nursing facility must be licensed separately. We did not find a separate Article 11 statement about multiple sites, so ask ADHS if you plan more than one.

Buying a center. For a planned change of ownership, the current licensee must notify ADHS in writing at least 30 days before, and the new owner must file a new license application. ADHS decides whether an inspection is needed. Name changes, changes in hours of service and similar changes also need 30 calendar days written notice.

Renewal and inspections. An Arizona health care institution license does not expire. It stays valid unless it is revoked, suspended, or voided for unpaid fees or penalties (A.R.S. 36-425). ADHS must inspect at least once a year, but after a deficiency-free survey the next compliance survey is not done for 24 months.

What are the staffing rules for adult day centers in Arizona?

Arizona sets no staff-to-participant ratio for adult day health care. Instead, the licensing rules require at least 2 staff on site whenever 2 or more participants are present, a CPR and first-aid certified staff member at all times, and a nurse on site every day under a registered nurse's direction. Centers must also have enough qualified staff to meet participants' needs.

The staffing rules are in R9-10-1106.

• Licensing (ADHS): no ratio specified. At least 2 personnel on the premises whenever 2 or more participants are present, and at least 1 person with CPR and first-aid certification on the premises at all times.
• Medicaid (AHCCCS): no ratio specified. AMPM 1240-B adds no staffing or qualification rules and relies on the ADHS license.
• Other funding (DES): we did not find staffing standards for DES or Area Agency on Aging adult day contracts.

Dementia and higher needs. We did not find a dementia ratio or a rule that scales staffing with census. The rule requires enough qualified staff whenever participants are present to deliver the center's services, meet participants' needs and keep them safe.

Nurses. A registered nurse must manage nursing services and direct health-related services, and a nurse must be on the premises every day to give medications and treatments and monitor participants' health.

Administrator and staff. The administrator must be at least 21, with qualifications the governing authority sets in writing. When the administrator is away, a designated person aged 21 or older must be on site and accountable. Staff must be at least 18 and cannot be participants. Each center sets staff qualifications in its own job descriptions, based on its services and participants' needs.

Training. Article 11 sets no minimum training hours for aides. Orientation and in-service education follow the center's own policies. Staff other than a medical practitioner or RN must complete training with a skills demonstration, given by a medical practitioner or RN, before helping participants take their own medications (R9-10-1113).

Health screening. Staff, employees and volunteers with more than 8 hours a week of direct participant contact must show they are free of infectious tuberculosis by their start date.

Background checks. We did not confirm whether Arizona's fingerprint clearance law for health care workers (A.R.S. 36-411) applies to adult day health care staff. Ask ADHS which checks it expects before you hire.

Records. Personnel records must be kept for 24 months after a person leaves.

What does an adult day center in Arizona have to provide?

Every licensed Arizona center provides supervision, help with daily living and personal hygiene, planned therapeutic activities, nurse health monitoring and meals. Each center needs at least 40 square feet of indoor activity space per participant, an outdoor activity area, and a toilet and sink for every 10 participants. Transportation is not required by the licensing rules.

Services. Under Article 11 (R9-10-1113), required services include:

• Supervision, except when a participant is signed out.
• Help with activities of daily living and personal hygiene, as the care plan calls for.
• Planned therapeutic individual and group activities, including physical activity, group discussion, daily living skills, cognitive reinforcement, a participants' council and leisure.
• Nurse health monitoring, including monthly vital signs and nutrition checks.

Meals and activities. Menus are prepared a week ahead, posted a day before, kept 60 days, and follow federal dietary guidelines. Water must be available at all times, and a therapeutic diet needs a written order. A monthly activities calendar must be posted before the month begins and kept 90 days.

Space and capacity. Under R9-10-1117:

• At least 40 square feet of indoor activity space per participant, not counting bathrooms, halls, storage, kitchens, wall thickness and rooms used by non-participants.
• An on-site outdoor activity area with a hard-surfaced section for wheelchairs, shade and its own exit.
• At least one working toilet and one sink with running water for every 10 participants.
• Indoor temperature kept between 70 and 84 degrees F, and the building codes in effect when your plans were submitted to ADHS.

Hours. We did not find a minimum number of days or hours a center must be open, in the licensing rules or in AHCCCS policy.

Transportation. The licensing rules do not require a center to transport participants. For ALTCS members, AMPM 1240-B requires centers to help members use community transportation, including mobility and transportation training.

Medicaid setting duties. For ALTCS members, AMPM 1240-B requires centers to be located in the community among other homes and businesses, give members full access to the space, foster community interaction, support partial week or partial day attendance, offer meals and snacks at times members choose, and offer skill development.

Written policies. R9-10-1103 requires policies and procedures covering, among other things:

• Job descriptions, orientation and in-service education, and which staff must hold CPR and first-aid certification.
• Participant rights, complaints, identification, and sign-in and sign-out.
• Screening, enrollment and discharge, and the services in the center's scope of services.
• Medications (reviewed and approved by a pharmacist, medical practitioner or RN), response to out-of-control behavior, and emergency treatment.
• Medical records, a quality management program with incident reports, food services, environmental services, infection control and contracted services.

Policies must be available to staff and reviewed at least every 3 years, and documents must be given to ADHS within 2 hours of a request. The quality management program is reviewed at least every 12 months, and the administrator must help form a participants' council. AHCCCS adds a policy on managing members' personal funds so they can spend their money on outings and activities.

Safety. A disaster plan is reviewed every 12 months, disaster drills are held for staff on each shift every 3 months, and evacuation drills with participants are held every 6 months, with drill records kept 12 months. Evacuation paths must be posted in each hallway, and participant rights must be posted where people can see them.

What rules protect participants in Arizona adult day centers?

Before enrolling, each participant needs a medical assessment from their own practitioner dated within 60 days, a signed enrollment agreement, and a tuberculosis screening by 7 days after enrollment. A registered nurse completes an assessment within 30 days, and the care plan follows within 7 days. A center may discharge someone only for listed reasons, with 5 working days written notice.

Enrollment. Under R9-10-1107, the participant needs a signed medical assessment by their medical practitioner completed within 60 days before enrollment, and evidence of freedom from infectious tuberculosis before or within 7 days after enrollment. For ALTCS members, adult day health must be authorized by the member's case manager. ALTCS members who live in a behavioral health residential facility are not eligible, and members in assisted living need case manager and health plan prior approval.

Enrollment agreement. The written agreement must list:

• Enrollment requirements and the facility's own requirements.
• Customary services, and services at extra cost.
• Fees and charges.
• Termination procedures.
• Emergency contacts, and the facility's procedure for health care directives.

Assessment and care plan. An RN must complete a comprehensive assessment before the tenth visit or within 30 days of enrollment, whichever comes first. The care plan is due within 7 days after that assessment and must be reviewed at least every 6 months and whenever the participant's condition changes significantly (R9-10-1108).

Discharge. A center may discharge a participant with 5 working days written notice, and only for repeated failure to follow facility requirements, documented failure to pay, dangerous or disruptive behavior, or needs outside the center's scope of services. Discharge instructions must be given before discharge (R9-10-1109).

Attendance and records. The participant record documents whether the participant may sign in and out, the first visit date, services provided, progress notes, medications given, and injuries or significant changes. Electronic records need access safeguards and computer-clock time stamps. Medical records are kept under state law, which requires adult records to be kept at least 6 years after the last date of service (A.R.S. 12-2297).

Incidents. For an injury that may need medical care, the administrator must immediately notify the participant's representative and medical practitioner, report to Adult Protective Services when applicable, write a report the same day, investigate within 24 hours, and keep the report 12 months. Medication errors, refusals and adverse reactions must be reported within 12 hours and charted within 24 hours. We did not find a rule requiring incidents to be reported to ADHS itself, so ask ADHS what it expects.

Participant rights. Participants have a right not to be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status or diagnosis, and the center must help participants who do not speak English or who have a disability understand their rights.

How does Medicaid pay for adult day in Arizona?

AHCCCS pays for adult day health through ALTCS for elderly and physically disabled members who live at home, with case manager authorization. The fee schedule uses S5100 (15 minutes), S5101 (half day) and S5102 (per diem). Statewide fee-for-service rates effective January 1, 2026 are $4.18 per 15 minutes, $50.68 per half day and $101.33 per day.

ALTCS Elderly and Physical Disability (E/PD). ALTCS E/PD is managed long-term services and supports, run by AHCCCS through contracted health plans under Arizona's Section 1115 demonstration, approved through 2027. Mercy Care, Banner-University Family Care and UnitedHealthcare Community Plan held E/PD contracts that were extended through September 30, 2026. We did not confirm which plans hold contracts after that date, so check with AHCCCS. Arizona has no separate 1915(c) waiver for adult day.

Tribal ALTCS. AHCCCS also covers adult day health on a fee-for-service basis for Tribal ALTCS members, with case management by tribal contractors and Native Health. Claims go on the CMS 1500 form.

• Billing codes and units: S5100 per 15 minutes, S5101 per half day, S5102 per diem.
• Rates: $4.18 per 15 minutes, $50.68 per half day and $101.33 per day, effective January 1, 2026, from the AHCCCS HCBS rate public notice. Rates are higher in Flagstaff and Tucson zip codes. AHCCCS required its health plans to implement the increases. The preliminary notice for October 1, 2026 lists HCBS rates as unchanged. Ask each health plan you contract with what it pays.
• Who qualifies: members living at home who need supervision, help taking medication, recreation and socialization, or personal living skills training (AMPM 1240-B).
• Authorization: the member's case manager must authorize the service before you bill.

Transportation. We did not find whether transportation to adult day health is billed separately under ALTCS. Ask AHCCCS or the member's health plan.

Attendance documentation. For fee-for-service claims, AHCCCS matches each claim against the case manager's authorization on provider ID, member ID, dates of service, procedure code and units, and denies claims that do not match (FFS Provider Billing Manual, Chapter 21). The licensing rules require centers to record each participant's sign-in and sign-out status and the services provided. We did not find an electronic check-in requirement for adult day health in AHCCCS policy, and the ALTCS health plans' own provider manuals were not reviewed, so ask each plan you bill how it wants attendance documented.

Can a private-pay adult day center operate in Arizona without Medicaid?

Yes, a center can be fully private pay, but it still needs an ADHS license if it provides adult day health services to 5 or more unrelated adults for pay. Arizona's license requirement does not depend on whether the center takes Medicaid. We did not find a rule that allows an unlicensed program to serve private-pay participants.

Social-only programs. Arizona's rules do not say whether a purely social program, with no personal care or health monitoring, for 5 or more adults must be licensed. If you are planning that kind of program, ask ADHS in writing before you open.

Protections for private-pay participants. Every licensed center must give participants a signed agreement that lists fees and extra-cost services, keep a schedule of rates available on request, post participant rights, and follow the nondiscrimination rights listed in R9-10-1110. We did not find an explicit ban on treating participants differently by payment source.

Other funding.

• DES aging services. State law lists adult day care and adult day health among the Arizona Department of Economic Security's nonmedical home and community based services for older Arizonans and people with disabilities (A.R.S. 46-191). We did not find the contract standards for these programs. Your local Area Agency on Aging can tell you what is available in your region.
• Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical need, at VA medical centers, State Veterans Homes or community organizations where it is available, and a copay may apply. We did not find Arizona-specific VA adult day contracts.

The market. We did not find a published count of licensed adult day health care facilities in Arizona, or an Arizona adult day association. ADHS is the place to ask for a current list of licensed centers.

What is changing next for adult day in Arizona?

AHCCCS plans a new procurement for the ALTCS E/PD health plans that pay for adult day health, with proposals expected in fall 2026. No contract start date has been published. As of our last check on October 21, 2026, we did not find a pending change to the ADHS adult day licensing rules.

• New ALTCS E/PD health plan procurement (announced). AHCCCS ended its 2023 ALTCS E/PD procurement and has said it plans a new solicitation, with proposals anticipated in fall 2026 (AHCCCS notice). Existing E/PD contracts were extended through September 30, 2026. Timing and the plans chosen may change, so centers that contract with an E/PD plan should watch for AHCCCS updates.
• Section 1115 renewal (requested). The demonstration that covers ALTCS is approved through 2027, and AHCCCS has posted a renewal request for 2027 to 2032. Approval and its terms are not final.
• Rate increase, January 1, 2026 (in effect). AHCCCS raised fee-for-service adult day rates, including S5102 to $101.33 per day statewide. The preliminary notice for October 1, 2026 lists HCBS rates as unchanged.
• Licensing rules. The ADHS list of active rulemakings does not include adult day health care facilities (ADHS rules page).

Arizona adult day sources

• ADHS: Residential Facilities Licensing
• ADHS: 9 A.A.C. 10, Article 11, Adult Day Health Care Facilities
• A.R.S. 36-401: definitions, adult day health care facility
• Ariz. Admin. Code R9-10-1106: staffing
• Ariz. Admin. Code R9-10-106: license fees
• AHCCCS Medical Policy Manual 1240-B: Adult Day Health Facilities
• AHCCCS FFS Provider Billing Manual, Chapter 21: ALTCS Services
• AHCCCS HCBS rate public notice, effective January 1, 2026
• AHCCCS: ALTCS E/PD procurement termination notice
• A.R.S. 46-191: DES nonmedical home and community based services

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Adult Day Care Activity Ideas to Keep Clients Engaged
• Podcast: Adding Adult Day Services to Home Care Brings Synergy and Margins
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states where licensing depends on size, services or payer

Arkansas, Louisiana, Minnesota, New Hampshire, Virginia. See every state on the adult day services map.

Page history

• October 21, 2026: Page rewritten and checked against state sources.

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.