Adult Day Care Massachusetts

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Massachusetts adult day services at a glance

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

How is adult day care regulated in Massachusetts?

Massachusetts licenses the medical model of adult day care, called an Adult Day Health (ADH) Program, through the Department of Public Health (DPH). MassHealth, the state Medicaid program, pays licensed ADH programs under its own provider rules and rate rule. Two non-medical services, the Supportive Day Program and the Alzheimer's Day Program, are defined separately in the state Home Care Program rules.

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

• Licensing (DPH). The Licensure of Adult Day Health Programs rules, 105 CMR 158.000, adopted in 2015 and last amended September 29, 2023. They cover the license, staffing, space, services, policies, records and incident reporting for every ADH program, whatever the payer.
• Medicaid (MassHealth). The Adult Day Health provider rules, 130 CMR 404.000, decide who qualifies, how services are authorized and documented, and add a staffing ratio for complex-level members. The Executive Office of Health and Human Services (EOHHS) sets the payment rates in 101 CMR 310.00.
• Other funding (Executive Office of Aging and Independence). The state Home Care Program rules, 651 CMR 3.00, let the program buy Adult Day Health, Alzheimer's Day Program and Supportive Day Program services for eligible elders. This office was called the Executive Office of Elder Affairs until it was renamed by St. 2024, c. 392, approved January 9, 2025.

DPH defines an ADH Program as a community-based, non-residential program, for profit or not, that provides nursing care, supervision and health-related support in a structured group setting to people 18 and older with physical, cognitive or behavioral health impairments (105 CMR 158.004). MassHealth counts each location as a separate ADH program and pays at a Basic or a Complex payment level (130 CMR 404.402).

Under 651 CMR 3.02, a Supportive Day Program offers group services such as assessment, care planning, and health, social, therapeutic and nutrition services. An Alzheimer's Day Program offers specialized day services for people with Alzheimer's disease or related disorders. We could not open the state program standards for these two services, so this page does not describe how they must operate.

Where the layers overlap, the DPH licensing rules govern how an ADH program operates in the most detail. MassHealth is stricter on staffing for complex-level members, on hours and on transportation, and adds clinical eligibility and prior authorization.

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

Yes, if you will run an Adult Day Health Program. No one may establish or maintain an ADH program without a DPH license, whether participants pay privately, through MassHealth or some other way. Each site needs its own license.

The license. Under 105 CMR 158.005, a license covers one program site, and an operator with more than one site needs a separate license for each. Licensing began January 2, 2015, and programs already operating then had to apply by May 1, 2015.

How to apply.

• Apply on DPH forms, signed under penalty of perjury, with information on ownership and control (105 CMR 158.006).
• Before licensure, hold local board of health certificates where they apply, an occupancy permit and a local fire inspection certificate (105 CMR 158.007).
• DPH accepts only a complete application that complies with the rules and includes all required fees (105 CMR 158.009).
• DPH inspects or otherwise investigates before it approves an original license, and sets licensed capacity from the size of the participant area (see the services section below).

Fees and license term. We did not find the license fee amount or how many years a license lasts. The rule requires fees but does not state them, so ask DPH.

Certificate of need or moratorium. We did not find a certificate of need requirement or a moratorium in the current DPH rules. A 2011 law (St. 2011, c. 87) called for a study of whether to pause new ADH provider enrollments, but we found no moratorium in effect.

Billing MassHealth. A DPH license alone does not let you bill MassHealth. You also sign a MassHealth provider contract, accept MassHealth payment as payment in full, keep written policies that match 130 CMR 404.000, agree to periodic inspections and attend any required EOHHS orientation. You must tell MassHealth before you move or increase your approved capacity (130 CMR 404.404).

Buying a program. Licenses are not transferable. The buyer files a Notice of Intent with DPH at least 90 days before the transfer, a license application at least 45 days before, and proof of the transfer within 48 hours after. A timely, complete application works as a license from the transfer date (105 CMR 158.022 and 158.023).

Renewal and inspections. Renewal applications are due on or before the date the current license expires. DPH must inspect or investigate before approving an original, renewal or transfer license, and may inspect at any time without notice (105 CMR 158.010 and 158.011). We did not find a set routine inspection schedule.

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

Massachusetts licensing rules require at least 1 direct care staff member for every 6 participants and at least 1 program aide for every 12, plus licensed nurse hours that grow with census. MassHealth is stricter for members it authorizes at the Complex payment level: 1 staff person for every 4 of those members. We did not find a separate ratio for participants with dementia.

• Licensing (DPH): 1:6 direct care staff and 1:12 program aides, plus enough staff at all times to meet each participant's needs (105 CMR 158.032).
• Medicaid (MassHealth): 1:4 for complex-level members, with staffing documented for each date billed (130 CMR 404.414). The rule does not say which staff count toward this ratio.
• Other funding: we did not find a staffing ratio for Supportive Day or Alzheimer's Day Programs.

Who counts toward the licensing ratio. Direct care staff are nurses, program aides, social workers, people supervised by a social worker, and activities directors (105 CMR 158.004). We did not find a rule on whether volunteers count.

Staff that scale with census. Under 105 CMR 158.032:

• Licensed nurses on site at least 8 hours a day (4 of them by an RN), 12 hours (4 RN) at 35 or more participants, 16 hours (8 RN) at 50 or more, and proportionally more above 75.
• Programs with a licensed capacity of 24 or more need a social worker, or appropriately licensed or supervised staff, for at least 20 hours a week.
• A therapeutic activity director on site at least 4 hours a day, and a registered dietitian at least 4 hours every six months.

Minimum staff on site. A professional or qualified staff member must be on duty and accessible at all times, but we did not find a fixed minimum headcount apart from the ratios and nurse hours.

Program Director. The director must be 21 or older with a high school diploma, two years of experience with adults in health care and two years of related management experience. The director works at least 10, 20 or 35 hours a week, for a capacity of 35 or fewer, 36 to 72, or 73 or more. A licensed nurse may not serve as director while also counting toward minimum nurse staffing (105 CMR 158.030).

Qualifications and training. RNs need two years of recent direct care experience with adults or chronically disabled people. Program aides get at least 8 hours of orientation before giving direct care and must be found competent within 4 months of hire, through a training program or an RN's determination after at least 40 hours of training. Nurses and aides need CPR and first aid certification (105 CMR 158.033). Staff who work with participants need at least 12 hours of in-service training a year, and all personnel need training on Alzheimer's disease and related disorders.

Background checks. Before hiring staff or approving volunteers, the program checks references, job history, the Criminal Offender Record Information (CORI) system and the Nurse Aide Registry.

Health screening. Staff need a physical exam within 12 months before employment and every two years after, a TB risk assessment within 3 months before hire and every year, and yearly flu and COVID-19 vaccination following DPH guidance. Staff may sign a declination instead of being vaccinated.

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

Every licensed Massachusetts ADH program provides nursing care, service coordination, therapeutic activities, dietary services and medication management, and arranges rehabilitation therapies through licensed therapists. Programs serve a hot mid-day meal and two snacks, must be open at least Monday through Friday, and need at least 50 square feet of participant area per participant.

Services and activities. Therapeutic activities must run at least four hours in each eight-hour period, not counting meals and snacks (105 CMR 158.038).

Meals. At least one hot mid-day meal that meets one third of daily nutritional needs, plus a morning and an afternoon snack.

Medications. Only staff legally authorized under state and federal law may administer medications, under RN supervision (105 CMR 158.039).

Hours. The licensing rules require programs to be open at least Monday through Friday but set no daily hours. The MassHealth rate rule defines a day setting as a facility open at least Monday through Friday for eight hours a day (101 CMR 310.02).

Transportation. The licensing rules do not require transportation, but the enrollment agreement must describe transportation arrangements where they apply. For MassHealth, a program may provide transportation itself or through a subcontractor. Vehicles must be licensed by the Registry of Motor Vehicles, and drivers need a valid license, a CORI check, drug and alcohol testing, CPR and first aid, and training in wheelchair securement, the needs of elders, abuse reporting and universal precautions (130 CMR 404.413).

Space and capacity. Under 105 CMR 158.026 and 158.045:

• DPH sets licensed capacity from the square footage of the participant area, at least 50 square feet per participant. Half of the kitchen floor counts if the kitchen is used for activities, and the rest area counts as participant area.
• At least two toilet rooms (one accessible), and at a capacity of 24 or more, at least one toilet per 12 participants. Half of the toilets must be accessible, within 40 feet of the participant area, with emergency call stations.
• A private, quiet, monitored rest area near a toilet, with one bed, cot or recliner per 20 participants.
• At least one shower, a staff toilet, a nursing office of at least 80 square feet, corridors at least five feet wide, and participant area temperatures between 72 and 78 degrees F.
• A protected, secure environment for participants who wander (105 CMR 158.042). The rules do not call for a separate dementia space.

Written policies. Programs need 21 written policies, developed with the Participant and Family Advisory Council and relevant professionals and reviewed at least once a year (105 CMR 158.031). They cover:

• Enrollment, emergency transport and discharge; medical emergencies, including when to call 911; participant elopement; and disaster and emergency plans, including evacuation and transfer.
• Nursing, diagnostic (including laboratory), medication management, dietary, rehabilitation, service coordination, therapeutic activity and other professional services.
• Health records, participant rights and grievances, abuse, mistreatment, neglect and misappropriation, and safekeeping of participant items, funds and property.
• Quality assessment and performance improvement, infection control, personnel, research, and compliance with antidiscrimination provisions.

Councils and postings. The Participant and Family Advisory Council, at least half made up of participants, family or caregivers, meets at least every four months. A quality committee (the director, an RN and appointees) meets at least twice a year and reports to the council (105 CMR 158.046). Programs post the license, two years of DPH and other agency notices and correction plans, participant rights, six advocacy and complaint contacts, MassHealth application information, a disaster dietary plan, the evacuation plan and staffing schedules (105 CMR 158.027).

Safety. Fire and emergency procedures are developed with fire and safety officials and posted. Fire and evacuation drills are held every quarter with all staff, and each participant has an emergency fact sheet.

What rules protect participants in Massachusetts adult day centers?

Massachusetts requires a primary care provider's order before enrollment, a written enrollment agreement, a comprehensive assessment within 14 days and a care plan 7 days after that. A program may discharge a participant only for listed reasons and with at least 30 days written notice. Serious events are reported to DPH immediately.

Enrollment. Under 105 CMR 158.034, enrollment requires a written order from the participant's primary care provider, written consent, and a TB history and risk assessment within three months before enrollment (and every year after). The health record must include a recent physical exam (105 CMR 158.040).

Enrollment agreement. The agreement must state:

• Services offered and their costs, and the responsibilities of each side.
• Days and hours, holiday closures, the participant's days of attendance, and how the program gives notice of an unexpected closure.
• Transportation arrangements, emergency procedures, and the reasons the program may discharge a participant.

Assessment and care plan. An interim plan is set at enrollment. The comprehensive assessment is due within 14 days, and the comprehensive care plan within 7 days after the assessment. Both are reviewed at least every six months and within 14 days after a significant change, and a new assessment is done within 365 days (105 CMR 158.037).

Discharge. A program may start a discharge only for one of six reasons, such as the participant's welfare or needs that cannot be met, improvement, the safety or health of others, non-payment after notice, or program closure. The program gives at least 30 days written notice to the participant and the primary care provider, and 30 days notice to the local Aging Services Access Point (ASAP) if referring the person to other services.

Rights. Participants have the right to be free from discrimination based on source of payment or referral, and to voice grievances without reprisal (105 CMR 158.041).

Attendance and records. Programs keep daily attendance records, enrollment and waiting lists, incident and complaint reports, personnel files and service contracts, and must give DPH records within 7 days of a request (105 CMR 158.031). Participant health records, which include the attendance record, are kept at least seven years, with the most recent 24 months on site. Personnel, time, payroll and staffing records are also kept seven years. MassHealth requires medical and billing records to be kept at least six years from the date of service (130 CMR 450.205), so the seven-year licensing rule is the one to follow.

Incidents. Programs report to DPH immediately any unexpected death, evacuation, fire, suicide, serious crime, strike, outbreak, or suspected abuse, neglect or misappropriation. Other serious incidents that cause serious injury are reported within 7 days (105 CMR 158.031). MassHealth providers also report transportation critical incidents to MassHealth.

How does Medicaid pay for adult day in Massachusetts?

MassHealth pays licensed ADH programs a daily rate. A day of more than three hours is billed as S5102 and a partial day of three hours or less as S5101, at a basic level or a complex level (modifier TG). Since July 1, 2025 the basic day rate is $99.49 and the complex day rate is $136.72, and transportation is paid separately per one-way trip.

MassHealth Adult Day Health. MassHealth runs this service under 130 CMR 404.000, and EOHHS sets the rates in 101 CMR 310.00. A member qualifies at age 18 or older with a primary care provider order and a chronic or post-acute condition that needs nurse monitoring, plus either a listed skilled service or daily or regular hands-on help or cueing with at least one of bathing, toileting, transferring, mobility or eating (130 CMR 404.405). Prior authorization is required before the first day of service, then every year and after a significant change. Ninety days without ADH is treated as a significant change (130 CMR 404.406).

Rates for dates of service on and after July 1, 2025 (101 CMR 310.03):

• S5102, basic day: $99.49. S5102 TG, complex day: $136.72.
• S5101, basic partial day: $49.75. S5101 TG, complex partial day: $68.36.
• S5105, admission, and S5105 KZ, re-engagement: $2,000 each, paid one time, on or after the 45th day.
• T2003, transportation: $28.56 per one-way trip. T2003 U6: $34.98 per one-way trip.

MassHealth pays the lower of the program's charge or the listed rate. Payment does not include room and board, and MassHealth does not pay for service beyond six hours a day. The basic rates were lowered on July 1, 2025 from $106.32 a day and $53.16 a partial day, while the complex, admission, re-engagement and transportation rates did not change.

Attendance documentation. Time in attendance decides the billable rate, because more than three hours is a full day and three hours or less is a partial day (101 CMR 310.02). For each member and each date billed, the program documents in the medical record how the member's qualifying needs were met under the plan of care, such as help with daily activities, behavior support, activities and skilled services, and for complex members, the staffing (130 CMR 404.414). MassHealth does not pay for canceled days, missed time, or time away from the site unless staff served the member in the community, and it does not pay for transportation on a day with no ADH attendance claim. Only one ADH provider is paid per member per day (130 CMR 404.415). We did not find a rule requiring a specific sign-in format or electronic attendance tracking.

Frail Elder Waiver. This 1915(c) waiver (control number 0059.R08.00) serves people 65 or older, or 60 to 64 with a physical disability, who meet nursing facility level of care (CMS waiver list). Its service list includes the Supportive Day Program, with transportation as a separate waiver service, and does not list Adult Day Health by name. MassHealth runs it with the Executive Office of Aging and Independence. We did not find the billing unit, code or rate for Supportive Day under the waiver, so ask the waiver program.

PACE. MassHealth runs PACE as the Elder Service Plan, for people 55 or older who are certified as needing nursing facility services and live in a service area. Services are delivered in day-health centers, at home and in other settings (130 CMR 519.007). We did not find how PACE organizations are paid for day center care.

Managed care plans. Senior Care Options, for MassHealth Standard members 65 and older, and One Care, for members 21 to 64 at enrollment, coordinate all covered services through contracted plans (130 CMR 508.008 and 508.007). We did not confirm how these plans cover or pay for ADH, so ask each plan you would contract with.

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

Yes, an ADH program can be fully private pay, but it still needs a DPH license. The licensing rule has no payer exemption. Whether a non-medical day program needs any state license is the open question: we did not find a license rule for those programs.

Private-pay ADH programs. The same 105 CMR 158.000 rules apply, including staffing, space, services and records. The enrollment agreement must list the services offered and their costs, and participants may not be treated differently because of how they pay or who referred them.

Non-medical day programs. DPH defines an ADH program by its nursing care, supervision and health-related support. We did not find a rule that says what an unlicensed, non-medical day program may or may not do, such as hands-on personal care or help with medications. Ask DPH before you plan any nursing or medication services outside an ADH license.

Other funding.

• State Home Care Program. The Executive Office of Aging and Independence can buy Adult Day Health, Alzheimer's Day Program and Supportive Day Program services for eligible elders under 651 CMR 3.02.
• Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who are eligible for community care and meet clinical criteria, at VA medical centers, State Veterans Homes or community organizations. A copay may apply.
• Older Americans Act. We did not find how Older Americans Act funds are used for adult day in Massachusetts. Your local Aging Services Access Point can tell you what is available in your area.

The market. We did not find a published count of DPH-licensed ADH programs or a confirmed website for a state adult day association. Ask DPH for its current list of licensed programs.

What is changing next for adult day in Massachusetts?

As of our last check on October 21, 2026, we did not find an upcoming change to Massachusetts adult day licensing rules or MassHealth adult day payment. Two recent changes matter for operators, and both are already in effect.

• Lower basic MassHealth rates, July 1, 2025. For dates of service on and after July 1, 2025, the basic ADH rates fell to $99.49 a day and $49.75 a partial day, from $106.32 and $53.16. The complex rates stayed at $136.72 and $68.36 (101 CMR 310.03). We did not find a later rate change.
• Licensing amendments, September 29, 2023. DPH amended 105 CMR 158.000, including the staff flu and COVID-19 vaccination requirements (105 CMR 158.030).
• Agency name change, January 2025. The Executive Office of Elder Affairs is now the Executive Office of Aging and Independence, which runs the state Home Care Program and Frail Elder Waiver services.

Massachusetts adult day sources

• 105 CMR 158.000: Licensure of Adult Day Health Programs (DPH)
• 105 CMR 158.005: license requirement and one license per site
• 105 CMR 158.032: staffing
• 130 CMR 404.000: MassHealth Adult Day Health Services
• 130 CMR 404.414: MassHealth service and documentation requirements
• 101 CMR 310.03: Adult Day Health rates (EOHHS)
• 651 CMR 3.02: Home Care Program definitions
• CMS waiver list: Massachusetts Frail Elder Waiver
• 130 CMR 519.007: Frail Elder Waiver and PACE (Elder Service Plan) eligibility
• St. 2024, c. 392: Executive Office of Aging and Independence

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
• Improving Care with Adult Day Care Activity Tracking Software
• 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, Maryland, 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.