Adult Day Care in California

All states: adult day services map

California adult day services at a glance

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

How is adult day care regulated in California?

California has two separate adult day licenses run by two different departments. The California Department of Social Services (CDSS) licenses Adult Day Programs, which are nonmedical. The California Department of Public Health (CDPH) licenses Adult Day Health Care (ADHC) centers, which are health facilities that must provide nursing, therapy and social work. Medi-Cal, the state Medicaid program, pays for adult day health care through Community-Based Adult Services (CBAS), and the California Department of Aging (CDA) certifies the ADHC centers that provide it.

Four layers of rules can apply, each from a different agency:

• Licensing for Adult Day Programs (CDSS). The Adult Day Programs regulations, Cal. Code Regs. tit. 22, sections 82000 to 82095.5, adopted under Health and Safety Code 1500 and following. An Adult Day Program is a community-based program that provides nonmedical care and supervision (22 CCR 82001). These rules apply whatever the payer.
• Licensing for Adult Day Health Care (CDPH). The Adult Day Health Centers regulations, Cal. Code Regs. tit. 22, sections 78001 to 78609, under the California Adult Day Health Care Act (Health and Safety Code 1570 to 1596.5). An ADHC center must provide therapies, medical, nursing, nutrition, psychiatric or psychological, social work, planned activities and transportation services (22 CCR 78301). These rules also apply whatever the payer.
• Medicaid (DHCS and CDA). CBAS is a Medi-Cal benefit run by the Department of Health Care Services (DHCS), CDPH and CDA under an interagency agreement, and authorized under the CalAIM Section 1115 demonstration (CDA program authority). The Medi-Cal ADHC regulations (Cal. Code Regs. tit. 22, sections 54001 to 54507) add staffing, hours, care planning and billing rules. CDA also runs the Multipurpose Senior Services Program (MSSP), a 1915(c) waiver that can purchase adult day care.
• Other funding. CDA lists Area Agencies on Aging, Regional Centers (for people with developmental disabilities) and the U.S. Department of Veterans Affairs as payers. We did not review their contract standards.

Dementia programs. An Alzheimer's Day Care Resource Center (ADCRC) is a specialized dementia program that runs inside a licensed Adult Day Program or ADHC center. It is not a separate license. CDA notes the ADCRC program lost state funding in 2009 (Cal-COMPASS).

Which layer is stricter. ADHC centers, under CDPH licensing plus the Medi-Cal and CBAS standards, carry the heavier rules on services and professional staff. For general direct care staffing, the CDSS Adult Day Program ratio of 1 to 8 is the tightest number.

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

Yes. Anyone who operates or advertises an Adult Day Program needs a CDSS license, and anyone who operates or advertises an Adult Day Health Care center needs a CDPH license, whoever pays. CDSS says an Adult Day Program application takes 90 to 120 days. An ADHC center that wants to serve Medi-Cal members also needs CBAS certification from CDA, which CDA says can take 18 to 24 months.

Adult Day Programs (CDSS). The license rule and its exemptions are in 22 CCR 82005 and 82007. CDSS's Centralized Application Units page lays out the steps:

• Complete the online orientation. The certificate goes with your application.
• Submit form LIC 281 with the nonrefundable application fee and the LIC 9283 infection control plan.
• Meet one on one with a licensing analyst and complete category training.
• CDSS checks criminal record clearance, fire clearance, start-up funds, credit and compliance history, then makes a pre-licensing inspection.
• If your city or county requires a conditional use permit, get it first.

CDSS must approve or deny the application in writing within 90 days of accepting it, and it sets your licensed capacity based on fire clearance, activity space, available staff and your ability to comply (22 CCR 82028).

Adult Day Health Care (CDPH). Initial and change of ownership applications go to the CDPH Centralized Applications Branch, not the district office. Per the CDPH application checklist, the packet includes form HS 200, proof of local building code compliance or a certificate of occupancy, a fire safety inspection request (STD 850), a staffing and services form, a balance sheet current within 90 days, a one-year monthly cash flow forecast, an operating budget, a service area map and a floor plan with square footage. CBAS applicants also include a CDA pre-screening approval letter. PACE organizations apply for this same license without that letter. Sharing space with an Adult Day Program needs a separate proposal form. All ADHC centers must be on the first floor (22 CCR 78503).

The ADHC regulation also calls for a public hearing when a center is first proposed, after review by the Adult Day Health Care Review Committee and the county Adult Day Health Planning Council (22 CCR 78209). This step is not on the current CDPH checklist, so ask CDPH whether it still applies.

CBAS certification (CDA). To become a new CBAS provider, you complete CDA pre-screening (a program plan, two online training modules and contact with local Medi-Cal managed care plans about need), then a four-part initial certification application. You need an ADHC license or a pending CDPH application, and CDA finalizes certification only after licensure. CDA advises checking first whether local plans are contracting with new centers.

Fees. The CDPH annual license fee for an Adult Day Health Center is $8,830 per facility statewide for both 2025-26 and 2026-27, with no Los Angeles County supplement (CDPH license fees). Adult Day Program fees are set in Health and Safety Code 1523.1: an application fee based on capacity, an annual fee due on each license anniversary, and fees for capacity changes and relocation, all nonrefundable. We did not find the current Adult Day Program fee amounts, so ask CDSS.

Certificate of need. We did not find a certificate of need or a moratorium for either model. CDA does note that managed care plans may not be contracting with new CBAS centers in every area.

One license per site and changes. For an Adult Day Program, a new application is required for a change of location, a change of licensee (including a sale or transfer of a majority of corporate stock, or a merger), most capacity increases, and a permanent change of a client to non-ambulatory status. Changes of corporate chief executive officer are reported within 10 working days (22 CCR 82034). An ADHC license cannot be transferred. The licensee gives CDPH written notice at least 30 days before a change of ownership, and the new owner applies for a new license. An ADHC license moves to a new site only after accidental destruction or a similar emergency (22 CCR 78225). A change of ADHC program director also needs a CDPH application packet with Live Scan, sent first to CDA for CBAS providers.

Renewal and inspections. An ADHC license runs one year and is renewed one year at a time, with the renewal application and fee due at least 30 days before it expires. CDPH inspects each center at least once a year (22 CCR 78229). CDSS may enter an Adult Day Program at any time, with or without notice, and inspects within 90 days after a license is issued. We did not find the current routine inspection frequency for Adult Day Programs.

Exemptions. The Adult Day Program license does not apply to health facilities, clinics, care by relatives, care by a close friend not run as a business, certain religious programs and similar facilities the CDSS Director names.

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

California Adult Day Programs need at least 1 direct care staff member for every 8 clients present, and at least 2 people on duty whenever 2 or more clients are present. ADHC centers follow a different formula: one-half program aide for every 8 participants, plus a licensed nurse on duty and required director, social work, therapy and dietitian staffing. We did not find a separate ratio for participants with dementia in any layer.

• Licensing, Adult Day Programs (CDSS): 1 direct care staff per 8 clients present, or fraction of 8 (22 CCR 82065.5). For clients who rely on others for all activities of daily living, the ratio is 1 to 4 for those clients if they are not Regional Center clients. For Regional Center clients, staffing follows what the Regional Center specifies. CDSS may require more staff based on client needs or building layout.
• Licensing, Adult Day Health Care (CDPH): one-half program aide for every increment of 8 in licensed capacity, which works out to about 1 aide per 16. A licensed nurse must be on duty whenever basic services are offered. Monthly therapy or psychological service hours run from 40 hours (10 or fewer average daily attendance) to 240 hours (51 to 60), and dietitian hours from 2 to 10 a month. Above a licensed capacity of 40, each additional 10 adds a half-time licensed vocational nurse (LVN) and a half-time social work assistant (22 CCR 78419).
• Medicaid (Medi-Cal ADHC and CBAS): on duty, a program director, a registered nurse with a public health background, a medical social worker, a program aide and an activity coordinator. Therapy, dietitian, LVN and social work assistant hours scale with the previous quarter's average daily attendance, and program aides are one-half aide per 8 in average daily attendance (22 CCR 54423). CDA's CBAS certification standards check these ratios and hours and that an administrator or program director is on site during program hours, but add no new numbers.
• Other funding: we did not find staffing standards from Area Agencies on Aging, Regional Centers or the VA.

Who counts toward the ratio. In Adult Day Programs, direct care staff are people who provide care and supervision at least 70 percent of program hours each month, or who supervise direct care staff. Time spent on clerical work, cooking, housekeeping or maintenance does not count, and clients never count as staff. The rules are not fully consistent on volunteers: 82065.5 lets volunteers count only if they meet the direct care staff definition, while 82065(c) says supervised volunteers are not counted in the staffing plan. In ADHC centers, volunteers may not replace required employees, and the Medi-Cal rules leave volunteers out of the staff ratio.

Directors. An Adult Day Program administrator must be at least 21 and have either a bachelor's degree in a human services field plus one year of human services management, or three years in human services (one in management) plus two years caring for the population served. Administrators complete 30 hours of continuing education every 24 months. An ADHC center needs a full-time program director who is a professional in nursing, social work, psychology, recreation, a therapy field, dietetics or gerontology. Centers with a capacity of 50 or more need both an administrator and a full-time program director (22 CCR 78415).

Nurses. ADHC centers must have a licensed nurse on duty, and Medi-Cal centers need a registered nurse. We did not find a nurse requirement for Adult Day Programs.

Training. Adult Day Program direct care staff need at least 8 hours of documented training each year under a written training plan, and all staff get on-the-job training in client care, medication assistance, emergency procedures and mandated elder abuse reporting. Staff who provide care must be at least 18. All ADHC staff must complete first aid and CPR training within their first six months (22 CCR 78413).

Background checks and health screening. In Adult Day Programs, people subject to criminal record review are fingerprinted through the California Department of Justice and the FBI and must be cleared or exempted before they start. Employees need a physician-supervised health screening with a negative TB test within one year before or seven days after starting, and volunteers need a good-health statement and a negative TB test. We did not find background check or TB rules for ADHC staff in the sections reviewed, so ask CDPH.

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

An Adult Day Program must provide supervision, personal care, planned activities and meals or snacks. An ADHC center must also provide nursing, medical, therapy, psychological, social work and nutrition services, plus transportation when needed. Medi-Cal ADHC centers must be open 6 to 12 hours a day, at least 5 days a week.

Activities. Adult Day Programs offer planned activities covering group interaction, daily living skills, physical activity, leisure time and special projects, with rest periods and a written activity plan, supervised by direct care staff (22 CCR 82079). Medications in Adult Day Programs are self-administered, with staff assistance.

Meals. In Adult Day Programs, meals meet USDA requirements. Clients in care under 8 hours may not go more than 3.5 hours without a meal or snack, and clients in care 8 hours or more get a midmorning snack, lunch and a midafternoon snack. Menus are written a week ahead and kept 30 days. In ADHC centers, participants there 4 or more hours get a meal with at least one-third of the recommended daily allowances, those there 8 hours get about one-half, and a dietitian reviews diet orders every 90 days (22 CCR 78319).

Transportation. Adult Day Programs that transport must use properly licensed drivers, stay within rated seating and keep vehicles safe, and the plan of operation must describe transportation for clients without their own (22 CCR 82074). ADHC centers must provide or arrange transportation to and from home when necessary (22 CCR 78343).

Hours. Medi-Cal ADHC centers must be open 6 to 12 hours a day, at least 5 days a week. New programs may run shorter schedules for up to six months. After that, fewer than 5 days or 6 hours needs written approval, and the floor is 4 hours a day and 3 days a week (22 CCR 54221). Adult Day Programs set their own hours in the plan of operation, and we did not find a minimum.

Space and capacity.

• Neither model's rules, in the sections we read, set square feet per participant. CDSS sets Adult Day Program capacity from fire clearance, activity space and staff.
• Adult Day Programs need one toilet and one handwashing facility for every 15 clients of licensed capacity, or fraction of 15, and a space for clients not taking part in activities.
• ADHC centers need a multipurpose room large enough for all participants, a secluded rest area with chaise lounges or beds, an isolation area, office and storage space, and accessible outdoor space (22 CCR 78505). We did not find an ADHC toilet ratio.
• Adult Day Programs may use delayed egress devices on exterior doors or perimeter gates with fire clearance approval and notice to CDSS, but they cannot replace staff, and fire and earthquake drills are then required at least every three months on each shift (22 CCR 82087.5).

Written policies. An Adult Day Program's plan of operation (22 CCR 82022) covers its purpose and goals, admission policies, services, hours, the client group served, a copy of the admission agreement, organization, staffing plan, staff training plan, building and grounds sketches, sample menus, transportation, a fee and refund policy, consultants and community resources, and family communication. It also needs an infection control plan (LIC 9283), an internal evaluation plan with an annual timetable, and a disaster and mass casualty plan with drills at least every six months and drill records kept one year. An ADHC center's plan of operation covers eight areas, including days and hours, participants, services, admission and discharge, assessment, staffing and training (22 CCR 78403). Its disaster plan is posted, kept current and reviewed each year by local fire and disaster authorities (22 CCR 78423), and a dated weekly staff schedule must be posted. Each Medi-Cal ADHC center also needs a utilization review committee, including professionals not employed by the center, that meets at least every quarter (22 CCR 54419).

What rules protect participants in California adult day centers?

Both models require a health assessment at enrollment and a written plan of care. Adult Day Programs need a signed admission agreement within seven days and must give two weeks' notice before most discharges. Records are kept at least three years for Adult Day Programs and seven years for ADHC centers.

Enrollment. An Adult Day Program needs a written medical assessment by a physician or licensed designee before acceptance or within 30 calendar days after. It can be no more than one year old and includes a TB and communicable disease exam. An ADHC participant is assessed before acceptance by a team of physician, registered nurse, social worker and occupational and physical therapists, with a physician's written health assessment, including TB screening, within 90 days, and a written plan of care signed by each team member (22 CCR 78303). For Medi-Cal, the center also needs a written physician request listing diagnoses, treatment, goals, medications and diet, and a signed agreement of participation.

Admission agreement. In Adult Day Programs, the agreement states basic and optional services, rates, who pays, due dates, refund and termination conditions, and the family involvement policy. It is signed within seven calendar days of admission, and basic rate changes need at least 30 days' written notice (22 CCR 82068).

Care plans. An Adult Day Program completes a Needs and Services Plan within 30 days of admission (before admission for clients with restricted health conditions) and updates it as needs change, with no fixed review interval (22 CCR 82068.2). Medi-Cal ADHC participants are reassessed at least every quarter with a reauthorization request (22 CCR 54215).

Discharge. An Adult Day Program may discharge a client it can no longer serve with at least two weeks' notice to the client, family and care providers. It may discharge right away after a sudden change in condition that endangers the client or others, with phone notice to CDSS by the next working day and written notice within seven days. Medi-Cal ADHC participants may leave at any time. The center may request discharge when a participant reaches maximum benefit or cannot or will not use services, and forwards the request to the state within five working days. No fixed notice period is set for Medi-Cal ADHC (22 CCR 54213).

Records. Adult Day Program client records are kept at least three years after service ends, and a confidential register of clients is kept on site. ADHC health records are kept at least seven years (22 CCR 78435). Medi-Cal centers report each participant's attendance day count with monthly billing. We did not find a daily attendance log or sign-in rule in the Adult Day Program regulations.

Incidents. Adult Day Programs report deaths, injuries needing treatment, AED use, unusual incidents, epidemics, poisonings, catastrophes and fires to CDSS by phone by the next working day and in writing within 7 days. Suspected physical abuse is reported to the ombudsman, CDSS and law enforcement within 2 hours if there is serious bodily injury, otherwise within 24 hours. ADHC centers report deaths, serious injuries and unusual incidents to CDPH and responsible persons by phone within 48 hours and in writing within 7 days, and epidemics to the local health officer and CDPH within 24 hours (22 CCR 78427).

How does Medi-Cal pay for adult day in California?

Medi-Cal pays for adult day health care through Community-Based Adult Services (CBAS), delivered mainly as a Medi-Cal managed care benefit at licensed ADHC centers that CDA certifies. Centers are paid per day of attendance, and a day counts only when the participant receives covered services at the center for at least 4 hours, not counting transportation. We did not find current CBAS rates or billing codes from a state source. MSSP can also purchase adult day care for some older adults.

Community-Based Adult Services (CBAS). CBAS began April 1, 2012, replacing the earlier Medi-Cal ADHC benefit, and is authorized under the CalAIM Section 1115 demonstration (DHCS CBAS page). Participants must be 18 or older, meet medical necessity and program criteria, and be eligible for Medi-Cal under a qualifying aid code. Medi-Cal managed care plans decide eligibility for their own members, and a small group of members outside managed care is covered fee-for-service. CDA reports 323 certified CBAS centers serving 28 counties, with about 41,722 participants in fiscal year 2024-25 and about 46,000 in 2025-26 (CDA CBAS program narrative).

• Billing unit: one day of attendance, at least 4 hours at the center excluding transportation (22 CCR 54113), paid only within the period approved for the participant.
• Rate: the Medi-Cal ADHC regulation sets an all-inclusive daily rate that includes meals and transportation (22 CCR 54501), but its rate table is long out of date. We did not find a current published CBAS rate, and the state does not publish managed care plan rates in any source we opened. Ask each plan you contract with what it pays.
• Billing codes: we did not confirm the CBAS billing codes from a state source. Check the Medi-Cal provider manual and each plan's billing guide.
• Transportation: included in the daily rate, not billed separately, under 22 CCR 54501.
• Monthly billing: a monthly invoice, each participant's attendance day count and monthly service reports, due by the 15th of the following month (22 CCR 54507).

Attendance documentation. CDA's CBAS certification standards check that the center keeps attendance and billing records that show the 4-hour minimum was met, along with transportation records and staff time sheets. CDA does not describe regular center-based CBAS days as needing electronic sign-in. Its electronic visit verification guidance covers only CBAS Emergency Remote Services delivered in a participant's home or community. We did not find managed care plan attendance rules from a state source, so ask each plan.

Multipurpose Senior Services Program (MSSP). CDA runs MSSP, a 1915(c) waiver approved for July 1, 2024 to June 30, 2029, through 37 local sites. It serves Medi-Cal members aged 60 and older who are certifiable for nursing facility care, and adult day care is among the services it can purchase. We did not find the MSSP billing unit or rate for adult day care, so ask the local MSSP site.

Adult Day Programs and Medi-Cal. CDA lists Medi-Cal as a payer for ADHC centers (through CBAS) but not for nonmedical Adult Day Programs. MSSP is the one Medi-Cal route we found that can pay for nonmedical adult day care.

Can a private-pay adult day center operate in California without Medi-Cal?

Yes. Many California centers are private pay, but both licenses apply whoever pays. A nonmedical program needs a CDSS Adult Day Program license and a medical-model center needs a CDPH ADHC license. Medi-Cal standards apply only to centers certified for CBAS.

Unlicensed programs. The license applies to anyone who operates or advertises an Adult Day Program, with narrow exemptions such as care by relatives or by a close friend not run as a business (22 CCR 82005). CDPH tells an unlicensed adult day health center to stop operating or apply for a license within 15 days (22 CCR 78203). We did not find a list of services an unlicensed program may not provide.

Protections for private-pay participants. In Adult Day Programs, the admission agreement must state rates, who pays, due dates and refund conditions, and basic rate changes need at least 30 days' written notice. The plan of operation must include a fee and refund policy. We did not find a rule barring discrimination by payment source.

Other funding. CDA's adult day services comparison lists these payers:

• Adult Day Programs: private pay, Regional Centers, Veterans Affairs and Area Agencies on Aging.
• ADHC centers: Medi-Cal (for people who meet CBAS criteria), private pay, Regional Centers and Area Agencies on Aging.

The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical and community care rules, at VA medical centers, State Veterans Homes or community organizations, sometimes with a copay. We did not review Older Americans Act contract standards or Regional Center vendor standards for adult day. Your local Area Agency on Aging or Regional Center can tell you what it funds.

The market. CDPH's 2026-27 license fee table counts 336 licensed Adult Day Health Centers, not counting state facilities (undated table, checked October 21, 2026). That count does not include CDSS Adult Day Programs, and we did not find a dated count of those. The California Association for Adult Day Services (CAADS), founded in 1977, is the state association.

What is changing next for adult day in California?

The federal approval behind CBAS, Medi-Cal's adult day health benefit, runs through December 31, 2026. A renewal has been submitted to CMS and is not yet confirmed. As of our last check on October 21, 2026, we could not confirm whether the renewal is approved or whether CBAS terms change in 2027.

• CalAIM 1115 renewal (not final). CBAS is authorized under the CalAIM Section 1115 demonstration, approved from December 29, 2021 through December 31, 2026. State listings describe a five-year renewal request, covering 2027 to 2031, sent to CMS in May 2026. We could not open the DHCS or CMS documents to confirm its status or any CBAS changes. Operators should watch the DHCS CBAS page and CDA notices, and ask their managed care plans.
• Updated Adult Day Program regulations, July 14, 2026. CDSS posted an updated Title 22 Adult Day Programs regulation file dated July 14, 2026. The staffing ratio, staffing, training, admission, discharge, records and toilet sections match the earlier text. We did not identify what the update changed, so ask CDSS if you need to know.

California adult day sources

• CDSS: Adult Day Programs regulations, Title 22 sections 82000 to 82095.5 (July 14, 2026 file)
• CDSS: Adult and Senior Care Centralized Application Units
• CDPH: Adult Day Health Center Initial and Change of Ownership Application Checklist
• CDPH: Health Care Facility License Fees
• 22 CCR 78419: Adult Day Health Center staffing
• 22 CCR 54423: Medi-Cal Adult Day Health Care staffing
• 22 CCR 54113: Medi-Cal day of attendance
• DHCS: Community-Based Adult Services (CBAS)
• CDA: Become a New CBAS Provider
• CDA: Adult Day Services Programs

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• Simplifying Payments with Electronic Billing for Adult Day Care
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Effective Transportation Tracking for Elder Day Centers
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states that license or certify every adult day center

Delaware, Florida, Georgia, Hawaii, Iowa, Kansas, Maine, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Wyoming. 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.