Indiana Adult Day Services: No License, FSSA Certification, 1:4 Ratio

Adult Day Care in Indiana

In short: No state license; Medicaid centers are certified by FSSA at three levels with minimum staff ratios of 1:8, 1:6 and 1:4, billed per 15 minutes.

Indiana adult day services at a glance

License or certification	No state license. Centers that serve Medicaid waiver members need FSSA certification for each location.
Who licenses or certifies	No agency licenses centers. FSSA's Office of Medicaid Policy and Planning (OMPP) certifies Medicaid providers.
Adult day care vs adult day health	No separate adult day health care type. Medicaid uses one Adult Day Service with three levels of care.
Strictest staffing ratio	1 staff per 4 participants at Medicaid Level 3 (Intensive); 1:6 at Level 2 and 1:8 at Level 1
Dementia ratio	No separate dementia ratio. Levels 2 and 3 are set partly by degree of cognitive impairment.
Medicaid programs	PathWays for Aging; Health and Wellness, TBI, CIH and Family Supports waivers; AMHH; PACE
Medicaid billing unit	15 minutes (S5100), $2.93 to $4.76 per unit by level and category since July 1, 2023. Half day (S5101) also in CIH and Family Supports.
Licensed centers	Not confirmed. Indiana does not license centers, and we did not find a state count.

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

How is adult day care regulated in Indiana?

Indiana does not license adult day centers. Instead, the Indiana Family and Social Services Administration (FSSA) certifies centers that serve Medicaid waiver members, and almost all of the state's rules on staffing, space and services come from that Medicaid layer. There is no separate adult day health care license. Medicaid uses one service, called Adult Day Services, with three levels of care.

Important: The statement that Indiana has no adult day license rests on FSSA listing no licensure for adult day providers and on our not finding a licensing statute. We did not find any state document that speaks directly to centers that serve only private-pay participants. If you plan a center that will not take Medicaid, confirm with FSSA that no state license or registration applies.

Several layers of rules can apply to an Indiana center, and each comes from a different part of FSSA:

Medicaid certification (FSSA OMPP). OMPP runs the HCBS certification process. Its standards are in the FSSA Adult Day Service definition (last updated August 25, 2025) and the Indiana Health Coverage Programs (IHCP) provider module for the PathWays for Aging Waiver (version 2.2, published June 15, 2026). One certification covers the PathWays, Health and Wellness and Traumatic Brain Injury (TBI) waivers.
Medicaid provider rules (FSSA DDARS). The Division of Disability, Aging and Rehabilitative Services, which took over the work of the former Division of Aging, enforces the home and community based services provider rules in 455 IAC 2. These apply to providers paid through the division and the nursing facility level of care waivers.
Disability waivers (DDARS Bureau of Disabilities Services). Adult day for people with intellectual or developmental disabilities is paid through the Community Integration and Habilitation (CIH) and Family Supports waivers.
Behavioral health (FSSA). The Adult Mental Health Habilitation (AMHH) program covers adult day for adults with significant behavioral health needs under its own rule, 405 IAC 5-21.6-8.
State funding (DDARS Bureau of Better Aging and area agencies on aging). The state-funded CHOICE program covers adult day care under 455 IAC 1-5, which defines it as an organized program in a protective, supervised setting during daytime and early evening hours.

Levels and categories. Medicaid adult day has three levels: Level 1 (Basic), Level 2 (Enhanced) and Level 3 (Intensive). The levels differ in staffing and services, and the participant's level is set in their person-centered assessment. Separately, there are two rate categories. Category 1 pays a higher rate to centers that meet FSSA's facility standards, and Category 2 is the base rate.

Where the layers overlap, the Medicaid layer is the stricter one, because it is the only layer that sets service levels, staffing and facility standards.

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

No state license is required, as far as we found. FSSA lists no licensure for adult day providers and reviews them as nonlicensed providers. To serve Medicaid waiver members, though, each center location must be certified by FSSA OMPP, enrolled in Indiana Health Coverage Programs (IHCP) and, for PathWays members, enrolled with one or more of the PathWays health plans (Anthem, Humana and UnitedHealthcare).

How to get certified. You apply through the OMPP HCBS certification process. Under the FSSA Adult Day Service definition:

Staff must already be hired, and staff licenses uploaded, at the time of certification.
Required documents include background check results, negative TB test or chest x-ray results, proof of liability insurance, a Secretary of State letter, a W-9 or EIN letter and an operations manual (see the policies list below).
An on-site visit checks that the center meets the federal HCBS Settings Rule.

The IHCP PathWays module says OMPP reviews applications within four business days, corrections are due within five business days, and the IHCP enrollment application must be filed within 90 calendar days of certification. Under 455 IAC 2-6-1, an approved provider must meet the minimum provider requirements, show any required Indiana license or certification, use only qualified staff and keep a signed provider agreement. Centers may choose accreditation from the Indiana Association of Adult Day Services as part of FSSA credentialing, but it is optional.

The module also says providers must follow the Adult Day Services Provision and Certification Standards. We did not locate that document, so ask OMPP for a copy.

Fees, permits and certificate of need. We did not find a certification fee, a certificate of need requirement or a moratorium for adult day. We also did not find state rules on local health, occupancy or fire permits, so check with your city or county and the local fire marshal before you sign a lease.

One certification per site. Each adult day location must be certified on its own, enrolled separately in IHCP and given its own IHCP Provider ID.

Buying a center. A change of ownership requires a new OMPP provider application and new service certification, filed through the OMPP HCBS Certification Portal within 10 calendar days of the change. Adding a service location also requires new certification.

Renewal and inspections. Waiver providers recertify with OMPP every three years and have a provider compliance review every three years, with site visits for group settings such as adult day centers. OMPP sends a renewal notice three months before the due date. Under 455 IAC 2-6-4, DDARS also monitors providers through records reviews, on-site inspections and meetings with participants, and a corrective action plan is generally due within 10 days of an inspection report.

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

Indiana's staffing ratios come from the Medicaid layer and depend on the level of care: at least 1 staff member per 8 participants at Level 1, 1 per 6 at Level 2 and 1 per 4 at Level 3. Higher levels also require nursing and other professional staff. There is no licensing layer, and we did not find a separate ratio for participants with dementia.

The ratios are set in the FSSA Adult Day Service definition and the IHCP PathWays module, Section 7:

Level 1 (Basic): at least 1 staff per 8 participants, with a registered nurse (RN) consultant for health assessments.
Level 2 (Enhanced): at least 1 staff per 6 participants, plus at least one full-time licensed practical nurse (LPN) with monthly RN supervision.
Level 3 (Intensive): at least 1 staff per 4 participants, plus the full-time LPN, at least one qualified full-time staff person for psychosocial needs, and physical, occupational and speech therapy coordinated or available.

By layer.

Licensing: no licensing layer exists, so no ratio.
Medicaid (OMPP, for PathWays, Health and Wellness and TBI): the three level ratios above.
Medicaid disability waivers (CIH and Family Supports): we did not confirm the adult day staffing standards for these waivers. They are in the DDARS waiver manual, which our research did not cover. Ask the Bureau of Disabilities Services.
State funding (CHOICE): no ratio specified in the CHOICE rule we read.

Dementia. No separate dementia ratio was found. Instead, Level 2 serves people with mild to moderate cognitive impairment and Level 3 serves moderate to severe impairment, so a center serving people with more advanced dementia will usually staff at 1:6 or 1:4.

What we did not find. We did not find a minimum number of staff on site regardless of census, a rule on which staff count toward the ratio, director qualifications or required aide training hours. The Provision and Certification Standards mentioned in the IHCP module may cover some of these, so ask OMPP.

Health screening and training. The IHCP module requires direct care staff to have a TB test on hire before face-to-face contact with participants, yearly TB education, retesting after a known exposure, and CPR and first aid training and certification on hire. Under 455 IAC 2-6-3, direct care staff must also be at least 18, show a negative TB test or chest x-ray each year and be able to carry out the plan of care.

Background checks. Each employee or agent in management, administration or direct service needs a limited criminal history check (through the Indiana State Police or a third party, with a copy of the driver's license), completed within 90 days of the certification application. Unlicensed direct care staff must have no finding on the nurse aide registry, and the convictions listed in 455 IAC 2-15-2 bar hiring.

AMHH adult day. Under 405 IAC 5-21.6-8, AMHH adult day staff must be licensed professionals or qualified behavioral health professionals supervised by a licensed professional, with a physician on site at least once a week.

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

A Medicaid adult day center in Indiana provides supervision, planned activities, support services and help with personal care, along with breakfast, lunch and snacks as appropriate. Services grow with the level of care, from health monitoring at Level 1 to nursing and therapy at Level 3. Adult day can be authorized for up to 10 hours a day, and transportation is a separate waiver service.

Services by level. Under the IHCP PathWays module, Section 7:

Level 1: monitoring of activities of daily living (ADLs) with hands-on help, therapeutic activities for cognitive impairment, an RN initial health assessment and medication monitoring.
Level 2: adds hands-on help with two or more ADLs or with bathing, medication assistance, and psychosocial assessment and counseling.
Level 3: adds direct health interventions, rehabilitation therapies and therapeutic intervention for moderate to severe cognitive impairment.

Hours. FSSA says adult day runs during normal business hours on a days-per-week and hours-per-day schedule, and the module caps authorized service at 10 hours a day. We did not find a minimum number of days or hours a center must be open.

Space and facilities. FSSA lists these facility standards:

At least 100 square feet per participant including staff office space, or 60 square feet excluding office space.
Separate, designated space when the center shares a building with another program.
At least one toilet per 10 participants, accessible and preferably within 40 feet of the program area, plus bathing facilities.
A quiet room with at least one bed, an exam or medication room, a kitchen, a multipurpose room that can be divided, a counseling room, a reception area, safe outdoor space and locked storage.

The two FSSA documents describe these standards differently. The Adult Day Service definition says each facility must have them, while the IHCP module calls them recommended standards that earn the higher Category 1 rate. Ask OMPP which applies to your certification.

Transportation. Transportation to adult day is a separate waiver service, including a round-trip Adult Day Service Transportation service, billed by certified transportation providers. FSSA suggests that adult day providers also apply for Transportation certification.

What adult day cannot be combined with. Medicaid adult day is not allowed for participants receiving the Assisted Living waiver service, cannot duplicate therapies paid under other services and cannot be provided by a participant's spouse.

Written policies. The operations manual filed for certification must include:

Employee rights and responsibilities, a personnel policy, job descriptions, a job performance evaluation policy and an organizational chart.
A file retention policy, a HIPAA compliance policy and a transfer of information policy.
An incident reporting policy and a quality assurance and quality improvement policy.

The personnel policy must state the yearly TB education, TB retesting after exposure and current CPR and first aid certification rules. Under 455 IAC 2-8-1, providers also need written procedures to protect participants and to investigate, discipline or dismiss staff involved in abuse, neglect, exploitation or rights violations, plus protocols for reporting unusual occurrences and for telling participants how to file a complaint. Under 455 IAC 2-15-2 the personnel policy must also cover background checks, barred convictions, performance reviews after training and each year, discipline, employee rights and HIPAA. We did not find rules on how often policies must be reviewed, posting requirements or emergency drill frequency.

AMHH adult day. AMHH adult day may include care planning, health monitoring, medication administration by licensed staff, a dietitian assessment, exercise and daily living skills.

What rules protect participants in Indiana adult day centers?

Participant protections in Indiana come from the Medicaid layer. A PathWays member must meet nursing facility level of care, Level 1 requires an RN health assessment before services begin, and the center must follow a written service plan. A waiver provider must give at least 30 days written notice before ending services, and incidents go to FSSA within 48 hours, or 24 hours for a death or suspected abuse.

Who can enroll. PathWays for Aging serves Medicaid members 60 and older who meet nursing facility level of care. Since July 1, 2025, that level of care assessment has been done by the state's contractor, Maximus. The participant's adult day level is set in their person-centered assessment.

Service plan. The adult day provider must follow a written service plan based on the participant's assessment and share it with the participant's service coordinator. Service coordinators review the plan face to face at least every 90 days and complete an assessment each year.

Ending services. Waiver providers must give at least 30 calendar days written notice before terminating services, to the member, any legal representative, the service coordinator and FSSA OMPP. We did not find a list of permitted discharge reasons.

Records. Under 455 IAC 2-16-1, providers keep a record of every service delivered to each participant at the provider's office. Records are kept after discharge as HIPAA guidelines or other law require. The rule does not state a fixed number of years.

Incidents. Under the IHCP PathWays module and 455 IAC 2-8-2, incident reports are filed through the state's IFUR web tool within 48 hours of the incident or of learning about it, and within 24 hours for a death or suspected abuse, neglect or exploitation. Reportable events include falls with injury, medication errors in a day setting, elopement, any use of restraint and significant injuries. Suspected abuse is also reported to Adult Protective Services at 800-992-6978.

What we did not find. We did not find a required physician order or physical exam at enrollment, TB screening of participants, required contents for an enrollment agreement or permitted discharge reasons. Families should ask the center for its written policies, and operators should ask OMPP what it expects.

How does Medicaid pay for adult day in Indiana?

Indiana Medicaid pays for adult day through PathWays for Aging, the Health and Wellness and TBI waivers, the CIH and Family Supports waivers, the AMHH program and PACE. Most adult day is billed under code S5100 in 15-minute units. The state rate table, in effect since July 1, 2023, pays $2.93 to $4.76 per unit depending on the level of care and the rate category.

PathWays, Health and Wellness and TBI. PathWays for Aging is Indiana's managed long-term services program for people 60 and older, run by FSSA OMPP through three health plans: Anthem, Humana and UnitedHealthcare. Health and Wellness and TBI are 1915(c) waivers run by DDARS. All three use the same S5100 rates from IHCP bulletin BT202359, which the June 15, 2026 PathWays module still lists:

Code and modifiers: S5100 U7 with U1, U2 or U3 for Levels 1 to 3, plus UC for Category 1 centers.
Category 2 rates: $2.93 (Level 1), $3.30 (Level 2) and $4.20 (Level 3) per 15 minutes.
Category 1 rates: $3.32 (Level 1), $3.74 (Level 2) and $4.76 (Level 3) per 15 minutes.

These are the state table rates. PathWays health plans may pay different contract rates, so ask each plan you contract with.

CIH and Family Supports. These disability waivers, run by the DDARS Bureau of Disabilities Services, pay S5100 U7 U5 per 15 minutes at $2.93, $3.30 and $4.20 by level, and also have a half-day code, S5101 U7 U5, at $37.18, $43.75 and $54.74. These rates come from BT202359 for July 1, 2023. We did not confirm whether later bulletins changed them.

Billing rules. At least 8 minutes of service must be provided to bill one 15-minute unit, and partial units may be added up and rounded at the end of the day. Claims are denied without an approved service authorization that lists the units, code and modifiers. PathWays claims go to the member's health plan.

Transportation. Transportation is billed separately. For PathWays, Health and Wellness and TBI, the IHCP module lists T2003 codes, with a nonassisted base trip at $12.12 and an assisted trip at $20.19, plus mileage. CIH and Family Supports have their own per-trip transportation codes (T2002).

AMHH. The AMHH program covers adult day services, but we did not find its billing unit, codes or rates.

PACE. Indiana's PACE program includes adult day services for people 55 and older who need a nursing home level of care and live in a PACE service area, with 11 PACE organization sites. PACE is paid a set amount per enrollee, so adult day is not billed by the unit.

Attendance documentation. Units billed must be supported by documentation that meets the Indiana Administrative Code and FSSA waiver documentation standards and matches the person-centered plan, and 455 IAC 2-16-1 requires a record of each service delivered. We did not find a state requirement for electronic attendance tracking or sign-in and sign-out for adult day, and we did not find the PathWays health plans' own documentation rules. Ask each plan you bill how it wants attendance documented.

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

It appears so. Indiana has no adult day license that we could find, and the Medicaid provider rules in 455 IAC 2 apply to providers funded through FSSA, not to every center. But no state document we found addresses private-pay-only centers directly, so confirm with FSSA before you open.

What the rules cover. Under 455 IAC 2-2-1, the HCBS provider rules apply to providers of services funded through the division and the nursing facility level of care waivers. FSSA certification, staffing ratios and facility standards attach to that funding.

What we did not find. We did not find limits on what a center without Medicaid certification may do, such as nursing or medication administration (those may be governed by professional practice laws we did not research), or consumer protections for private-pay participants. Families choosing a private-pay center should ask about staffing, nursing coverage and written policies, and whether the center is also certified for Medicaid.

Other funding.

CHOICE. Indiana's state-funded CHOICE program covers adult day care under 455 IAC 1-5. Under 455 IAC 2-5-1, adult day is also a non-Medicaid service brokered by area agencies on aging.
Area agencies on aging. The DDARS Bureau of Better Aging offers services in part through 15 area agencies on aging, including Older Americans Act and family caregiver support programs. Your local area agency can tell you what is available in your region.
Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical criteria, at VA medical centers, State Veterans Homes or community organizations. We did not find Indiana-specific VA adult day contracts.

The association. The Indiana Association of Adult Day Services (IAADS) is named by FSSA as optional to join, and FSSA credentialing allows IAADS accreditation.

The market. Because Indiana does not license adult day centers, there is no state license list, and we did not find a state count of centers.

What is changing next for adult day in Indiana?

As of our last check on October 21, 2026, we did not find an upcoming change to Indiana's adult day rules or Medicaid adult day payment. Two recent waiver changes are in effect, and neither changes adult day.

Waiver amendments, August 1, 2026. CMS approved amendments to the Health and Wellness, TBI, PathWays, CIH and Family Supports waivers, effective August 1, 2026, and FSSA withdrew proposed live-in caregiver rate changes (FSSA announcement). The notice does not mention adult day.
New self-directed options, January 1, 2026. Self-directed options for attendant care, respite and home and community assistance were added to the waivers (IHCP bulletin BT2025169). Adult day was not changed.

The adult day rates in the state table date from July 1, 2023. We did not find a newer adult day rate bulletin, so check with OMPP and your health plans for any rate update.

Get notified when Indiana adult day rules change

Leave your email and we will let you know when Indiana changes its adult day licensing, staffing or Medicaid rules. No newsletter, only changes for this state.

Who to ask about adult day rules in Indiana

Questions about Indiana adult day rules are best put to the state. Start with FSSA OMPP HCBS Certification Process. The state lists this contact: IHCP Customer Assistance 800-457-4584; Health and Wellness and TBI waiver enrollment: BDSProviderServices@fssa.in.gov.

Indiana adult day sources

Other states with no state adult day license

Alabama, Alaska, Colorado, Connecticut, District of Columbia, Idaho, Illinois, 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.

Questions about Adult Day Care?

There's a lot to learn about Adult Day Care and the opportunity that it presents both for entrepreneurs, and for families. Below are some frequently asked questions, but you are also welcome to learn more by filling out the form on the right.

Indiana adult day questions

Do I need a state license to open an adult day center in Indiana?

No. Indiana has no adult day license, and FSSA lists no licensure for adult day providers. To serve Medicaid waiver members, each center location must be certified by FSSA's Office of Medicaid Policy and Planning, enroll with Indiana Health Coverage Programs within 90 days, and, for PathWays, contract with the managed care plans.

What staff ratios apply to Medicaid adult day in Indiana?

FSSA sets three levels. Level 1 needs at least one staff per eight participants and an RN consultant, Level 2 needs one per six plus a full-time LPN with monthly RN supervision, and Level 3 needs one per four plus a full-time psychosocial staff person and access to physical, occupational and speech therapy.

How is Medicaid adult day billed in Indiana, and what does it pay?

PathWays, Health and Wellness and TBI pay per 15 minutes under S5100, at $2.93 to $4.20 by level, or $3.32 to $4.76 for Category 1 centers that meet FSSA's facility standards. The CIH and Family Supports waivers also have a half-day code (S5101) at $37.18 to $54.74. These are the state table rates from July 1, 2023, and PathWays health plans may pay different contract rates.

Can I run a private-pay adult day center in Indiana?

We did not find a state license for adult day, and the Medicaid provider rules apply to funded providers, so a private-pay center appears not to need state approval. No state document addresses private-pay-only centers directly, so confirm with FSSA before you open.

Are there special rules for dementia care in Indiana adult day centers?

There is no separate dementia license or dementia staffing ratio. Instead, Medicaid levels are set partly by cognitive impairment: Level 2 (1 staff per 6) serves mild to moderate impairment and Level 3 (1 staff per 4) serves moderate to severe impairment.

What space does an Indiana adult day center need?

FSSA's standards call for 100 square feet per participant including staff offices (60 excluding them), at least one toilet per 10 participants, a quiet room with a bed, an exam or medication room, bathing facilities, a kitchen and safe outdoor space. The IHCP module ties these standards to the higher Category 1 rate, while the FSSA service definition says each facility must have them, so ask OMPP which applies.

Is transportation to adult day paid separately in Indiana?

Yes. Transportation is a separate waiver service, including a round-trip Adult Day Service Transportation service, billed by certified transportation providers. FSSA suggests adult day providers also apply to be certified for Transportation.

What background checks and health screening do adult day staff need in Indiana?

Each employee in management, administration or direct service needs a limited criminal history check, unlicensed direct care staff need a clear nurse aide registry check, and certain convictions bar hiring. Direct care staff need a TB test on hire, yearly TB education and CPR and first aid certification.

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