Adult Day Care in the District of Columbia

All states: adult day services map

District of Columbia adult day services at a glance

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

How is adult day care regulated in the District of Columbia?

The District of Columbia does not license adult day centers. Instead, programs are sorted by who pays. The Medicaid Adult Day Health Program (ADHP) is a medical model run under rules set by the Department of Health Care Finance (DHCF), and social-model adult day care (sometimes called geriatric or senior day care) is funded by grants from the Department of Aging and Community Living (DACL).

Three layers can apply to a DC adult day program, and each comes from a different agency:

• Medicaid (DHCF). 29 DCMR Chapter 97, Adult Day Health Program Services, sets who is eligible, what a provider must do to take part, staffing, services, records and payment. The ADHP offers medical supports and supervised therapeutic activities during the day in a community setting.
• Certificate of Need (DC Health). DC Health's State Health Planning and Development Agency (SHPDA) runs the Certificate of Need program under D.C. Code 44-401 and following. A Certificate of Need (CON) is a state approval to open a new health service. The Medicaid rule requires every ADHP provider to hold one.
• Grant funding (DACL). DACL, formerly the DC Office on Aging, funds social-model adult day care through grants. Those programs follow the terms of their grant, not a published rule. We did not find current grant terms.

DC Health's list of the facilities it licenses and certifies includes nursing homes, hospitals, home health agencies, assisted living and others, but not adult day programs. The Medicaid rule treats adult day care funded by the Older Americans Act as a separate service from the ADHP, and Medicaid will not pay for both at the same time (29 DCMR 9721).

Where the layers overlap, DHCF's Chapter 97 is the only detailed written standard, so it is the stricter layer for any program that bills Medicaid. We did not find a dementia-specific adult day model or standard in any layer.

Do you need a license to open an adult day center in the District of Columbia?

We did not find a DC license for adult day centers. If you want to be paid by DC Medicaid as an Adult Day Health Program, though, you must enroll with DHCF, pass an on-site Provider Readiness Review and hold a valid Certificate of Need from DC Health. DHCF then visits at least once a year.

Steps to become a Medicaid ADHP. Under 29 DCMR 9702, a provider must:

• Submit a Medicaid provider enrollment application under 29 DCMR Chapter 94 and meet every requirement in Chapter 97.
• Hold a valid Certificate of Need under the Health Services Planning Program Re-establishment Act of 1996 (D.C. Code 44-401 and following).
• Pass DHCF's on-site Provider Readiness Review, which looks at your service delivery plan, required policies, staffing and training plan, and whether your setting meets federal home and community based settings rules.
• Meet the network requirements of District Dual Choice, the plan for people with both Medicare and Medicaid, if you want to serve its members.

Insurance. ADHP providers must carry at least $1,000,000 per incident in blanket malpractice insurance, $1,000,000 per occurrence in general liability insurance, and product liability insurance where it applies (29 DCMR 9703.8).

Certificate of Need. DC Health says a CON is required before developing a new institutional health service or making certain capital spending, and applications are filed through its online portal. The CON law's list of health services includes medically supervised day care. We did not find CON fees, review timelines or thresholds for adult day, and we did not find a moratorium or cap on new ADHPs. Ask SHPDA before you sign a lease.

Each site counts separately. Each location of an ADHP is a separate site. To move, a provider needs DHCF approval through a new readiness review and must give 60 days' notice. A provider leaving the Medicaid program must give 90 days' notice and submit a transition plan at least 60 days ahead (29 DCMR 9703.6 and 9703.7).

Buying a program. Chapter 97 does not address a change of ownership. If you are buying an existing ADHP, ask DHCF early how enrollment, the readiness review and the Certificate of Need carry over.

Local permits. Chapter 97 does not mention a certificate of occupancy or fire permit. We did not check DC building and zoning rules, so confirm what your location needs with the District's permitting agencies.

What are the staffing rules for adult day centers in the District of Columbia?

For Medicaid Adult Day Health Programs, DHCF requires at least 1 Direct Support Professional for every 10 participants at Acuity Level 1 and 1 for every 4 participants at Acuity Level 2, the higher-need level. Only Direct Support Professionals count, and volunteers cannot be used or counted. There is no separate ratio for participants with dementia.

The ratio is in 29 DCMR 9704.2. A Direct Support Professional is the aide who gives hands-on help and supervision.

• Medicaid (DHCF): 1:10 at Acuity Level 1 and 1:4 at Acuity Level 2. The number of aides goes up with census and with each participant's acuity level.
• Licensing: no ratio specified, because there is no adult day license.
• Grant funding (DACL): we did not find current grant staffing terms. Ask DACL.

Required professional staff. On top of the aides, every ADHP must employ a full-time Program Director, a full-time registered nurse, a full-time activities coordinator and a full-time social service professional. It also needs a medical director who is a licensed physician and a licensed dietician or nutritionist, employed or under contract. In this rule, full-time means on site during all hours participants are present.

Qualifications. Under 29 DCMR 9704:

• Program Director: a bachelor's degree in a human services field plus 4 years working with older adults, a master's degree plus 1 year, or a licensed RN with 2 years.
• Registered nurse: a DC license and 2 years of experience with older adults.
• Activities coordinator: 1 year in a program serving older adults.
• Social service professional: a master's degree with 1 year or a bachelor's degree with 2 years in a listed field, plus DC licensure where required.
• Direct Support Professionals: 18 or older, a high school diploma or GED, able to read and write English at a fifth grade level, and current CPR and first aid.

Training. Staff get orientation and in-service training at least every quarter on infection control, plan of care development, abuse and neglect reporting, body mechanics, emergency evacuation, and the needs of older adults, including Alzheimer's disease and dementia. Direct Support Professionals complete 3 hours of continuing education each quarter and are trained on each participant's plan of care before helping that person.

Background checks and health screening. Direct Support Professionals must pass reference checks and a criminal background check under the DC Health-Care Facility Unlicensed Personnel Criminal Background Check Act. They also need a yearly physician statement that they are free of TB and communicable disease. We did not find other required vaccinations.

What does an adult day center in the District of Columbia have to provide?

A Medicaid Adult Day Health Program must provide nursing, therapeutic activities, counseling, personal care, medication administration and nutrition services, and coordinate transportation for off-site activities. Services are capped at 5 days a week and 8 hours a day. The rules also set minimum space per participant and tiered meal requirements based on hours attended.

Required services. Under 29 DCMR 9705.1, each ADHP provides:

• Nursing services.
• Individual and group therapeutic activities.
• Individual and group counseling for participants and their families.
• Personal care help supervised by the RN.
• Medication administration, assistance and counseling.
• Nutrition services.
• Coordination of transportation for off-site therapeutic activities.

Hours. ADHP services may not be given more than 5 days a week or more than 8 hours a day (29 DCMR 9721.5). Each program sets its own hours and days in its policies and participant agreement. We did not find a minimum number of days or hours a program must be open.

Meals. Meals are planned under a dietician or nutritionist and must include hot food. Participants who attend fewer than 3 hours get at least one meal or snack; 3 to 4 hours, one meal and one snack; and 5 to 8 hours, two meals and two snacks or one meal and two snacks (29 DCMR 9706).

Medications. Medications need a written order from a physician or advanced practice registered nurse and may be given only by a physician, RN or LPN. They must be stored locked, and a medication record must show who gave each dose (29 DCMR 9707).

Transportation. Non-emergency medical transportation, including trips to and from the program, is provided under DHCF's transportation contract or may be arranged by the program. It is not part of the ADHP daily rate.

Space. Under 29 DCMR 9708:

• Program space of at least 100 square feet for each of the first 5 participants and 80 square feet for each of the next 10. Offices, bathrooms, storage, exam rooms, food preparation areas and dining areas do not count unless they are also used for activities. The rule's wording for participants beyond the first 15 is unclear, so ask DHCF how it applies.
• One large room where all participants can gather, separate small group areas including a quiet rest area, and a private room with a bed or exam table.
• Enough ADA-compliant toilets for participants with disabilities. The rule sets no number per participant.
• Fire extinguishers and smoke and carbon monoxide detectors on each level, and a free private telephone for participants.

Written policies. Each provider needs a current organizational chart, a governing body that oversees policy, and written policies covering 18 topics (29 DCMR 9703.4), including:

• Mission, goals and the governing body's role.
• A fee schedule that shows what the Medicaid daily rate includes.
• Admission and discharge procedures, and how the person-centered plan of care is carried out.
• Participant rights and responsibilities, with contacts for complaint agencies.
• Hours and days of operation.
• Personnel, nutrition, site, health and wellness, and medication standards.
• Safety and emergency preparedness, quality assurance, incident and complaint handling, record keeping, a HIPAA compliance plan and a community outreach plan.

Providers must also post evacuation routes and train staff on evacuation. We did not find a required fire drill frequency or how often policies must be reviewed.

What rules protect participants in District of Columbia adult day programs?

For Medicaid Adult Day Health Programs, DC requires an assessment that authorizes the service, a recent physician or nurse practitioner medical release, and a signed agreement before admission. The plan of care is due within 14 business days and reviewed at least every 90 days. Participants get at least 15 days' notice before services are reduced or ended, and serious incidents must be reported to DHCF within 24 hours.

Admission. Under 29 DCMR 9710, admission requires:

• The assessment that authorizes ADHP and sets the participant's acuity level.
• A medical release signed by a physician or advanced practice registered nurse, with a report of a physical exam in the past 90 days that certifies a chronic condition.
• A pre-admission interview.
• A signed agreement covering hours and holidays, closing procedures, rights, the HIPAA policy, the emergency plan and the participant's financial obligations.

Assessment and plan of care. DHCF or its agent does a face-to-face needs assessment and reassesses at least every 12 months or after a significant change. The Aging and Disability Resource Center at DACL, or the District Dual Choice plan for its members, writes the person-centered service plan (29 DCMR 9709). The program's own plan of care is due within 14 business days of admission and is reviewed at least every 90 days and after a significant change by a team that includes the RN, social worker, dietician, activities coordinator and aides (29 DCMR 9711).

Rights. The written statement of participant rights and responsibilities must be posted where people can see it and given free to anyone who asks (29 DCMR 9712). Providers must explain, orally and in writing, the services offered, the charge for each, how billing works, and whether Medicare, Medicaid or other payers cover them.

Discharge. A participant must be discharged if a reassessment finds their needs are below the required level, if they need long-term placement in an institution, or if they choose to leave. The program sends a discharge plan to DHCF within one week. Participants must be told at least 15 days before any reduction or end of services (29 DCMR 9720 and 9712.3).

Attendance and records. Aides document each participant's daily attendance and participation, and the program keeps a daily attendance roster. Participant records are kept 10 years or until all audits are done, whichever is longer (29 DCMR 9713).

Incidents. The program must notify DHCF in writing within 24 hours of a fire, a serious accident or injury, abuse, neglect or another event that affects participant health or safety, a serious communicable disease, a participant death at the site or on the way to or from it, and staffing changes that may disrupt services (29 DCMR 9703.5).

What we did not find. We did not find a separate TB screening requirement for participants (the medical release must address infectious disease), or participant rules for grant-funded or private-pay programs. Families choosing a non-Medicaid program should ask for its written admission, discharge and fee policies.

How does Medicaid pay for adult day in the District of Columbia?

DC Medicaid pays Adult Day Health Programs a daily rate under code S5100, at one unit per day. As of July 1, 2026, DHCF lists $127.92 per day for Acuity Level 1 (S5100-U1) and $168.64 per day for Acuity Level 2 (S5100-U2) under the 1915(i) State Plan benefit, and $168.64 per day under the EPD Waiver (S5100-U3). PACE also serves eligible people in Wards 7 and 8.

Adult Day Health Program, 1915(i) State Plan benefit. DHCF runs this benefit. A 1915(i) benefit is a Medicaid State Plan option for home and community based services. Under 29 DCMR 9701.1, a participant must be 55 or older, have a chronic medical condition diagnosed by a physician, have income up to 150 percent of the federal poverty level, have an assessment that authorizes ADHP and its level, and need at least one ADHP service each month.

• Acuity Level 1: S5100-U1, $127.92 per day.
• Acuity Level 2: S5100-U2, $168.64 per day.
• Limit: 1 unit per day.
• Source: DHCF's 2026 payment rate table, labeled current rates as of July 1, 2026.

Elderly and Persons with Physical Disabilities (EPD) Waiver. This 1915(c) waiver is run by the DHCF Long Term Care Administration, and DHCF's EPD Waiver quick reference lists adult day health among its services. EPD adult day health is billed as S5100-U3 at $168.64 per day, 1 unit per day.

District Dual Choice. This plan for people with both Medicare and Medicaid can authorize ADHP and writes the service plan for its members (29 DCMR 9709). We did not find what it pays ADHPs, so ask the plan.

PACE. PACE4DC opened to District participants in March 2023 and serves ZIP codes 20019, 20020 and 20032 in Wards 7 and 8. Participants must be 55 or older and meet nursing facility level of care. PACE is paid a set amount per member, not per unit.

What Medicaid will not pay. DHCF will not pay for ADHP while the participant is also receiving or being billed for personal care aide services, day habilitation for intellectual and developmental disabilities, mental health day treatment, or Older Americans Act adult day care during the time at the ADHP site. For people who use both ADHP and personal care aide services, schedule changes must be coordinated and sent to DHCF on the 1st and 15th of the month for prior authorization (29 DCMR 9721).

Transportation. Transportation to and from the program is provided through DHCF's non-emergency medical transportation contract or arranged by the program, and it is not included in the ADHP rate.

Attendance documentation. Aides must document each participant's daily attendance and participation, and the program keeps a daily attendance roster and records of the services given, how often and by whom (29 DCMR 9704.18 and 9713). We did not find a rule requiring electronic sign-in and sign-out for adult day.

Cost reports. Each site files an annual cost report within 90 business days after its reporting period ends. If DHCF sends a delinquency notice, it holds back 75 percent of monthly payments until the report is filed (29 DCMR 9722).

Can a private-pay adult day center operate in the District of Columbia without Medicaid?

We did not find a DC license or registration for a private-pay adult day center. DHCF's Chapter 97 applies only to providers that seek Medicaid payment. One open question is the Certificate of Need: the CON law lists medically supervised day care as a health service, and we did not confirm whether it reaches a private-pay program, so ask DC Health's SHPDA before you open.

What applies. Chapter 97 defines a provider by Medicaid payment (29 DCMR 9799 and 9702.1), so its staffing, space and service rules do not, by their own terms, cover a center that never bills Medicaid. We did not find DC rules that limit what an unlicensed program may do, such as personal care, nursing or giving medications, and we did not find private-pay consumer protection rules specific to adult day. Families should ask any private-pay center for its staffing, written fee policy and admission and discharge rules.

Grant-funded adult day care. DACL funds social-model senior day care through grants. Its FY 2024 Lead Agency grant announcement named the Genevieve N. Johnson Senior Day Care Program as the Ward 4 grantee. We did not find current DACL adult day grant terms, amounts or a full grantee list, so contact DACL to learn what it funds now.

Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical need where the service is available, at VA centers, State Veterans Homes or community organizations. A copay may apply. We did not confirm whether the Washington DC VA Medical Center contracts with community adult day programs.

The market. Because the District does not license adult day, there is no official count of centers, and we did not find a current count of Medicaid ADHP providers. We also did not find a DC adult day services association.

What is changing next for adult day in the District of Columbia?

As of our last check on October 21, 2026, we did not find an upcoming change to DC's adult day rules or Medicaid adult day payment. Several recent changes matter for operators, and all are already in effect.

• Higher daily rates, July 2026. DHCF's rate table lists ADHP rates of $127.92 per day for S5100-U1 and $168.64 for S5100-U2 and U3 as current as of July 1, 2026, up from $119.04 and $151.70 in January 2025.
• Service authorization rule amended, May 15, 2026. A DHCF final rule amending 29 DCMR Chapters 50 and 97 (personal care aide and ADHP services) changed the ADHP service authorization section, 29 DCMR 9709. We could not read the rule notice that explains what changed, so check the current section text.
• 1915(i) benefit renewed, March 2025. According to a DHCF report from May 2025, CMS approved a state plan amendment on March 10, 2025 that renewed the 1915(i) Adult Day Health Program with no changes.
• ARPA supplemental payments ended, March 2025. Extra payments to ADHPs that employed personal care aides as direct care staff, tied to paying those aides 17.6 percent above the DC living wage, covered dates of service from October 1, 2022 through March 31, 2025 (29 DCMR 9724).

District of Columbia adult day sources

• DC Municipal Regulations: 29 DCMR Chapter 97, Adult Day Health Program Services
• 29 DCMR 9704: ADHP staffing requirements
• DC Health: Health care facilities it licenses and certifies
• DC Health: Certificate of Need
• D.C. Code 44-401: Certificate of Need definitions
• DHCF: 2026 payment rate table (current rates as of July 1, 2026)
• DHCF: EPD Waiver quick reference
• DHCF: PACE in DC
• DACL: FY 2024 Lead Agency grant recipients
• U.S. Department of Veterans Affairs: Adult Day Health Care fact sheet

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
• 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 with no state adult day license

Alabama, Alaska, Colorado, Connecticut, 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.

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.