Adult Day Care Maryland

All states: adult day services map

Maryland adult day services at a glance

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

How is adult day care regulated in Maryland?

Maryland licenses one kind of adult day center: the adult medical day care center (often shortened to AMDC or medical day care), licensed by the Office of Health Care Quality (OHCQ) in the Maryland Department of Health. Social model programs that provide only meals or diversion activities are excluded from licensure. A social program can still serve Medicaid participants through Senior Center Plus, a non-medical day program approved by the Maryland Department of Aging and paid under a Medicaid waiver.

State law describes two kinds of licensed center, and one set of rules covers both. A day care center for the elderly (Health-General Article 14-201) cares for 4 or more people age 55 or older with a qualifying disability who need daytime supervision. A day care center for adults (Health-General Article 14-301) cares for 4 or more medically handicapped adults age 16 or older. Either kind can also be a family home serving 2 or 3 people.

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

• Licensing (OHCQ). COMAR 10.12.04, Day Care for the Elderly and Adults with a Medical Disability, adopted effective December 13, 2014. It covers every adult medical day care center, whatever the payer. It does not cover informal care by relatives, neighbors or friends, nutrition sites, senior centers run under the Department of Aging, or social model programs that provide meals or diversion activities (10.12.04.01).
• Medicaid (Maryland Department of Health, Medicaid Administration). COMAR 10.09.07, Medical Day Care Services, sets the provider and billing rules for licensed centers. Medicaid pays for medical day care through the Medical Day Care Services Waiver (COMAR 10.09.61), the Home and Community-Based Options Waiver (COMAR 10.09.54), the Increased Community Services program (COMAR 10.09.81) and PACE.
• Funding program (Maryland Department of Aging). Senior Center Plus providers must be approved and monitored by the Department of Aging as a nutrition service provider (COMAR 10.09.54.07). We did not find written Department of Aging program standards for Senior Center Plus, so the Medicaid waiver rules are the only written standards we could confirm.

For medical day care, the OHCQ licensing rules govern how a center operates, and Medicaid adds staff positions, a quality assurance program and billing rules on top. We did not find a separate license for dementia care.

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

Yes, if you will run a medical model adult day center. No one may establish or operate one without an OHCQ license, whoever pays for care, and each center on separate premises needs its own license even under common management (COMAR 10.12.04.03). Licenses last 2 years. A social program that provides only meals or diversion activities does not need an OHCQ license.

How to apply. Under COMAR 10.12.04.04:

• Submit a letter of interest to OHCQ describing your policies, ownership, job descriptions, hours, expected census and staffing plan, with proof that your structural plans went to the Department's Plans Review and Approval Unit.
• Wait for OHCQ to approve the letter. Only then do you file the license application.
• OHCQ interviews the applicant and inspects the site before licensing.

Building and local codes. A new center must meet federal, State and local building, zoning, fire, food, safety and health codes and the Americans with Disabilities Act. Centers should be at street level, and a center that is not needs OHCQ approval before design (10.12.04.28).

Fees. OHCQ's letter of interest form says there is no fee to apply for a license. We did not find a renewal fee in the rule. We could not read the current application form, so confirm with OHCQ that no fee applies.

Medicaid enrollment. To bill Medicaid, a center must hold the COMAR 10.12.04 license and sign a provider agreement with the Department (COMAR 10.09.07.02).

Certificate of need. We did not find a certificate of need requirement or a moratorium for adult medical day care. Ask OHCQ before you sign a lease.

One license per site. The license must be posted, and a center may not serve more participants than its licensed capacity. Capacity increases need Department approval.

Buying a center. Licenses cannot be transferred to another place or person. A license becomes void on sale or lease, on closure for more than 30 days in a row, or on relocation. Under 10.12.04.05, a change of ownership creates a new program that needs a new license. The current licensee must give OHCQ written notice at least 45 days before a change of ownership, location, closure or sale, the new owner must apply at least 45 days before the transfer, and participants must get 45 days' written notice.

Renewal and inspections. Centers are open to announced or unannounced inspections at any reasonable time (10.12.04.07). On its adult medical day care page, OHCQ says it conducts prelicensure, licensure, biannual, change of ownership and follow-up surveys and investigates complaints and self-reported incidents. Its September 2026 presentation reported 76 biennial surveys and 9 initial surveys in fiscal year 2026, which fits a survey at each 2-year license cycle.

Operating without a license. Running an unlicensed medical day center can bring a civil money penalty of up to $10,000 per violation (10.12.04.50).

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

Maryland's licensing rule sets a minimum of 1 staff member for every 7 participants, but the rule says that ratio applies for 2 years after the subsection was adopted. After that, staffing is set by each participant's needs as measured in the state's ADCAPS assessment, and staffing must always be enough to meet those needs. Senior Center Plus programs must have at least 1 staff member for every 8 clients. We did not find a separate ratio for participants with dementia.

The ratio is in COMAR 10.12.04.14. Each layer sets its own rule:

• Licensing (OHCQ): 1:7, written as a 2-year transitional ratio, then based on assessed needs. Staffing must always meet participant needs.
• Medicaid medical day care: no separate ratio. Centers must have staff able to monitor participants at all times, with the licensing rule as the minimum (COMAR 10.09.07.04).
• Senior Center Plus (Medicaid waiver and Department of Aging): at least 1 staff member per 8 clients, and the Department of Aging may require more (COMAR 10.09.54.07).

Minimum staff on site. The registered nurse (RN), who needs 3 years of health care experience, must be on site or readily available by phone. A licensed practical nurse (LPN) must be on site when the RN is not, and a certified nursing assistant (CNA) must be on site when neither nurse is. At least one staff member trained in first aid and CPR must be on site whenever participants attend and must go along on outings and off-site activities (10.12.04.19).

Staff that scale with size. A full-time director is required at a licensed capacity of 35 or more, and a part-time director is allowed at 34 or fewer. The director needs a bachelor's degree (preferably in health and human services) or an RN license. Two sites within 50 miles of each other, each with fewer than 50 participants, may share a director if each has an on-site manager.

Other required positions (licensing). A full-time activities coordinator with a high school diploma or GED and 3 years of activities or therapeutic recreation experience. Program assistants need a diploma or GED, or must be working toward one. Social work services must come from a licensed social worker (10.12.04.16).

What Medicaid adds. Medicaid providers also need a full-time or part-time licensed social worker with 1 year of adult health care experience and a full-time, part-time or contractual medical director. If the program director is not an RN, an RN must be named health director. On positions, Medicaid is the stricter layer.

Senior Center Plus. The manager or another staff member must be a licensed health professional or licensed social worker with 3 years of direct care experience and Department of Aging approved training.

Who counts toward the ratio. We did not find a rule on whether volunteers or the director count. Ask OHCQ.

Training. Staff who give individual care need at least 2 hours of training on cognitive impairment and mental illness within 90 days of hire. The center must hold at least 8 in-service sessions a year on listed topics, including dementia, infection control, emergencies and abuse reporting.

Background checks. A criminal history records check under Health-General 19-1901 is required before hire.

Health screening. Personnel records must show freedom from tuberculosis, measles, mumps, rubella and varicella. Volunteer records must show a discussion of yearly flu vaccination and TB testing (10.12.04.26).

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

A licensed Maryland medical day center provides nursing directed by an RN, meals and snacks, a daily activities program, help with daily living tasks, and transportation it provides or arranges. It must be open at least 6 hours a day, 5 days a week, and meet space and restroom minimums. Senior Center Plus programs have lighter, non-medical requirements.

Required services. Under COMAR 10.12.04.15, every center provides RN-directed nursing, consultation with participants' health care providers, coordination of mental health care, observation by an RN or LPN at least monthly, meals and snacks, an emergency medical plan, a daily activities program (exercise, rest, social interaction, personal care if needed and mental stimulation) and help with activities of daily living. When participants need them, the center must provide or arrange special diets, physical, occupational and speech therapy, licensed social work, mental health consultation and medical specialists.

Hours. At least 6 hours a day, 5 days a week, with hours posted and advance notice of planned closings (10.12.04.10). Medicaid repeats the same minimum (COMAR 10.09.07.03).

Meals. Meals scale with time at the center (10.12.04.20):

• 4 to 6 hours: 1 meal and 1 snack, meeting one third of the recommended dietary allowance.
• 7 to 8 hours: 2 meals and 1 snack, or 1 meal and 2 snacks, meeting one half.
• More than 8 hours: 2 meals and 2 snacks, meeting two thirds.

Therapeutic diets need a dietitian's approval.

Transportation. The center must provide or arrange transportation to the center, to outings and to medical appointments. Drivers need training, and no participant may ride more than 1 hour without a chance for a rest stop (10.12.04.27). For Medicaid, one-way transit time may not exceed 1 hour, and less costly transportation must be used first.

Space and capacity. Under 10.12.04.28 and 10.12.04.34:

• Activity space of 100 square feet per participant for the first 5 participants and 60 square feet for each one after that. Half of a kitchen's usable area counts if it is used for activities. Offices, reception, storage, bathrooms, utility rooms and hallways do not count.
• A rest or quiet area with visual privacy, a large group room and a private space for conversations.
• Exterior doors that lock with an automated exit alert, or a staffed exit with a log.
• At least one toilet and one handwashing sink per 10 participants, ADA compliant and within 30 feet of the main activity areas, with space to change clothes in private.

Written policies. The governing body must adopt written policies on admissions, discharges, fees, health care, hours, personnel, emergencies, disasters and epidemics, use of consultants, relationships with other agencies, medications released into the community and quality assurance, and review them every year with RN input on health policies (10.12.04.09). The center also needs written admission criteria that include nondiscrimination and a written emergency medical plan. Medicaid providers must have a quality assurance program signed and dated by the program director or designee.

Emergencies and drills. The emergency and disaster plan must cover participant safety, notifications, staff roles and continuity of operations, and evacuation plans must be posted. Fire drills are held at least every quarter on all shifts and disaster drills twice a year, with records kept 2 years. New staff are oriented within 24 hours of starting (10.12.04.29). A weekly or monthly activities calendar must be posted.

Senior Center Plus. A Senior Center Plus program must operate at least 4 hours a day on 1 or more days a week, serve at least one meal meeting one third of the recommended dietary allowance from a licensed food establishment, offer snacks if open more than 6 hours, and have a dietitian approve menus every quarter. It offers structured group recreation, supervised care, help with daily tasks and socialization, but not direct health care, transportation or a full three-meal plan (COMAR 10.09.54.15).

What rules protect participants in Maryland adult day centers?

Before someone starts at a Maryland medical day center, the center must have a written assessment from the person's health care provider and a signed service contract. An RN assesses each participant within 30 days and every 120 days after that, and the plan of care is due within 30 days. Discharge needs at least 30 days' written notice in most cases, and serious incidents must be reported to OHCQ right away.

Who can enroll. The provider's assessment must be certified within 45 days of admission and cover history, diagnoses, medications, diet, advance directives and confirmation that the person is free of communicable disease (COMAR 10.12.04.11). For Medicaid, the participant must be certified as needing a nursing facility level of care, be 16 or older, have a medical order and be enrolled in a waiver that includes medical day care (COMAR 10.09.07.01).

Service contract. A signed written contract must state the days per week and services, how goals are set, the conditions for discharge, and consents for transportation, treatment, medication administration, off-site activities, photographs and release of medical information (10.12.04.12).

Assessment and care plan. Under 10.12.04.21 and .22:

• An RN completes the first ADCAPS assessment within 30 days of admission and repeats it every 120 days.
• After a significant change, the RN reassesses by the participant's next attendance day.
• The plan of care is due within 30 days, updated within 7 days of a change in status and reviewed at least every 6 months.
• For Medicaid participants, daily nursing observations are documented for the first 5 days, then monthly.

Case management. Since March 16, 2026, every Medical Day Care Services Waiver participant gets case management from one of five authorized case management agencies, which submit plans of service to the Department. Centers no longer provide case management and must respond to the case manager's requests.

Discharge. A discharge needs a discharge plan and at least 30 days' written notice, unless the participant endangers self or others, has urgent medical needs, or an emergency requires shorter notice (10.12.04.24). We did not find discharge appeal rights in that section.

Attendance and records. Centers keep attendance records, budgets with per diem costs, the fee schedule, training records, health and fire inspection reports and audit reports. Licensing requires participant records to be kept 5 years after discharge. Medicaid requires daily attendance and transportation records and generally requires providers to keep records at least 6 years (COMAR 10.09.36.03), so Medicaid is the stricter layer on retention.

Incidents. Events that threaten health or safety, such as outbreaks, poisoning, a death, a fire, restraint use or other unusual incidents, must be reported immediately to OHCQ, to the local health officer where required, and to the participant and family. Suspected abuse, neglect, self-neglect or exploitation goes to the police, the Department and the local department of social services (10.12.04.25). An August 12, 2026 OHCQ memo requires all reportable events to go to OHCQ by online form, email (AMDC.Help@maryland.gov), phone or fax, and lists reportable incidents including non-natural deaths, elopement, injuries that may need treatment, abuse and medication errors. Neither the rule nor the memo sets an hour or day deadline beyond "immediately."

How does Medicaid pay for adult day in Maryland?

Maryland Medicaid pays licensed medical day centers a daily rate, or per diem, under procedure code S5102. The rate has been $116.59 per day since July 1, 2024, through the Medical Day Care Services Waiver and the Home and Community-Based Options Waiver. A day is paid only when the participant is present at least 4 hours. Senior Center Plus is paid $72.19 per day.

Programs.

• Medical Day Care Services Waiver: run by the Medicaid Administration's Office of Long Term Services and Supports for people 16 and older who need a nursing facility level of care. Billed per day under S5102.
• Home and Community-Based Options Waiver (Community Options Waiver): for people 18 and older at a nursing facility level of care, with a registry (waitlist). It pays for medical day care at the same per diem and for Senior Center Plus at $72.19 per day (COMAR 10.09.54.22).
• Increased Community Services (ICS): for certain nursing facility residents moving to community services. It pays medical day care at $116.59 and Senior Center Plus at $72.19 per day (COMAR 10.09.81.41).
• PACE: for people 55 and older at a nursing facility level of care, at four sites (Hopkins ElderPlus, Senior CommUnity Care of Maryland, Trinity Health PACE Montgomery County and West Baltimore PACE Community Coalition). PACE is paid a set amount per member, so adult day is not billed per visit.

Rate. The $116.59 rate comes from the Department's fiscal year 2025 rate transmittal. COMAR 10.09.07.08 provides a 4 percent increase each July 1, subject to the State budget, but we did not find a rate notice for fiscal year 2026 or 2027, and the waiver rate table amended May 11, 2026 still shows $116.59. Confirm the current rate with Medicaid before you budget.

Payment limits. Medicaid pays the lesser of the per diem or the center's customary charge to the general public, unless the service is free to people not on Medicaid. It pays only one day of care per participant per day, only for days authorized in the waiver plan of service, and not on the same day as day habilitation, PACE, Senior Center Plus or certain other services. It does not pay for participants above the center's licensed capacity (10.09.07.06).

Transportation. Transportation is a covered part of medical day care, and we found no separate transportation rate, so it is not billed on its own. Transportation is not a covered Senior Center Plus service, though a provider may offer it with other funding.

Case management. Since March 16, 2026, Medical Day Care Services Waiver case management is billed separately by case management agencies (S5103, $23.2645 per 15 minutes), not by centers. The change did not alter licensure, the per diem or covered services (Transmittal PT 64-26).

Attendance documentation. A medical day care day is paid only when the participant is certified present at least 4 hours, documented in a properly kept participant register, authorized in the waiver plan of service and supported by signed and dated progress notes (10.09.07.05). A Senior Center Plus day needs at least 4 hours of attendance, not counting transportation time. Licensing requires attendance records but does not set their format. We did not find any electronic attendance or sign-in requirement for adult day in Maryland's rules.

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

Yes. A medical day center can be fully private pay, but it still needs an OHCQ license, because the law covers centers that give care with or without charge. A social model program that provides only meals or diversion activities is excluded from licensure, so a private-pay social program can operate without an OHCQ license.

What an unlicensed social program may do. The rule frames the exclusion as programs that provide meals or diversion activities. We did not find a list of nursing or personal care tasks an unlicensed program may not perform, so ask OHCQ before adding any health or hands-on care to a social program.

Protections for private-pay participants. At a licensed center, every participant, whoever pays, gets a signed service contract, written admission criteria that include nondiscrimination, at least 30 days' written notice of discharge in most cases and 45 days' notice of an ownership change or closure. The fee schedule must be kept on file. We did not find a rule against treating people differently by payment source.

Other funding.

• Senior Center Plus. OHCQ refers social, non-medical model centers to the Maryland Department of Aging's Senior Center Plus program, (410) 767-1100 or (800) 243-3425.
• State elderly day care funds. Under Health-General Article 14-205, the Department may use funds appropriated for elderly day care to help with startup costs of new centers and to pay for care of financially eligible older adults. We did not confirm current funding amounts.
• Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who qualify for community care and meet clinical criteria, at VA medical centers, State Veterans Homes or community organizations.
• Older Americans Act. We did not confirm whether Older Americans Act funds pay for adult day in Maryland. Your local Area Agency on Aging can tell you what is available.

The market. OHCQ's licensee directory, updated October 7, 2026, lists 129 adult medical day care centers with their license numbers and capacities. OHCQ reported 120 licensed centers in fiscal year 2023 and 128 in fiscal year 2026. The Maryland Association of Adult Day Services (MAADS) is the state provider association, and OHCQ posted a presentation it gave at the MAADS annual meeting in June 2026. We did not find a MAADS website.

What is changing next for adult day in Maryland?

OHCQ lists a targeted revision of the adult medical day care rules, COMAR 10.12.04, as pending. No draft or date has been published, and its working draft, Maryland Register notices and effective date are all shown as pending. Until a proposal appears, the current rules on this page apply.

• Pending licensing rule revision (no date). Watch OHCQ's COMAR 10.12.04 regulations page and the Maryland Register for a proposed text. We do not know what the revision will cover or when it will take effect.
• Incident reporting memo, August 12, 2026 (in effect). OHCQ now requires all reportable events in adult medical day care centers to be reported to it immediately and defines which incidents are reportable.
• Waiver case management, March 16, 2026 (in effect). Case management became a mandatory, separately billed Medical Day Care Services Waiver service provided by case management agencies instead of centers, with no change to licensure, the per diem or covered services.
• Rate update (not found). The rule allows a 4 percent increase each July 1, subject to the budget, but we did not find a rate notice after the July 1, 2024 rate of $116.59.

Maryland adult day sources

• Maryland Department of Health, OHCQ: Adult Medical Day Care
• COMAR 10.12.04: Day Care for the Elderly and Adults with a Medical Disability
• COMAR 10.12.04.14: staffing
• COMAR 10.12.04.04: license application and term
• COMAR 10.09.07: Medical Day Care Services (Medicaid)
• COMAR 10.09.54: Home and Community-Based Options Waiver
• Maryland Medicaid: Fiscal Year 2025 Rates for Medical Day Care Services (PT 05-25)
• Maryland Medicaid: Medical Day Care Services Waiver case management (PT 64-26)
• OHCQ Licensee Directories (Adult Medical Day Care Centers)
• OHCQ: COMAR 10.12.04 regulation revision status

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• Simplifying Payments with Electronic Billing for Adult Day Care
• 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 with no state adult day license

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