Adult Day Care in Hawaii

All states: adult day services map

Hawaii adult day services at a glance

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

How is adult day care regulated in Hawaii?

Hawaii has two kinds of adult day programs, and both are licensed by the Hawaii Department of Health (DOH), Office of Health Care Assurance (OHCA). Adult day care centers give supportive care such as supervision, personal care and activities. Adult day health centers serve adults who need nursing oversight and must provide medical, nursing and dietetic services. Medicaid pays for both through QUEST Integration health plans, and the I/DD waiver pays for Adult Day Health.

The two models.

• Adult day care center. A facility that gives regular supportive care to four or more disabled adults, with or without charging a fee. Supportive care means a supportive setting, personal care, supervision, and social and psychological stimulation (HAR 17-1424-2). These centers receive a certificate of approval.
• Adult day health center. An organized day program of therapeutic, social and health services for adults with physical or mental impairments that require nursing oversight or care (HAR 11-96-2). These centers receive a license. A center licensed as an adult day health facility is not also covered by the adult day care center rules.

Who sets each layer's rules.

• Licensing (DOH OHCA). Adult day care centers follow Hawaii Administrative Rules (HAR) chapter 17-1424, handled by OHCA's State Licensing Section, which has named Community Ties of America to do the licensing and certification work. Freestanding adult day health centers follow HAR chapter 11-96, handled by OHCA's Medicare Section (OHCA).
• Medicaid. The Department of Human Services (DHS) Med-QUEST Division covers adult day care and adult day health through QUEST Integration managed care plans. The DOH Developmental Disabilities Division (DDD) runs the I/DD waiver, which pays for Adult Day Health.
• Other funding. DHS buys adult day care for some eligible adults under contracts with licensed centers (HAR chapter 17-1417), and the Executive Office on Aging funds adult day care through the kupuna care program.

Why the adult day care rules have a DHS number. DHS used to license adult day care centers. Act 93 of 2012 moved that job to DOH and kept the DHS rules in force until DOH amends them, so chapter 17-1424 still applies, now administered by OHCA (HRS 321-493).

Where the layers differ, adult day health licensing is the heavier set of rules (RN supervision, physician orders, a team care plan and a Certificate of Need step), while the adult day care center rules contain the only numeric staffing ratio. We did not find a separate dementia license or model in either chapter.

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

Yes. An adult day care center that gives regular supportive care to four or more disabled adults needs a DOH certificate of approval, whether or not it charges a fee. Every freestanding adult day health center needs a DOH license, and before applying it must get a Certificate of Need decision. Programs run only for education, social or recreational activities are outside the adult day care center rules.

Adult day care center: how to apply. Under HAR 17-1424-3 and 17-1424-4, you submit:

• A signed application.
• A statement of services and operating policies, and information on your organization and staffing.
• Floor plans.
• County building, zoning and fire compliance reports and a state sanitation report. The department arranges the county building, fire and health inspections.

The department must decide within 60 days or issue a temporary certificate. A temporary certificate for minor deficiencies runs up to three months, with limited extensions (HAR 17-1424-5). The center must carry comprehensive liability insurance.

Adult day health center: how to apply. OHCA's Opening an Adult Day Health Center page sets out the steps:

• Get an approved Certificate of Need from the State Health Planning and Development Agency (SHPDA), or a letter saying one is not needed.
• Send that response with a written request for licensure to OHCA in Kapolei.
• Submit an application package with policies on the governing body, personnel, patient care, emergency and disaster plans, infection control, in-service training, medical records and program evaluation, plus service contracts, staff credentials, legal name and tax ID, address, hours and administrator contact.
• Pass an on-site survey. OHCA warns it may not be able to schedule initial licensure for several months.

Adult day health applicants must also report owners of 10 percent or more, officers, partners and mortgage holders, and show enough money to operate (HAR 11-96-28). Running a freestanding adult day health center without a license can bring civil money penalties or imprisonment.

Fees. We did not find license fees for either type on the OHCA pages or in the rules. Ask OHCA (adult day health) or Community Ties of America (adult day care).

Certificate of need and moratorium. A Certificate of Need step applies to adult day health centers. The adult day care center rules do not address a Certificate of Need, so ask SHPDA or OHCA if you are opening that type. We did not find a moratorium on new centers.

One license per site. An adult day health license is issued to a named licensee at a specific address. An adult day care certificate names the center, its address and its maximum capacity, and must be posted (HAR 17-1424-6).

Buying a center. Neither license can be transferred to a new licensee or location, so a buyer needs its own approval. We did not find an advance notice period for a sale. An adult day health center must report a change of administrator in writing within 14 working days, and an adult day care center that plans to close must give 30 days written notice. Check the steps with OHCA early in any purchase.

Renewal and inspections. An adult day health license lasts one year or less, expires automatically if renewal is not filed in time, and the center is inspected at least once a year, with unannounced visits allowed. After an inspection the center has 10 days to return a plan of correction, and no more than two provisional licenses in a row may be issued (HAR 11-96-3). An adult day care certificate is valid for up to 24 months, and renewal is due at least 30 days before it expires, followed by a re-evaluation (HAR 17-1424-8). Violating the adult day care center rules can bring a court fine of up to $5,000 (HAR 17-1424-21).

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

Hawaii adult day care centers must keep at least 1 regular staff member for every 6 participants, and the director may count toward that ratio while volunteers may not. Adult day health centers have no numeric ratio, but they need RN-supervised nursing, a full-time program director and a full-time activity coordinator. Both types need a first aid and CPR certified staff member on site at all times.

• Licensing, adult day care center (DOH OHCA): 1:6 regular staff to participants (HAR 17-1424-12).
• Licensing, adult day health center (DOH OHCA): no ratio specified. Staffing must be enough to carry out activities, nursing services, physician orders and care plans (HAR 11-96-39).
• Medicaid, QUEST Integration: we did not find plan staffing standards for adult day.
• Medicaid, I/DD waiver: Adult Day Health rates are set by staffing tier (Tier 1, 2, 3 and 1:1), but the rate sheet does not state a center staffing ratio.
• Other funding: no ratio specified in the DHS adult day care services rules or the kupuna care statute.

We did not find a separate ratio for people with dementia or other high needs in any layer.

Adult day care center staff.

• The director must have basic knowledge and training or experience in caring for disabled adults, and must name a staff member in charge when away. A staff member must greet each participant on arrival.
• Staff must be certified in first aid and CPR. At least one certified staff member must be at the center whenever participants are there and must go on field trips.
• Staff need a physician health exam with TB clearance within one year before hire and every year after. Volunteers need TB clearance, and volunteers working 10 or more hours a week also need a health exam.
• Medication may only be reminded or supervised, except that licensed nurses, or unlicensed staff delegated by an RN under HAR 16-89, may give it with a physician's authorization.

Adult day health center staff.

• Every center needs an administrator and a full-time program director on the premises. Centers with a capacity of 50 or more need these to be two different people, and one person may administer no more than three centers (HAR 11-96-4).
• In a center with average daily attendance of 20 or less, the program director may also serve as the RN, social worker, therapist, activity coordinator or dietitian if qualified and not also the administrator.
• Nursing must be supervised by a registered nurse, skilled nursing must be given or directly supervised by an RN, and only a licensed nurse or physician may give medications (HAR 11-96-25).
• A full-time activity coordinator with two years of relevant experience (or an OT, OT assistant or recreational therapist), social services given or supervised by a qualified social worker, and psychiatric consultant staff available when a client needs them (HAR 11-96-34).
• Volunteers cannot replace required professional staff, and clients cannot substitute for staff.
• At least one staff person certified in CPR and basic first aid must be present at all times.

Training. Adult day health centers must run orientation and at least yearly in-service training on infection control, fire and accident prevention, client rights and the needs of aged, ill and disabled people, and keep records of it. Nurse's aides must have finished a nurse aide training course (HAR 11-96-22). We did not find required training hours for aides in adult day care centers.

Health screening. Adult day health employees need a physician health evaluation before hire and every year, with a TB skin test or chest x-ray (two-step baseline), and the center needs a volunteer health screening policy (HAR 11-96-19).

Background checks. We did not find criminal background check rules in the adult day rule sections we read. Ask OHCA what checks apply to your staff.

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

Hawaii adult day care centers must provide supervision, personal care, a planned activity program with daily exercise and outings at least twice a month, and morning and afternoon rest periods. Adult day health centers must provide medical, nursing and dietetic services and serve at least one meal a day. Both need at least 50 square feet per person, and transportation is optional for both.

Adult day care center services (HAR 17-1424-16):

• Supervision throughout the stay, handling of illness and notice to the family, counseling and referral, and a place to separate anyone with a communicable disease.
• A planned activity program with daily exercise and outings at least twice a month.
• Personal care such as help with toileting, and morning and afternoon rest periods.
• Meals, when served, must come close to federal school lunch standards, with snacks between meals.
• Transportation, when provided, must meet public utilities commission rules and HRS chapter 286.

Adult day health center services (HAR 11-96-7):

• Medical, nursing and dietetic services and planned therapeutic and social activities, plus social services, speech, physical and occupational therapy and psychiatric or psychological services when clients need them.
• Nursing includes an RN assessment and care plan, monthly nursing summaries, monthly weights, giving or monitoring medications, and frequent checks that all clients are present.
• At least one meal a day: one-third of recommended daily allowances for 4 hours or more, half for 8 hours or more, two meals for more than 10 hours, and breakfast for anyone arriving at 7:00 a.m. or earlier (HAR 11-96-10).
• Transportation may be provided or arranged. Centers that transport must use licensed drivers, safety devices and vehicles that meet the Hawaii Vehicle Code (HAR 11-96-40).

Space and capacity.

• Adult day care centers: at least 50 square feet per person for recreation, rest and dining; one toilet and one wash basin for every 10 persons (or part of 10) for each sex, with grab bars; at least one bed, lounge or recliner for every three participants; and one chair with arms per participant. Buildings must meet county building code for children's day care buildings, and kitchens serving more than 10 people must meet DOH food establishment rules (HAR 17-1424-17).
• Adult day health centers: at least 50 square feet per client of recreation and dining area, one toilet room for every 12 clients, at least one tub or shower, call systems in toilets and baths, separate staff toilets and a secluded rest area (HAR 11-96-30).
• Capacity is the most people served at one time, as shown on the license or certificate.

Hours. We did not find a minimum number of days or hours in either chapter. Adult day care centers must state their hours in their written operating policies.

Written policies. Adult day care centers need written operating policies covering name and address, operator, admission, maximum capacity, hours, meals and transportation, fees, routine and emergency medical care plans, and program and services (HAR 17-1424-11). They also need a fire evacuation plan approved by the fire department, with fire drills at least once a month, yearly fire extinguisher inspections, and a tsunami, flood or similar evacuation plan if the center is in a risk area (HAR 17-1424-18). Adult day health centers need far more written policies, including services, admission and discharge (with non-discrimination), client rights, personnel and abuse prevention, fire and disaster plans with quarterly drills, emergency care, infection control, a pharmacy manual, health record access, restraints, transportation safety and volunteer health screening (HAR 11-96-12).

What rules protect participants in Hawaii adult day centers?

Adult day care centers need a physician exam with TB clearance within 90 days before admission, a pre-admission interview, written notice of fees and daily attendance records. Adult day health centers need a referral, physician orders, a written care plan made by a team and reviewed by the physician at least yearly, and limits on why a client can be discharged. We did not find a state deadline for reporting incidents to the agency for either type.

Adult day care center enrollment (HAR 17-1424-13):

• A physician exam within 90 days before admission, with diagnosis, TB clearance and special care instructions, then a yearly exam or health statement with TB clearance.
• An interview with the applicant and family before admission.
• An admission form with name, address, birth date, sex, responsible person, family physician, consent to call another physician, and the hours the participant will attend.
• Written notice of the fees the participant will be charged (HAR 17-1424-14).

We did not find care plan timelines or discharge reasons and notice periods in the adult day care center rules.

Adult day health center enrollment and care plans.

• Admission requires a referral from a community or health agency, physician or hospital, a documented need for center services, physician contact details and a written physician order for therapeutic services.
• A team from several disciplines writes an individualized plan of care signed by each member, including the physician. The physician authorizes it and reviews it at least once a year, and a statement that the client does not have active TB is required (HAR 11-96-31).
• A discharge plan must be documented within 14 days of the first assessment.
• Clients may be discharged only for medical reasons, their own or others' welfare, or non-payment, with reasonable advance notice. The rules give no set number of days (HAR 11-96-9).
• Clients must sign an acknowledgment of their rights, rights must be posted, and there must be a fair hearing procedure.
• A client absent 30 days or more because of illness needs a physician statement before coming back.

Records. Adult day care centers keep staff lists and health records, daily activity schedules, menus, emergency information, a participant list, attendance records, application forms and participant health records. Adult day health client records must include admission data, consents, any restraint use, exams and progress notes, the yearly plan of care review, treatments and medications, and a discharge summary (HAR 11-96-24). Adult day health employee records and medication incident reports are kept for three years. We did not find a client record retention period in either chapter.

Incidents. In adult day health centers, medication errors and drug reactions must be recorded, reported right away to the prescribing physician and written up in an incident report. Injuries and accidents are documented in the client record, and the abuse policy must include reporting to the State (HAR 11-96-29). We did not find incident reporting rules in the adult day care center chapter, so operators should ask OHCA what it expects.

DHS-funded participants. When DHS pays for a participant's adult day care, it holds the space for up to one month if the person is ill. Services can end because of decline in health, loss of eligibility, lack of contracted space or funds, or the participant's request (HAR 17-1417-8).

How does Medicaid pay for adult day in Hawaii?

Hawaii Medicaid covers adult day care and adult day health through QUEST Integration, the state's managed care program, for members who meet the required level of care. The I/DD waiver pays for Adult Day Health in 15-minute units after the DDD case manager authorizes it. We could not confirm the QUEST Integration codes, units or rates.

QUEST Integration. The DHS Med-QUEST Division runs QUEST Integration under a section 1115 demonstration, through contracted managed care health plans. Its benefits page lists adult day care and adult day health as home and community-based services for members who meet the required level of care. QUEST Integration replaced the older QUEST Expanded Access program. Non-medical transportation is listed as a separate QUEST Integration benefit, but we did not confirm whether transportation to adult day is billed separately.

I/DD waiver (Adult Day Health). The DOH Developmental Disabilities Division runs this 1915(c) waiver with the Med-QUEST Division. All approved waiver services in a person's Individualized Service Plan are prior authorized by the DDD case manager.

• Billing unit: 15 minutes.
• Codes on the January 2024 rate sheet: H2032 with modifiers U1 to U5, and S5100 with modifiers U1 to U5 on the Hawaii Island lines. The modifiers mark the staffing tier: Tier 1, Tier 2, Tier 3, 1:1, and 1:1 with a Registered Behavior Technician.
• Rates: the January 2024 rate sheet shows two rates per line. For Tier 1 they are $3.62 and $3.75 per 15 minutes (H2032), or $4.05 and $4.19 on Hawaii Island (S5100). The November 2023 rate models label the two columns current and final rates. Higher tiers pay more, up to $15.00 ($17.37 on Hawaii Island) for 1:1 with a Registered Behavior Technician.
• Code update: DDD issued an updated rate sheet effective July 1, 2025 that changed service codes and modifiers (DDD Memo FY2026-02). Confirm current codes and rates with DDD before billing.

Attendance documentation. Adult day care centers must keep a record of participant attendance. The rule does not require sign-in and sign-out or electronic tracking. We did not find QUEST Integration plan rules or I/DD waiver rules that spell out the attendance records needed to bill adult day, so ask each plan and DDD what they require.

We did not find a PACE program in Hawaii.

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

Yes, a center can be fully private pay, but it still needs DOH approval. The adult day care center rules apply with or without a fee, and every freestanding adult day health center must be licensed whoever pays. Programs run only for education, social or recreational activities are outside the adult day care center rules.

Unlicensed programs. The rules exempt purely educational, social or recreational programs but do not list what such a program may not do. Because the licensing rules cover supportive care, supervision and personal care for four or more disabled adults, a program that plans to give hands-on care should ask OHCA or Community Ties of America before opening without a certificate.

Protections for private-pay participants. Adult day care centers must tell participants in writing what fees they will be charged (HAR 17-1424-14). Adult day health centers must tell clients about services and charges, including any charges outside the basic daily rate, before or at admission. They may not deny admission based on race, religion, sex, color, ancestry or national origin, and may not take responsibility for client funds (HAR 11-96-18).

Other funding.

• DHS purchase of service. DHS pays for adult day care only where it contracts with licensed centers, and only as spaces and funds allow. Eligibility comes through income maintenance status or protective services, with waiting lists by island area (HAR 17-1417-4). Services include activities, exercise, medication reminders, rest periods, family consultation and meals if specified in the license, plus casework by DHS social workers. A contracted center may charge the participant or another payer the difference between the DHS payment and its actual charge, but may not turn away an eligible person who cannot pay it (HAR 17-1417-7). Billing follows each center's DHS contract.
• Kupuna care. The Executive Office on Aging lists adult day care (personal care for dependent elders in a supervised, protective group setting) as a kupuna care service. It is delivered through the area agencies on aging by contracted providers or participant-directed options, and funds are paid directly to the provider (HRS 349-16, 349-17). We did not find current kupuna care rates for adult day care.
• Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who are eligible for community care and meet clinical criteria, as a half-day or full-day program at VA, State Veterans Home or community sites. A copay may apply. We did not confirm which Hawaii centers have VA contracts.

The market. The OHCA adult day care center list updated March 2026 shows 28 certificated centers: about 23 on Oahu, three on Maui, one on Molokai and one on Hawaii Island, with capacities from 6 to 105. Several certificates on that list show expiration dates before March 2026, so check a center's status with OHCA. Adult day health centers are licensed separately and are not on that list, and we did not find a count of them. We did not confirm whether a Hawaii adult day association exists.

What is changing next for adult day in Hawaii?

As of our last check on October 21, 2026, we did not find an upcoming change to Hawaii's adult day licensing rules or Medicaid adult day payment. One recent change is already in effect.

• New I/DD waiver codes and modifiers, July 1, 2025. DDD issued an updated rate sheet that changed service codes and modifiers, including those for Adult Day Health (DDD Memo FY2026-02). Providers billing the waiver should use the current sheet.

The adult day care center rules (HAR 17-1424) are former DHS rules that stay in force until DOH amends them. We did not find a DOH proposal to replace them. If one is published, it could change the 1:6 ratio and other adult day care center rules on this page, so check with OHCA before relying on these details for a new center.

Hawaii adult day sources

• Hawaii DOH Office of Health Care Assurance
• OHCA: Opening an Adult Day Health Center
• HAR 17-1424-12: adult day care center staffing
• HAR 17-1424-6: adult day care certificate of approval
• HAR 11-96-3: adult day health center licensing
• HAR 11-96-39: adult day health center staffing
• HRS 321-493: day care centers for elder disabled and aged persons
• Med-QUEST: QUEST Integration benefits
• DDD: Medicaid I/DD Waiver Services Schedule of Rates (issued January 2024)
• OHCA: Adult Day Care Center list (updated March 2026)

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
• Effective Transportation Tracking for Elder Day Centers
• Podcast: How Adult Day Services Let You Serve 50 Clients with Just 8 Staff
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states that license or certify every adult day center

California, Delaware, Florida, Georgia, 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.