All states: adult day services map

Kentucky adult day services at a glance

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

How is adult day care regulated in Kentucky?

Kentucky licenses one kind of adult day program: adult day health care (ADHC), licensed by the Office of Inspector General (OIG) in the Cabinet for Health and Family Services. The state once certified social model adult day centers too, but that statute and its rules have been repealed, and we did not find any current state license for a social-only program. Medicaid pays for adult day health care through several waivers, and each waiver relies on the OIG license.

Three layers of rules can apply to a Kentucky center, and each comes from a different agency:

• Licensing (OIG). KRS 216B.0441 defines an adult day health care program as one licensed by the Cabinet that provides organized health care during daytime hours, for people of any age. The program rules are 902 KAR 20:066, and license procedures and fees are in 902 KAR 20:008. OIG's Division of Certificate of Need reviews proposals for new programs.
• Medicaid (Department for Medicaid Services, DMS). DMS sets the waiver rules. The Home and Community Based (HCB) waiver (907 KAR 7:010) is operated by the Department for Aging and Independent Living (DAIL). The Michelle P. Waiver (907 KAR 1:835) and the Supports for Community Living (SCL) waiver involve the Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID). The two acquired brain injury (ABI) waivers are run by the DMS Acquired Brain Injury Branch. DMS also covers PACE.
• Other funding. DAIL runs a state Homecare program for older adults through Area Development Districts, and the U.S. Department of Veterans Affairs pays for adult day health care for some veterans. Neither sets its own adult day center standards that we found.

A few program names to know. Adult day health care is the licensed health model, which can include supervision of self-administered medication, nursing, personal care, self-care training and social activities. Adult day training is a separate skills-focused day service in the Michelle P., ABI and ABI long term care waivers, and it must not be only diversional. SCL day training may be provided in a licensed ADHC center for participants 21 or older who need skilled nursing or nursing supervision.

Where the layers overlap, licensing defines the model and is the only layer that applies to every payer. Medicaid adds participant rules (age 21 or older and nursing facility level of care for the HCB waiver), nurse presence and stricter records. We did not find a dementia-specific adult day license or certification.

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

Yes, if your program provides adult day health care. KRS 216B.0441 says no person or organization may operate an adult day health care program without a license, and the law has no exception for private pay. New programs also go through Certificate of Need review with OIG. We did not find a current state license for a social-only program.

The license. OIG licenses ADHC programs under 902 KAR 20:066, which was amended effective February 17, 2026. A program that provides nursing services must hold a license that includes nursing services. You request this on the license application form, and OIG may survey the program before issuing the amended license (Section 4).

Certificate of Need. Proposals to establish an adult day health care program go through Certificate of Need review by the OIG Division of Certificate of Need, under KRS Chapter 216B and the State Health Plan. OIG's March 2026 Certificate of Need notice listed two adult day health care proposals for decision by June 17, 2026 and two more applications received in February and March 2026. Affected persons may ask for a public hearing within 10 days of notice. We did not find a moratorium. We also did not confirm the State Health Plan's review criteria for adult day health care, or whether Certificate of Need applies to a program that will never bill Medicaid, so ask the Division of Certificate of Need early.

Fees. The fee schedule in 902 KAR 20:008 lists "Day health care" at $170 for the initial and annual fee. It does not say "adult day health care" and has no other adult day entry, so confirm the amount with OIG. Plans review for construction or renovation costs $0.10 per square foot, with a $200 minimum.

Provisional license and inspections. After a provisional license, OIG makes an unannounced inspection within three months. Other inspections may be unannounced or follow a complaint. We did not find a set routine inspection schedule for this license category.

One license per site. Only one license may be issued for a licensure category at a specific location, so each site is licensed separately (902 KAR 20:008 Section 2).

Renewal. Licenses expire one year from their effective date and are renewed each year. A late renewal costs a penalty of 20 percent of the renewal fee or $25, whichever is greater.

Buying a center. A change of ownership of more than 25 percent of the facility, or of the owning entity's equity or voting rights, must be reported to OIG in writing within 30 calendar days after it takes effect. A new provisional license is not required. If the center bills Medicaid, ask DMS what it needs from the new owner as well.

Local permits. We did not find local health, occupancy or fire permit prerequisites in the current adult day rules. Check with your city or county and with OIG.

Before billing Medicaid. The DMS provider type 43 summary says an in-state ADHC needs an OIG license, a Certificate of Need, DMS certification, a CLIA certificate and an NPI, and applies through the KY Medicaid Partner Portal. DMS or its designee certifies and recertifies waiver providers, investigates complaints and can require corrective action plans (907 KAR 7:005).

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

No current Kentucky rule sets a numeric staff-to-participant ratio for adult day health care. The licensing rule requires enough qualified staff to meet participants' needs, and the HCB waiver requires an RN or LPN to be present and a supervisor to be available at all times. We did not find a separate ratio for participants with dementia.

• Licensing (OIG): no ratio specified. Programs must have sufficient qualified staff to meet service needs, and supportive staff, assistants and volunteers must be supervised (902 KAR 20:066 Section 2).
• Medicaid (HCB waiver): no ratio specified. An RN or LPN must be present and provide skilled nursing during posted hours, and a staff supervisor must be available at all times (907 KAR 7:010). The Michelle P. Waiver also requires skilled nursing by an RN, or by an LPN under RN supervision.
• Medicaid (brain injury waivers, adult day training only): adult day training under the ABI and ABI long term care waivers may not exceed 5 participants per staff person (907 KAR 3:090 and 907 KAR 3:210). The ABI waiver allows an exception when a participant needs individualized special service. This is a specialized rehabilitation day service that an ADHC center may provide; it is not a ratio for adult day health care.
• Other funding: we did not find staffing standards from any other funding source.

Minimum staff and who counts. We did not find a minimum number of staff on site regardless of census, staffing that scales with census, nurse hours tied to census, or a rule on who counts toward a ratio.

Administrator. The administrator must have at least two years of college or equivalent training plus two years of clinical experience, or a degree or health-related license, or be a licensed nursing home administrator. A coordinator must be named for dietary services and for activities.

Training. Licensing requires orientation and planned in-service training, with no set hours, and current CPR certification (American Heart Association or American Red Cross) for every employee with direct care duties. Under the HCB waiver, staff must be trained before providing services on abuse, neglect and exploitation, how to report it, person-centered planning and documentation, and must complete CPR and first aid within six months of hire.

Background checks and drug tests. We did not find a background check requirement in the licensing rule. The HCB waiver requires pre-hire checks of criminal records, the Nurse Aide Abuse Registry and the Caregiver Misconduct Registry, a Central Registry check within 30 days of hire, and a passed drug test. Michelle P. Waiver providers must also check the Vulnerable Adult Maltreatment Registry for potential employees.

Health screening. Licensing requires a TB test before or within the first week of employment and every year after. The HCB waiver requires a TB risk assessment.

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

Every licensed adult day health care program provides health monitoring, first aid, personal care, self-care training, a written activity program and a daily rest period, and serves at least one hot meal a day. Centers that bill the HCB waiver must also provide skilled nursing with a nurse present during posted hours. Transportation is optional under the license.

Services (licensing). Under 902 KAR 20:066 Sections 3 and 5, programs provide health monitoring (including supervision of self-administered medication), first aid and arranging medical care, personal care, self-care training, a written activity program covering four categories, and a daily rest period. Physical therapy, speech therapy and nursing services need a written order.

Services (Medicaid). HCB waiver participants must be at least 21. During posted hours the center provides skilled nursing, an RN or LPN on site, at least one meal a day with therapeutic diets, snacks, activities suited to age and diagnosis, and routine care such as vital signs and help with daily living activities (907 KAR 7:010 Section 5). State law also says skilled nursing for Medicaid recipients is provided only during posted hours (KRS 205.635).

Meals. Licensing requires one or more hot meals a day, each meeting at least one third of daily nutritional needs, which is stricter than the Medicaid rule of one meal plus snacks.

Transportation. A licensed program does not have to offer transportation. If it does, it must accommodate wheelchair users and provide an escort when needed. We did not find a transportation requirement for ADHC under the HCB waiver.

Space. The rule requires adequate space for participants' needs and comfort, and a place where an ill participant can rest in comfort and privacy. Programs with nursing services need a treatment room of at least 120 square feet with a hand-washing sink, plus a workroom or closet. We did not find a square feet per participant figure, a restroom ratio, a method for setting licensed capacity, or dementia space rules.

Hours. We did not find a minimum number of days or hours a center must be open. Medicaid pays only for time during the center's posted hours, and HCB centers must give participants written notice of their hours and policies.

Written policies. The licensee must adopt written policies on:

• A description of services, first aid and arranging medical care, and transport of patients in an emergency.
• Admission, evaluation of needs and discharge.
• Reporting abuse, neglect or exploitation to the Cabinet under KRS Chapters 209 and 620.
• Protection of and accounting for patients, and infection control consistent with CDC guidelines.
• Medication storage and administration, including controlled substance records, and prompt access to pharmacy services for programs with nursing.
• Care of children if children attend, and waste disposal.

Written job descriptions must be reviewed every year. HCB waiver centers also need policies for nursing and medical procedures. We did not find a required review cycle for other policies, a required quality committee, or an emergency drill frequency.

What rules protect participants in Kentucky adult day centers?

Licensing requires an evaluation and a care plan at admission, a medical history and physical in each record, and records kept at least five years. The Medicaid waivers add an annual level of care and plan cycle, 30 days written notice before an involuntary discharge, and fast incident reporting. In each case the Medicaid rule is the stricter one.

Admission and care plan (licensing). Each patient is evaluated on admission and a care plan is developed. The record includes a history and physical exam report, allergies, and the names of the physician and next of kin.

Enrollment and plan (Medicaid). HCB waiver services require nursing facility level of care, redetermined at least every 12 months, an approved person-centered service plan and prior authorization. The ADHC plan of treatment is developed each year from the assessment and signed by each team member and the participant. As of September 2, 2025, the HCB waiver had 5,360 people on its waiting list.

Discharge. The licensing rule requires a written admission and discharge policy but sets no discharge reasons or notice period that we found. Under the HCB waiver, a provider ending services involuntarily must give written notice at least 30 days ahead to the participant, case manager, assessor and DMS, with appeal rights and help with the transition (907 KAR 7:010 Section 10).

Records. Licensed programs keep records at least five years, or for minors three years after they reach majority if that is longer, plus a permanent registry of admissions and discharges. HCB waiver providers keep fiscal, service and critical incident records at least six years from the date of service.

Incidents. Licensing requires written incident and accident reports signed by the administrator or a designee, but we did not find a deadline for reporting incidents to OIG. Under the HCB waiver, suspected abuse, neglect or exploitation is reported immediately in the Medicaid Waiver Management Application (MWMA), and other critical incidents within 8 hours of discovery, followed by an investigation report from the provider.

What we did not find. We did not find a TB screening requirement for participants, required contents for an enrollment agreement, or licensing discharge reasons. Families should ask the center for its written admission, discharge and fee policies.

How does Medicaid pay for adult day in Kentucky?

Kentucky Medicaid pays licensed adult day health care centers through 1915(c) waivers in 15-minute units under code S5100. The HCB waiver pays $3.82 per unit for Level I and $4.15 per unit for Level II (S5100 U1), effective January 1, 2025. PACE also covers adult day center care for eligible people in its service areas.

• Home and Community Based (HCB) waiver. Run by DMS with DAIL as operating agency, for people 21 or older who meet nursing facility level of care. ADHC Level I is $3.82 and Level II is $4.15 per 15 minutes, from the DMS 2025 HCBS rate schedule. Level II requires meeting the K-HAT Level II High Intensity criteria. ADHC is limited to 200 units a week and cannot be billed at the same time as other services. The waiver was renewed effective August 1, 2025, through July 31, 2030, and has a waiting list.
• Michelle P. Waiver. For people with intellectual or developmental disabilities, administered by DBHDID. ADHC (S5100) pays $3.82 and adult day training (T2021) pays $3.62 per 15 minutes. ADHC and adult day training are limited to 40 hours a week, and the waiver has a $63,000 yearly cap across all services.
• ABI long term care waiver. Covers ADHC from a licensed center at $3.86 per 15 minutes and adult day training at $4.88 per 15 minutes, up to 160 units a calendar week (907 KAR 3:210).
• ABI waiver. Covers adult day training only, at $4.88 per 15 minutes, which a department-certified licensed ADHC center may provide.
• SCL waiver. Day training provided in a licensed ADHC center, for participants 21 or older who need skilled nursing or nursing supervision, pays $3.99 per 15 minutes (S5100) (907 KAR 12:010).
• PACE. Covered under 907 KAR 3:250 for people 55 or older who meet nursing facility level of care and live in a PACE service area. Each PACE center offers primary care, social services, therapies, personal care, nutrition counseling, recreational therapy and meals. The DMS list of enrolled PACE organizations (updated December 9, 2024) names nine, each limited to listed counties. PACE is paid a set monthly amount per member, not by the unit.

Posted hours. ADHC is paid only for services delivered on site during the center's posted hours. Payments for time outside posted hours are taken back (907 KAR 7:015).

Transportation. We did not find whether transportation to adult day health care is billed separately. The SCL fee schedule lists a separate transportation service, but we did not confirm that it applies to day training at an ADHC. Ask DMS or the waiver's operating agency.

Attendance documentation. HCB waiver centers keep a sign-in and sign-out log showing the service date, duration, arrival and departure times, a description of the service, and the staff member's name, title and signature, plus a monthly progress note. Michelle P. Waiver ADHC records must show date, duration, services and arrival and departure times, not counting travel, and adult day training needs a time and attendance record with begin and end times and location. The licensing rule requires only an admissions and discharge registry, not a daily attendance log. We did not find a requirement to capture adult day attendance electronically.

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

Yes. A center can be fully private pay, but if it provides adult day health care it still needs an OIG license, because KRS 216B.0441 has no payer exception. The old state certification for social model centers, including the private pay Adult Day and Alzheimer's Respite rule (910 KAR 1:150), is repealed, and we did not find a current state license for a social-only program.

Where the line falls. We did not find a rule that says exactly which services, such as personal care, nursing or help with medication, a program may offer without an ADHC license. Because the licensed model is defined as organized health care, check with OIG before offering any health-related service in an unlicensed program.

Private-pay protections. We did not find contract or fee disclosure rules for private-pay participants. A licensed program still needs written policies on services, admission and discharge, and patient protection.

Other funding.

• DAIL Homecare. Under 910 KAR 1:180, independent care coordinators include adult day health services when they decide eligibility for services, but the program's list of homecare services does not include adult day and it sets no adult day provider standards.
• Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical criteria, through VA medical centers, State Veterans Homes or community organizations. The VA page lists no Kentucky-specific programs.
• Older Americans Act and state funds. We did not find current Older Americans Act or state general fund adult day standards, or confirm that any such program still pays for adult day. Your local Area Development District can tell you what is available.

The market. OIG's Miscellaneous Directory, updated monthly, listed 112 adult day health programs when checked in October 2026, each with its own facility ID and license expiration date. The state association is the Kentucky Association of Adult Day Centers (KAAD).

What is changing next for adult day in Kentucky?

As of our last check on October 21, 2026, we did not find a confirmed upcoming change to Kentucky's adult day licensing rules or Medicaid adult day rates. The Cabinet has announced plans to align waiver waiting list rules across its 1915(c) waivers, but no final rule or effective date has been published. Several recent changes are already in effect.

• Waiver waiting list alignment (announced, not final). In a September 2025 update to legislators, the Cabinet said it plans to align waiting list regulations and policies across all 1915(c) waivers, on a work timeline running into 2027, and that it has drafted regulations to clarify waiver eligibility processes. Watch for proposed rules from DMS.
• Licensing rule amended, February 17, 2026. 902 KAR 20:066 was amended and certified effective February 17, 2026, and now runs to February 17, 2033. We did not compare it with the earlier version, so this page describes the current text only.
• HCB waiver renewed, August 1, 2025. The renewed waiver runs to July 31, 2030. The HCB service rule (907 KAR 7:010) had not been amended after the renewal as of our check.
• HCB rate increase, January 1, 2025. HCB waiver ADHC rates rose to $3.82 (Level I) and $4.15 (Level II) per 15-minute unit, from $2.83 and $3.43.

Kentucky adult day sources

• KRS 216B.0441: adult day health care program license
• KRS 205.950: certification of adult day care centers (repealed 2020)
• 902 KAR 20:066: adult day health care program operation and services
• 902 KAR 20:008: license procedures and fee schedule
• OIG Division of Certificate of Need: March 2026 newsletter
• 907 KAR 7:010: HCB waiver services and provider requirements
• 907 KAR 7:015: HCB waiver reimbursement
• DMS: 2025 HCBS waiver rate schedule
• DMS: Adult Day Health Care provider type 43 summary
• OIG: Miscellaneous Directory (licensed adult day health programs)

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
• Simplifying Payments with Electronic Billing for Adult Day Care
• Podcast: Adding Adult Day Services to Home Care Brings Synergy and Margins
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states with no state adult day license

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