Adult Day Care in Arkansas

All states: adult day services map

Arkansas adult day services at a glance

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

How is adult day care regulated in Arkansas?

Arkansas licenses two kinds of centers, adult day care (ADC) and adult day health care (ADHC), under two separate sets of rules. Both licenses come from the Office of Long Term Care (OLTC), part of the Arkansas Department of Human Services (DHS) Division of Provider Services and Quality Assurance (DPSQA). Arkansas Medicaid pays for both through the ARChoices in Homecare waiver, and PACE also runs adult day centers in several parts of the state.

Three layers of rules can apply to an Arkansas center, and each comes from a different part of DHS:

• Licensing (OLTC). The Rules for Adult Day Care Providers in Arkansas (Ark. Admin. Code 016.25.22-005, revised June 1, 2022) and the Rules for Adult Day Health Care Providers (Ark. Admin. Code 016.06.06-059). Both are adopted under the long-term care facility licensing law, Ark. Code Ann. 20-10-201 and following, and apply whatever the payer.
• Medicaid (DHS Division of Medical Services and Division of Aging, Adult and Behavioral Health Services). The ARChoices in Homecare provider manual sets who can get adult day paid by Medicaid, how it is billed and what records support each claim. DPSQA certifies ARChoices providers. DHS also runs PACE, the Program of All-Inclusive Care for the Elderly.
• Other funding. We did not find adult day standards from the Older Americans Act, state general funds or the VA in Arkansas.

Adult day care is defined as care and supervision for 4 or more functionally impaired adults for more than 2 but less than 24 hours a day, somewhere other than their home. Adult day health care serves the same kind of group for the same hours, but adds an organized program of supportive health services, such as daily vital signs, injections and medication given by licensed nurses. It must have a full-time nurse as Health Care Coordinator and a tighter staff ratio. We did not find a separate dementia license in either rule set.

Where the layers overlap, the licensing rules are the stricter layer for how a center operates, and adult day health care is the stricter of the two licenses. ARChoices adds yearly provider certification, the federal home and community-based settings rules, an authorized service plan and its own billing and documentation rules.

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

Yes, in most cases. No adult day care or adult day health care facility may operate or admit clients without an OLTC long-term care facility license, whoever pays. The main exception is for small or part-week adult day care programs: one that serves 12 or fewer adults at any time, or serves clients 4 hours or less a day on no more than 2 days a week, is not a long-term care facility under state law and does not need the license.

That exemption comes from the long-term care facility definition in Ark. Code Ann. 20-10-101, which was written into the adult day care rules effective May 30, 2022. We did not find the same exemption in the adult day health care rules. An exempt program also cannot bill ARChoices, which pays only licensed facilities.

How to apply. Apply to OLTC and pay the fee in advance. No clients may be admitted until the license is issued. For adult day health care, the rules list what an initial application needs:

• Floor plans with measurements.
• A zoning letter from the city or county.
• Letters from a licensed electrician and a licensed plumber saying the building meets code.
• A health department letter if the site uses a well or septic tank.

OLTC does a life-safety survey before a new adult day health care facility admits clients. We did not confirm the full document list for an adult day care application, so ask OLTC.

Fees. The license fee is $5.00 per licensed slot, for both adult day care and adult day health care. It is paid in advance for a first license, each renewal and relicensure after a change of ownership, and is refunded if no license is issued. Fees received after June 1 carry a 10 percent penalty.

Certificate of need. We did not find a certificate of need requirement or a moratorium in either set of adult day rules.

One license per site. Each license states a number of slots, and a center may not serve more clients than that. Facilities on separate premises need separate licenses, even under the same management, while several buildings on land that touches can share one license. Licenses cannot be moved to another owner or another site.

Buying a center. Under the adult day care rules (204.7, 205.1 and 205.2), the buyer must file a new application and fee at least 30 days before the sale closes and pass an inspection, and the seller must tell OLTC in writing at least 30 days before the change. The buyer takes on the fixes for any earlier deficiencies, though not civil money penalties.

Renewal and inspections. Licenses run July 1 to June 30 and are renewed every year. The renewal must be delivered or postmarked by June 1, and a license that is not renewed is void after June 30. To get or keep a license, a center must allow unannounced inspections and complaint investigations. The rules do not set how often inspections happen. An adult day health care facility must send a plan of correction within 15 business days of getting a statement of deficiencies.

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

Arkansas licensing rules set two ratios. Adult day health care needs at least 1 full-time paid direct care staff member for every 5 clients. Adult day care needs 2 staff when 2 to 16 clients are present, plus 1 more for any part of each additional 8 clients. The ARChoices manual sets no ratio of its own, and we did not find a separate ratio for participants with dementia.

• Licensing, adult day health care: 1 full-time paid direct care staff per 5 clients (016.06.06-059, 303.8.1). OLTC may require more.
• Licensing, adult day care: 2 staff for 2 to 16 clients, then 1 more for any part of each 8 more clients. For example, 17 to 24 clients need 3 staff (rule 303.8.1). OLTC may require more.
• Medicaid (ARChoices): no ratio specified. Providers agree to keep adequate staffing, train staff before they deliver services and send someone to one of the two DHS provider workshops each calendar year.
• Other funding: we did not find staffing standards from any other funding source.

Who counts toward the ratio. Secretaries, accountants and other staff who do not give direct care do not count, except that one may count during an emergency when a direct care worker has to leave. In adult day care, trained volunteers with the same qualifications as the position may count. Any staff member on duty may count while doing housekeeping, laundry or dietary work if universal precautions are followed. An executive director who is responsible for more than the adult day program does not count. Substitutes must be used to keep the ratio when staff are out.

Director. An adult day care center licensed for more than 15 clients needs a full-time Program Director who is at least 21, has one year of human services experience, supervisory and administrative ability, a current health card, and knowledge of aging and activity programming. The Director must also pass a criminal background check.

Nurses. Adult day health care must have a full-time Health Care Coordinator who is a nurse licensed in Arkansas, and an LPN in that role must be supervised by an RN. A center of 15 or fewer clients may combine the Director and Health Care Coordinator roles if one person meets both sets of qualifications. We did not find a nurse requirement for adult day care, or nurse hours that grow with census.

Qualifications and training. Personal care staff must be at least 18, have a current health card, and have finished a nurse aide, personal care technician or home health aide course. Direct care staff need 16 hours of in-service training a year, 4 each quarter, covering client rights, safety, abuse reporting, aging, communication and dementia. Staff who do not give direct care, and part-time staff, need 8 hours a year.

Background checks. Before hiring, centers must check the OLTC Employment Clearance Registry and the Adult Abuse Registry, then recheck every employee every 5 years. Centers must also document criminal background checks under Ark. Code Ann. 20-33-201 and following.

Health screening. Staff need a current health card. We did not find a separate vaccination requirement, so ask OLTC what the health card must show.

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

Every licensed Arkansas center provides help with daily activities, a posted monthly activity schedule, meals and snacks, and at least 40 square feet of space per participant. Adult day health care adds daily health checks and nursing services. Transportation is optional, but it comes with rules if you offer it.

Adult day care services. Under the adult day care rules (501 and 502), centers help with walking, toileting, eating, grooming, dressing and other daily activities, help with special diets, give health counseling as needed and minor first aid, and arrange specialized services. A monthly group activity schedule with exercise, recreation and social activities must be posted.

Adult day health care services. Adult day health care must also provide daily vital signs and hygiene checks, monthly weights, a dental screening every 6 months, injections by licensed staff as ordered, weekly health education, and medication given by licensed nurses for clients who cannot take their own.

Meals. Licensing requires balanced meals and between-meal snacks to be available, with drinking water at all times, weekly menus posted and a record of meals served for the past month. ARChoices adds its own rule: a participant present more than 20 units (5 hours) must be served a meal equal to one-third of the recommended daily allowance, and anyone present when lunch is served between 11:00 a.m. and 1:30 p.m. must get it.

Transportation. If a center offers transportation, drivers need a valid Arkansas license, vehicles need liability insurance, all clients wear seat belts, wheelchair vans need locking devices, and any charges must be disclosed in advance.

Space and capacity. Under rules 601 and 611:

• At least 40 square feet per participant, not counting offices, bathrooms, storage, or dining rooms unless the dining room is also used for activities.
• Adult day care space and bathrooms may not be shared with another program in the same building, such as child care.
• One room where all clients can gather, and a quiet rest room with full-height walls, a latching swinging door and a bed with clean linens, used for nothing else.
• At least one toilet and washbowl for each 10 clients, plus one more for each 5 clients over 10, with at least one accessible toilet room, grab rails, and hot water between 100 and 115 degrees F. The rule's own example (4 toilets for 35 slots) does not match a literal reading of this formula, so confirm your count with OLTC.

Hours. Programs run more than 2 hours a day, and the written program description must state the days and hours of operation. We did not find a minimum number of days a week a center must be open.

Written policies. Centers must write, follow and make available for public inspection policies on client care, admission, discharge, incident and abuse reporting, client rights, fire safety, smoking, emergency treatment, medication storage and administration, and emergency relocation for fires, disasters or utility outages, along with written personnel policies (rule 303.1). We did not find a required schedule for reviewing these policies.

Safety and postings. Clients and staff take part in quarterly fire drills, disaster and tornado drills are held at least once a year, and staff safety training is held twice a year. Drill and fire equipment check records are kept for 12 months. The license and a summary of the clients' bill of rights must be posted, and adult day health care facilities must also post their latest statement of deficiencies.

What rules protect participants in Arkansas adult day centers?

Arkansas rules require a signed admission agreement that lists all charges, a written care plan within 5 days of attendance, reviewed at least every 6 months, and 30 days written notice before most discharges. Records are kept for 5 years, and suspected abuse must be reported to OLTC by 11:00 a.m. the next business day.

Who can enroll. Adult day care clients must be functionally impaired adults with a current medical history, and a written plan of care is required for anyone on an approved waiver. People who are bed-fast, cannot take their own medications, or whose behavior is a hazard cannot be served in adult day care. Adult day health care clients need a written physician recommendation for adult day health care, a current medical history and a written plan of care, and bed-fast clients and those whose behavior is a hazard are not eligible.

Admission agreement. Under the adult day care rules (401.1.1), each client signs an agreement listing all charges and the maximum monthly, weekly, daily or hourly rate. The center may not add charges that are not listed, must give 30 days written notice of rate changes, and must refund advance payments on a pro-rata basis.

Care plan. A written care plan is developed within 5 contact days (days the client actually attends) of entry. It lists the scheduled attendance days with arrival and departure times and is reviewed at least every 6 months and whenever the client's condition changes. For ARChoices participants, services can start only after the center receives the person-centered service plan authorized by the DHS nurse, and that plan expires 12 months after eligibility is approved.

Discharge. A client may be discharged only for listed reasons: the center cannot meet the client's needs, the client's health has improved, the client no longer benefits, others' health or safety is in danger, nonpayment after notice, or the center is closing. Written notice is due 30 days before discharge except in emergencies. The client may appeal to the Director within 7 calendar days, and a hearing is held within 14 days.

Records. Client records are kept on site for 5 years, or longer if an audit or lawsuit is pending, and must be produced within 24 hours of an official request (rules 307.4 and 308.3). Activity records are kept for 3 months and drill records for 12 months. We did not confirm a separate ARChoices record retention period.

Incidents. Suspected abuse, neglect, sexual abuse, misappropriation of property or exploitation must be faxed to OLTC on Form DMS-731 by 11:00 a.m. the next business day, followed by Form DMS-742 by the end of the fifth working day (rule 305). Other incidents need an internal written report within 5 days, kept for 3 years. ARChoices providers must also report any change in a participant's status right away to the DHS nurse on Form AAS-9511.

What we did not find. We did not find a participant TB screening or physical exam requirement for adult day care. Families should ask the center for its written admission, discharge and fee policies.

How does Medicaid pay for adult day in Arkansas?

Arkansas Medicaid pays for adult day through the ARChoices in Homecare waiver, a 1915(c) home and community-based services waiver. Centers bill code S5100 in 15-minute units, with the TD modifier for adult day health services, and must provide at least 2 hours a day to bill. PACE also covers adult day center care for eligible people in its service areas.

ARChoices in Homecare. The waiver is run by the DHS Division of Medical Services and the Division of Aging, Adult and Behavioral Health Services. It serves adults 21 to 64 with a physical disability and people 65 and older who need an intermediate nursing facility level of care. To bill, a center must hold the OLTC adult day care or adult day health care license, meet the federal home and community-based settings rules and recertify with DPSQA every year (ARChoices Provider Manual 213.510 and 213.610).

• Adult Day Services: S5100 U1 for 8 to 20 units a day, and S5100 with no modifier for 21 to 40 units a day. $2.47 per 15-minute unit for both on the ARChoices fee schedule.
• Adult Day Health Services: S5100 TD U1 for 8 to 20 units a day, and S5100 TD for 21 to 40 units a day. $3.14 per unit. This service fits only participants whose care plan calls for rehabilitative therapies, medication supervision, diagnostic evaluation or health monitoring, and it cannot be billed on the same day as Adult Day Services.
• Limits: 8 to 40 units (2 to 10 hours) a day, up to 200 units a week and 920 a month. Fewer than 8 units in a day cannot be billed.
• Other services that day: a participant who attends more than 5 hours cannot also get attendant care or a home-delivered meal that day without nurse approval.
• Respite: adult day health facilities may also bill facility-based respite under ARChoices (S5135 short term, T1005 long term).

Transportation. We did not find whether ARChoices pays for transportation to adult day separately, so ask DHS.

PACE. PACE serves people 55 and older who meet nursing facility level of care and live in a PACE service area. It is paid a set amount per member, so adult day is not billed by the unit. Arkansas PACE organizations are Washington Regional (Springdale), St. Bernards Total Life Healthcare (Jonesboro), Baptist Health PACE (North Little Rock and Hot Springs) and Wellquest River Valley PACE (Barling), each covering listed counties.

Attendance documentation. ARChoices requires adult day and adult day health providers to keep a daily attendance log (manual 213.500 and 213.600). Every billed service must be backed by the service plan, a description of the service, the signature and title of the person who provided it (an electronic PIN may be used) and the date and actual time it was provided. Entries may not be made in pencil, and missing records can lead to the state taking payments back. We did not find a required electronic attendance system for adult day.

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

Yes. A center can be fully private pay, but it still needs an OLTC license unless it is a small or part-week adult day care program that falls under the exemption. The license rules apply whatever the payer. For example, the Boone County Adult Day Center in Harrison is a licensed adult day care with all 22 slots listed as private pay.

Unlicensed small programs. An adult day care program that serves 12 or fewer adults at a time, or 4 hours or less a day on no more than 2 days a week, does not need a license. We did not find a rule that limits what such a program may do, such as hands-on care or medication help, and it cannot bill ARChoices. Ask OLTC before you plan services around the exemption.

Protections for private-pay participants. Licensed centers must give every client a written admission agreement listing all charges and the maximum rate, give 30 days notice of rate changes, refund advance payments pro rata, and post and explain client rights. We did not find a rule on discrimination by payment source.

Other funding. We did not find Older Americans Act or state general fund standards for adult day in Arkansas, and we did not confirm VA adult day health care on a VA page for Arkansas. A DHS facility listing shows the Area Agency on Aging of Northwest Arkansas running the licensed Boone County center. Your local Area Agency on Aging or VA medical center can tell you what funding is available in your area.

The market. We did not find a published count of licensed adult day centers. DHS has a page for each facility and a long-term care facility map, but no total, so ask DPSQA. We also did not find an Arkansas adult day services association.

What is changing next for adult day in Arkansas?

As of our last check on October 21, 2026, we did not find an upcoming change to Arkansas adult day licensing rules or ARChoices adult day payment. The most recent changes are already in effect.

• PACE rule updates, September 1, 2026. DHS lists a PACE rate setting methodology state plan amendment and a PACE provider manual update as final rules effective September 1, 2026 (DHS rules page).
• Small program exemption, May 30, 2022. The adult day care rules were revised to exempt programs serving 12 or fewer adults, or 4 hours or less a day on 2 or fewer days a week, from the long-term care facility license.

Two things are worth watching. The adult day health care rules in the state code are dated 2006, while the adult day care rules were revised in 2022, and the only ARChoices fee schedule we found dates from 2022. Ask OLTC and DHS whether either is being updated.

Arkansas adult day sources

• Arkansas DHS: Rules for Adult Day Care Providers in Arkansas (R. 06/01/2022)
• Ark. Admin. Code 016.25.22-005: adult day care rules
• Ark. Admin. Code 016.06.06-059: adult day health care rules
• ARChoices in Homecare provider manual
• ARChoices fee schedule (run date 8/25/22)
• Arkansas DHS: PACE (Program of All-Inclusive Care for the Elderly)
• Arkansas DHS: proposed and final rules
• Arkansas DHS facility listing: Boone County Adult Day Center

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• Effective Transportation Tracking for Elder Day Centers
• Simplifying Payments with Electronic Billing for Adult Day Care
• 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

Arizona, 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.