All states: adult day services map
In short: LDH licenses adult day health care (1 aide per 9) and HCBS adult day care (1 staff per 8); Medicaid ADHC pays per 15 minutes. Change ahead: Louisiana has proposed an amendment to the Adult Day Health Care Waiver and a revised reimbursement section of its manual. CMS approval and an effective date have not been published.
| License or certification | Yes. Every adult day health care (ADHC) center needs an LDH license, any payer. Adult day care (ADC) programs need one at 10 or more adults. |
|---|---|
| Who licenses or certifies | Louisiana Department of Health (LDH), Health Standards Section |
| Adult day care vs adult day health | Separate. ADHC is the medical model (LAC 48:I Chapter 42). ADC is a module of the HCBS provider license covering day habilitation and prevocational services. |
| Strictest staffing ratio | 1 staff per 8 clients in HCBS adult day care; ADHC centers need 1 direct service worker per 9 participants plus a nurse on site daily |
| Dementia ratio | No ratio specified |
| Medicaid programs | Adult Day Health Care Waiver; Community Choices Waiver; PACE |
| Medicaid billing unit | Per quarter hour (15 minutes) for ADHC services, with transportation built into the rate. Current rate not confirmed. |
| Licensed centers | Not confirmed |
Last verified against state sources: 2026-10-21.
Louisiana has two separate licensed adult day models, and the Louisiana Department of Health (LDH) Health Standards Section licenses both. Adult day health care (ADHC) is the medical model, with nursing, social services, meals and transportation. Adult day care (ADC) is a module of LDH's home and community-based services (HCBS) provider license and covers day habilitation and prevocational services. Medicaid pays for adult day health care through two waivers, and it pays only licensed ADHC centers for that service.
Three layers of rules can apply, and each comes from a different agency:
Adult day health care. The rules define ADHC as a medical model program that provides medical, nursing, social and personal care services to adults with physical, mental or functional impairments, using licensed professionals. An ADHC center is any place that serves two or more unrelated functionally impaired adults with these services and is open at least five continuous hours a day (LAC 48:I.4203).
Adult day care. Under R.S. 40:2120.2, adult day care is a group program for 10 or more functionally impaired adults who are not related to the owner or operator. The ADC module offers two programs: day habilitation (for clients 17 or older who have a developmental disability or are functionally impaired adults) and prevocational services. The applicant must say which it provides (LAC 48:I.5071).
We did not find a separate dementia license or a state rule for a social model senior day program outside the ADC module. Where the layers overlap, the ADHC licensing rules are the more demanding model, since nursing, social services, a dietitian, meals and transportation are all required. Medicaid does not add a separate model. It pays licensed ADHC centers and adds its own eligibility, hour limits and attendance rules.
Yes, for any adult day health care center. LDH is the only licensing authority for ADHC in Louisiana, and it is unlawful to operate an ADHC center without a current license, whoever pays. An adult day care program needs an HCBS license with the adult day care module once it serves 10 or more functionally impaired adults who are not related to the owner.
The ADHC license. Under LAC 48:I.4205, the license is issued to the named entity, is valid only at the specific address, lasts one year, cannot be sold or transferred, and must be posted.
How to apply for an ADHC license. The initial packet (LAC 48:I.4207) includes:
An incomplete packet must be completed within 90 days or the application closes. After LDH approves the packet, you have 90 days to request the announced initial licensing survey (LAC 48:I.4207 and 4209). LDH's ADHC licensing page also asks applicants to get any local approvals their area requires, such as zoning, an occupational license and local fire ordinance approval.
Fees. LDH's ADHC licensing page lists a $600 initial application fee and a $600 renewal fee. We did not find the fee for an HCBS license with the adult day care module, so ask LDH.
The HCBS adult day care module. LDH licenses adult day care as one module of a single HCBS provider license. Applicants must complete LDH's regulatory training videos and include the certificates with the application before LDH authorizes an initial survey. An HCBS provider with adult day care services may apply for satellite locations, generally in the same LDH region.
Facility need review and location limits. The current ADHC rules contain no facility need review requirement (Louisiana's prior approval process for some provider types), and the facility need review rule (LAC 48:I.12501) does not list ADHC. The adult day care module is also not on LDH's list of HCBS modules that need it. One location rule does apply: a new ADHC center may not be within 1,500 feet of another ADHC center unless both are owned and managed by the same organization. An ADHC inside another LDH-licensed program needs its own staff, space and storage (LAC 48:I.4295).
Buying a center. An ADHC license cannot be sold or transferred. On a change of ownership, the center must notify the Health Standards Section in writing at least 15 days before the effective date and send the signed transfer document, and the new owner files a new application with the change of ownership fee. A center under revocation, renewal or provisional licensure cannot change ownership. Changes in name, address, contact information or key staff must be reported within five working days (LAC 48:I.4215).
Renewal and inspections. The ADHC renewal packet is due at least 30 days before the license expires, with current fire and health inspection reports, the fee and proof of the $50,000 line of credit (LAC 48:I.4213). After the initial survey, licensing surveys are unannounced and happen at intervals LDH decides. We did not find a fixed schedule, such as yearly. An ADHC owned and run by a PACE organization may ask for accredited status, which LDH may accept in place of periodic on-site surveys.
Medicaid enrollment. To bill Medicaid for ADHC services, a center must hold the ADHC license and also enroll as an ADHC Medicaid provider.
Louisiana sets a different ratio for each licensed model. An adult day health care center needs at least one full-time direct service worker for every 9 participants, plus a nurse on site daily. An HCBS adult day care facility needs at least one staff person for every 8 clients, or more if a client's service plan requires it. Medicaid sets no ratio of its own, and we did not find a dementia ratio in any layer.
Nurse on site. Whatever its size, an ADHC center must have an RN or LPN on the premises every day for at least eight hours, the hours the center is open, or the time participants are present, whichever is less. After eight hours the nurse may leave if a key staff person (the social service designee or program manager) stays. A CPR-certified staff member must be on site whenever participants are present. Nurses supplied by an agency must come from a licensed nurse staffing agency.
Required ADHC positions.
Staff that scale with capacity. ADHC key staff depend on licensed capacity: at least one full-time person or equivalent for 15 or fewer participants (one person may fill up to three key positions), at least two for 16 to 30, and at least three for more than 30, with each key position filled by a full-time person or equivalent.
Who counts toward the ratio. The ADHC ratio counts direct service workers, which the rule defines as unlicensed staff. Volunteers and student interns supplement required staffing and must be directly supervised by paid staff. The rule does not say whether a nurse or the director counts toward the 1:9 ratio.
Training. Each ADHC direct care staff member completes at least 20 hours of face-to-face training a year, not counting orientation or supervision, including annual training on participant care, emergency procedures, participant rights, abuse reporting, behavior and crisis management, and the center's social media policy (LAC 48:I.4261). In an adult day care facility, supervisors need yearly training in supervisory and management techniques, and the facility needs a training supervisor with at least 15 hours a year of vocational or community-based employment training.
Background checks and health screening. Before offering a job to direct care staff, an ADHC center must check the Direct Service Worker Registry, get a statewide Louisiana State Police criminal background check and get three references. Staff health assessments must show freedom from active tuberculosis, with retesting on the Office of Public Health schedule (LAC 48:I.4259). We did not find any required vaccinations beyond TB screening.
An adult day health care center must be open at least five hours a day, five days a week, and must provide nursing, help with daily activities, exercise, recreation, health education, a hot meal and two snacks, and transportation to and from the center. An HCBS adult day care program must be open at least five hours on the days it operates, but meals are optional there.
ADHC core services. Under LAC 48:I.4243, an ADHC center provides:
The center runs a planned daily program of individual and group activities and gives participants and families a detailed description on request. The RN reviews medications monthly and gives health in-service training each quarter.
Meals. The ADHC noon meal must provide one third of the recommended dietary allowances, with a mid-afternoon snack, and a mid-morning snack where breakfast is not served. A licensed registered dietitian approves menus in advance and reviews special diet orders (LAC 48:I.4253). An adult day care facility does not have to serve meals, but if it prepares or contracts meals it must meet menu, diet and sanitation rules, and it must arrange food for clients who do not bring lunch.
Transportation. Transportation is required for ADHC centers. The center transports participants in its licensed region at the start and end of the program day, with no trip longer than one hour. A staff member trained in first aid and CPR rides in the vehicle, and drivers need a chauffeur's license or CDL if applicable. Any mileage radius limit needs LDH approval (LAC 48:I.4245).
Space and capacity.
Medicaid limits. Medicaid ADHC services follow a regular schedule of no more than 10 hours a day and 50 hours a week, and include escorted trips to medical and social activities (LAC 50:XXI.2301). ADHC Waiver participants must attend at least 36 days per calendar quarter unless their support coordinator approves an exception.
Written policies. An ADHC center needs a statement of philosophy and goals, a written program plan, and policies for all areas of care, including admission, transfer and discharge, records access and release, protection of participants' money and belongings, grievances (with LDH's toll-free complaint number posted), personnel, volunteers and interns, incident reporting, emergencies and evacuation, and family notification in an emergency. Policies are developed with a group that includes at least a licensed physician, the director and an RN, reviewed by that group at least once a year and approved by the governing body. A governing body with more than one member meets formally at least twice a year (LAC 48:I.4225 and 4227).
Safety. ADHC centers hold emergency drills at least once every three months and post emergency phone numbers, the license and the LDH complaint number. Adult day care facilities hold and document fire drills at least once a quarter.
Louisiana ADHC rules require admission information that includes a nursing assessment, an individualized service plan within 20 days of admission, quarterly reassessment, an attendance log, and written discharge policies. Incidents must be written up and reviewed within 24 hours. We did not find a required notice period for involuntary discharge.
Admission. Under LAC 48:I.4273, admission information includes the participant's physician and date of last physical exam, a social history, and a nursing assessment by the center's RN or LPN covering diet, medications, allergies, mobility, cognition, continence, self-care and self-medication. A current interRAI Home Care assessment can replace the nursing assessment summary. Admission may not be refused based on race, sex or ethnic origin.
Medicaid eligibility. For the ADHC Waiver, a person must be eligible for long-term care Medicaid, meet nursing facility level of care, and be 22 or older.
Service plan. An interdisciplinary team (the RN, the social service designee or social worker, and at least one direct care staff member, working with the participant or family) develops the individualized service plan before or within 20 days of admission. The team reassesses the participant and updates the plan at least every quarter.
Discharge. The center needs written voluntary and non-voluntary discharge policies, a written report on each discharge, an aftercare plan before a planned discharge, and a discharge health summary for the next provider (LAC 48:I.4275). A participant can be discharged from the ADHC Waiver for attending fewer than 36 days in a calendar quarter, among other reasons.
Rights and grievances. Participants must be told their rights and responsibilities, and may file a grievance with the center or a complaint with LDH.
Attendance and records. Each ADHC participant record includes a log of attendance and absence, physician orders, the service plan and progress notes. Staff who provide direct services write progress notes at least weekly and note any change on the day it happens. Records may be paper or electronic. The active record holds at least six months of current information, and records are kept and disposed of according to state law. Personnel files are kept at least three years after an employee leaves.
Incidents. An incident report is required for accidents and injuries, events that may affect other participants, elopement or unknown whereabouts, and suspected abuse. The director, a designee or a medical professional reviews each report within 24 hours, and the interdisciplinary team reviews all reports each quarter to spot patterns and training needs (LAC 48:I.4269). LDH must be told immediately of any fire, disaster or emergency that endangers participants, and the Health Standards Section by the next business day of any emergency interruption of services. For waiver participants, the center also reports incidents to the department within its timelines, but we did not find the exact deadline.
What we did not find. We did not find a TB screening or physician order required for admission (physician orders are required for medications and treatments), a set notice period for involuntary discharge, or required contents for an enrollment agreement. Families should ask a center for its written admission and discharge policies.
Louisiana Medicaid pays licensed adult day health care centers through the Adult Day Health Care Waiver and the Community Choices Waiver, both run by the LDH Office of Aging and Adult Services (OAAS). Centers are paid a per quarter hour (15 minute) rate set from their cost reports, with a provider-specific transportation amount built in. PACE also covers adult day center care in four areas of the state.
Important: We could not load Louisiana Medicaid's current adult day health care fee schedules, so this page does not give a rate. Ask OAAS or check the fee schedules on the Louisiana Medicaid provider site before you build a budget.
Adult Day Health Care Waiver. This 1915(c) waiver (LA.0121) is run by OAAS with the Bureau of Health Services Financing.
Community Choices Waiver. ADHC services are also part of this 1915(c) waiver (LA.0866), limited to 10 hours a day and 50 hours a week with transportation included. The per quarter hour unit comes from the general ADHC reimbursement rule. We did not confirm the Community Choices Waiver code or rate.
Transportation. Transportation is not billed as a separate service. Each center's rate includes a provider-specific transportation component.
PACE. PACE serves people 55 and older who meet nursing facility level of care and live in a service area. Providers operate in the Greater New Orleans, Baton Rouge, Lafayette and Alexandria areas. PACE is paid a set amount per member per month for Medicaid enrollees, so adult day is not billed by the unit.
Attendance documentation. Louisiana's Medicaid Services Manual, Chapter 9, Section 9.7 requires centers to check waiver participants in electronically when they arrive and out when they leave, using the state data contractor's system (LaSRS) or another system approved by the state. The manual calls this electronic visit verification. Payment authorization is released only after this check-in and check-out is recorded, and manual edits should be occasional. The transportation part of the service is exempt, although recording vehicle on and off times is encouraged. Health status monitoring calls are also checked in electronically. Attendance reported on cost reports must be backed by daily attendance records available for audit, and cost report records are kept at least six years.
Yes, a center can be fully private pay, but the licensing rules still apply. Any place that provides adult day health care to two or more unrelated functionally impaired adults needs an LDH ADHC license, with no exemption based on who pays. An adult day care program for 10 or more unrelated functionally impaired adults needs the HCBS license, again regardless of payer.
Exemptions. The HCBS statute (R.S. 40:2120.2) exempts some providers, including those offering free services and those providing only meals, sitter services or housekeeping. A program for fewer than 10 adults falls outside the adult day care definition, but we did not find rules saying what such a program may or may not do, such as personal care or medication help. Ask the LDH Health Standards Section before you open one.
Protections for private-pay participants. ADHC participants get the same rights statement, grievance process and posted LDH complaint number as everyone else, and the center must disclose financial transactions involving governing body members or their families. We did not find a fee disclosure or enrollment contract rule for private-pay participants, or a rule barring discrimination based on how someone pays.
Other funding. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical need and community care rules, through VA medical centers, State Veterans Homes or community organizations, with a possible copay. We did not confirm a Louisiana VA adult day site. The Governor's Office of Elderly Affairs oversees Older Americans Act funds through area agencies on aging, but we did not confirm whether those funds currently pay for adult day. Your local council on aging or area agency on aging can tell you what is available in your parish. We did not find a state general fund adult day program.
The market. We did not find a published count of licensed ADHC centers or adult day care providers, or a Louisiana adult day services association. LDH's Health Standards Section keeps provider directories.
Louisiana has proposed an amendment to the Adult Day Health Care Waiver and a revised reimbursement section of its Medicaid manual. As of our last check on October 21, 2026, we did not find CMS approval or an effective date for either, so neither should be treated as final.
We could not confirm what happened to ADHC rates after a temporary federally funded rate increase that was proposed to end in March 2025. If you rely on Medicaid payment, ask OAAS for the current rate.
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Questions about Louisiana adult day rules are best put to the state. Start with LDH Health Standards Section: Adult Day Health Care. The state lists this contact: LDH Health Standards Section, Adult Day Health Care: 225-342-6298; HCBS program desk: 225-219-9776.
Arizona, Arkansas, Minnesota, New Hampshire, Virginia. See every state on the adult day services map.
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.
