Adult Day Care in Minnesota

All states: adult day services map

Minnesota adult day services at a glance

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

How is adult day care regulated in Minnesota?

Minnesota licenses every adult day center under one set of rules from the Minnesota Department of Human Services (DHS). There is no separate adult day health care license. Every licensed center must offer health, social and nutrition services, and Medicaid programs pay for that same licensed service rather than setting their own center standards.

State law treats "adult day care" and "adult day services" as the same thing: a program of less than 24 hours a day that gives functionally impaired adults an individualized mix of health, social and nutrition services (Minn. Stat. 245A.02, subd. 2a). The license types differ by setting, not by medical or social model:

• Adult day care center (also called an adult day services center). A facility outside the participant's home and the operator's home, licensed under Minn. R. 9555.9600 to 9555.9730 (often called Rule 223).
• Family adult day services. Care in the license holder's own home, with the license holder as the main caregiver, for no more than 8 adults at a time (Minn. Stat. 245A.143).
• Remote adult day services. An optional designation a licensed center can request to serve participants by live audio or video. It is printed on the license, and remote services cannot start before DHS approves it (Minn. Stat. 245A.71).

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

• Licensing (DHS). Chapter 245A of state law and Rule 223 set the license, staffing, space, services, records and reporting rules for every center, whatever the payer.
• Medicaid (DHS, with counties, Tribal Nations and health plans as lead agencies). The Elderly Waiver, Alternative Care and the disability waivers decide who can get adult day paid for, how many hours are authorized and how the rate is set. DHS told the Legislature that every Medicaid adult day provider must hold the chapter 245A license and follow Rule 223.
• Other funding. The U.S. Department of Veterans Affairs pays for adult day health care for some veterans.

The licensing layer sets all operating standards. Medicaid adds authorization limits and rate rules but no separate kind of center. We did not find a dementia-specific license type.

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

Yes. No one may operate or advertise a nonresidential program for adults with a functional impairment without a DHS license, and doing so in willful disregard of the law is a misdemeanor (Minn. Stat. 245A.03). Right now, though, DHS is not accepting new adult day care license applications, so most new centers cannot apply until the pause ends.

The licensing moratorium. DHS announced in a December 16, 2025 licensing bulletin that, under Minn. Stat. 245A.03, subd. 7a, it would stop accepting new adult day care applications and cancel pending ones from February 1, 2026 to January 31, 2028. A county, managed care health plan or Tribal Nation can ask DHS for an exception to meet a local need. Even then, the named provider must still apply and meet every licensing rule.

Hospital and nursing home units. An identifiable unit of a nursing home, hospital or boarding care home that regularly provides day care to 6 or more functionally impaired people who do not live there must be licensed as an adult day center (Minn. R. 9555.9610).

Fees. Under Minn. Stat. 245A.10, the application fee is $2,100, nonrefundable, and DHS will not process an application until it is paid. Annual license fees for centers depend on licensed capacity:

• 1 to 24 participants: $2,600
• 25 to 49: $3,000
• 50 to 74: $5,000
• 75 to 99: $10,000
• 100 to 199: $15,000
• 200 or more: $20,000
• Family adult day services: $2,100 a year

Inspections before and after licensing. DHS must inspect the building and records before it issues a license (Minn. Stat. 245A.04). For a program not yet operating, DHS can finish observing the program within one year after the license is issued, and that first license can run up to two years. DHS says it makes a pre-licensing visit to every center to check the building, safety and state and local fire and building codes, then makes unannounced licensing reviews every two years, more often for a conditional license.

Building, fire and food rules. The center's occupancy classification is set under the Minnesota State Fire Code, and food service must meet the Minnesota Department of Health food code and local ordinances (Minn. R. 9555.9730). Check local zoning and building permits with your city or county.

Certificate of need. We did not find a certificate of need requirement for adult day in chapter 245A or Rule 223. The moratorium is the main limit on new centers.

One license per site. You apply for a license at a specific location, and a license is valid only for the named premises and license holder.

Buying a center. A license cannot be transferred. For a change of ownership, the current license holder must give DHS written notice at least 90 days before the change, and the new owner must apply, complete background studies and pay the application fee at least 90 days ahead (Minn. Stat. 245A.043). Ask DHS early how the moratorium affects a sale.

Renewal. Licenses expire on the date stated on the license. We did not confirm a fixed renewal term, so ask DHS.

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

Minnesota licensing rules require at least 1 staff member present for every 8 participants who can take action to get themselves to safety in an emergency, and 1 for every 5 who cannot. Centers that serve both groups use a weighted formula. Medicaid does not set a separate staffing minimum, and we did not find a separate ratio for participants with dementia.

The ratios are in Minn. R. 9555.9690.

• Licensing (DHS): 1:8 when all participants are capable of self-preservation, 1:5 when none are. For a mixed group, count 12.5 points for each capable participant and 20 points for each participant who is not, and staff 1 person per 100 points.
• Medicaid (DHS): no staffing rule. The Elderly Waiver rate formula assumes a 1:5 ratio (Minn. Stat. 256S.215, subd. 16), and disability waiver rates are built from each person's individual staffing ratio. These are payment assumptions, not staffing requirements.
• Other funding: we did not find staffing standards from any other funding source.

Minimum staff on site. When the 1:8 ratio calls for only one staff member, a volunteer or other adult who is not a participant must also be present once 6 or more participants attend. A person trained in first aid and certified in CPR and obstructed airway treatment must be at the center, in center vehicles and on outings whenever participants are present.

Who counts toward the ratio. Only employees whose main duties are direct care, supervision and help with the plan of care count. Participants never count. Volunteers count only if they meet the standards for paid staff. Staff of a larger organization count if they are assigned to the center for a set time.

Director. The center director must be a licensed practical nurse, or have two years of postsecondary education plus two years of health or social services experience including supervision, or have four years of that experience including two in supervision and administration (Minn. R. 9555.9680).

Nurses and therapists. A registered nurse must consult on and review the center's health services at least monthly, and a registered physical therapist must review the exercise program at least quarterly (Minn. R. 9555.9710). The rules set no minimum on-site nurse hours. Unlicensed staff who help with medications need a Minnesota Department of Health approved trained medication aide certificate or training from a registered nurse.

Training. Every employee gets 20 hours of orientation within the first 40 hours of work, including at least 4 supervised hours before working directly with participants, plus at least 8 hours of in-service training each year. A center that markets services for people with Alzheimer's disease or related disorders must train its direct care staff and supervisors in dementia care and describe that training to consumers in writing (Minn. Stat. 245A.04, subd. 12).

Background checks. DHS background studies under chapter 245C apply to license applicants, controlling individuals, staff with direct contact and certain volunteers (as amended by Laws 2026, chapter 121).

Health screening. We did not find a staff TB test or vaccination requirement in Rule 223. Ask DHS whether one applies.

Remote and family settings. Remote adult day staff may serve only 1 participant at a time by audio only, and no more than 8 at a time by two-way video. Family adult day homes need one person trained in first aid and CPR present whenever participants are there, a second staff person when 6 to 8 participants are present, and 12 hours of training a year (6 after six years of licensure).

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

Every licensed Minnesota center must offer nurse-developed health services, a daily structured exercise program, help with daily living activities, planned daily activities and social services. Participants who stay more than 4.5 hours get a meal. Centers need at least 40 square feet of usable indoor space for each participant and each staff member present.

Required services. Under Minn. R. 9555.9710, each center provides:

• Health services developed by a registered nurse, including health monitoring, health education, a referral list, and medication policies and supervision.
• A daily structured exercise program, reviewed quarterly by a physical therapist.
• Help with activities of daily living.
• A monthly plan of daily activities.
• Social services, including a family and social history updated each year.

Meals. A participant at the center more than 4.5 hours gets a meal that meets one third of the recommended dietary allowances. Centers also offer midmorning and midafternoon snacks, menus approved by a dietitian, modified diets and drinking water, and keep menus for six months.

Transportation. Centers do not have to provide transportation. If they do, a one-way ride between home and center may not be longer than 90 minutes.

Space and capacity. Licensed capacity is the most participants allowed on the premises at one time, and it is limited by space (Minn. R. 9555.9730):

• At least 40 square feet of usable space for each participant and each staff member present. Hallways, stairways, closets, offices, restrooms, utility and storage areas do not count, and no more than 25 percent of the space taken by furniture or equipment can be counted. Space shared with a larger organization counts only while others are not using it.
• A private room or area for personal hygiene or social services.
• Restrooms with a call signal by light or sound. We did not find a required number of toilets per participant.
• One cot, couch or recliner for every 8 participants, and an indoor temperature of at least 70 degrees.

Family adult day homes need at least 35 square feet of usable indoor space per participant, license holder and staff member present, and a fire marshal inspection.

Hours. We did not find a minimum number of days or hours a center must be open. Medicaid authorization under the Elderly Waiver is capped at 12 hours a day. A participant can receive in-person and remote services on the same day, but not at the same time, for no more than 12 hours combined and up to 6 hours remote, and must attend in person at least quarterly (Minn. Stat. 245A.74).

Written policies. At admission, centers must give participants and caregivers written information on the items in Minn. R. 9555.9640, including:

• Programs, services and care offered, and the population served.
• Conditions the center will not accept, such as a communicable disease that needs isolation, a history of violence, unmanageable incontinence or uncontrollable wandering.
• Participant rights and the grievance procedure, with the DHS licensing division contact and a copy or summary of the Vulnerable Adults Act.
• Transportation, meals and snacks, pets and smoking policies.
• Fees, billing arrangements and payment plans, and the insurance the center carries.
• Statements of compliance with the Vulnerable Adults Act and the Minnesota Human Rights Act, and the terms of the DHS license.

Centers also need written medical emergency procedures, health services policies for medication self-administration and training of unlicensed staff, and a written internal procedure for reporting suspected maltreatment. Fire, blizzard and tornado plans must be posted, rehearsed at least four times a year with dates recorded, and emergency numbers posted by the phone (Minn. R. 9555.9720).

What rules protect participants in Minnesota adult day centers?

Minnesota rules require an intake screening, a physician-signed medical report, a signed service agreement, a needs assessment within 30 days and a written plan of care within 90 days, reviewed quarterly. Centers must follow a participant bill of rights and report suspected maltreatment right away. The rules require a discharge summary but set no discharge reasons or notice period.

Enrollment. Before admission the center does an intake screening and tells the person the result within five working days of starting it (Minn. R. 9555.9700). A medical report signed by a physician (or by a physician assistant or registered nurse with a physician's cosignature) must be dated within three months before or 30 days after admission. It covers a physical exam updated each year, history, diet and medication needs, clearance for exercise and proof of freedom from communicable disease (Minn. R. 9555.9660).

Service agreement. Each participant's record holds a service agreement, signed by the participant or caregiver and the director, that sets out each side's responsibilities for payment and services.

Care plan. A needs assessment and a preliminary service plan are due within 30 days of admission. A written plan of care with measurable objectives is due within 90 days and is reviewed and revised every quarter. For Medicaid participants, a case manager must authorize the service first, and the center may not bill more than is authorized.

Participant rights. Centers must adopt and enforce a bill of rights that covers taking part in care planning, refusing care, physical privacy, confidential records and grievances (Minn. R. 9555.9670). License holders must let participants keep use of their own money and property and keep those funds separate from the program's.

Attendance and records. Participant records include attendance and participation reports, progress notes at least monthly, incident reports, the abuse prevention plan and a discharge summary. For participants paid for by a government program, the center records the person's full name and drop-off and pick-up times on the day they attend (Minn. Stat. 245A.14, subd. 14). Medicaid providers must keep health service and financial records at least five years after the first billing date (Minn. R. 9505.2190). We did not find a licensing retention period for participant records.

Incidents and maltreatment. Centers keep incident records for illnesses, accidents needing first aid, emergency medical or psychiatric care, police reports and maltreatment complaints, with the date, time, what happened, the response and notice to the caregiver. Staff are mandated reporters: suspected maltreatment of a vulnerable adult must be reported immediately to the state common entry point (the Minnesota Adult Abuse Reporting Center), and DHS investigates reports involving adult day centers (Minn. Stat. 626.557). When a staff member reports internally, the center must tell that person in writing within two working days whether it reported to the common entry point.

What we did not find. We did not find permitted discharge reasons or a discharge notice period in Rule 223. Families should ask the center for its written admission and discharge policies, and operators should ask DHS what it expects.

How does Medicaid pay for adult day in Minnesota?

Several Minnesota Medicaid programs pay for adult day: the Elderly Waiver (including through MSHO and MSC+ health plans), Alternative Care, the CADI, BI, CAC and DD disability waivers, and Essential Community Supports. A case manager must authorize the service before it starts. The Elderly Waiver pays in 15-minute units, up to 48 units (12 hours) a day, and the disability waivers pay per 15 minutes or per day of 6 or more hours.

Elderly Waiver (EW). A federal 1915(c) waiver run by DHS, with counties, Tribal Nations and health plans as lead agencies. Under Minn. Stat. 256S.12, adult day can be authorized for up to 48 fifteen-minute units a day. If an adult day bath is authorized, at least two 15-minute units must be authorized. Elderly Waiver services are also delivered through the Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+) health plans (Minn. Stat. 256B.69), so ask each plan how it wants to be billed.

Elderly Waiver rates. The rate is set by a formula in Minn. Stat. 256S.215, subds. 16 and 17 that assumes 1:5 staffing and includes a factor for food, supplies and transportation. We did not find the published dollar rates or the procedure codes, so check the Minnesota Health Care Programs provider manual or ask DHS.

Alternative Care (AC). State-allocated funding, with a federal match, for people 65 and older who would become eligible for Medicaid within 135 days of entering a nursing home. It covers adult day and adult day bath (Minn. Stat. 256B.0913). We did not confirm its billing unit.

Disability waivers. The Community Access for Disability Inclusion (CADI), Brain Injury (BI), Community Alternative Care (CAC) and Developmental Disabilities (DD) waivers all list adult day, and all but CAC also list adult day bath. Payment is built under the disability waiver rate system (Minn. Stat. 256B.4914, subd. 7a) from each person's individual staffing ratio averaged over a typical week, using a DHS staffing ratio worksheet. Billing is per 15 minutes or per day of 6 or more hours of direct service. The statute's formula includes a facility component of $19.30 per week and $7.01 per 15 minutes for a bath.

Essential Community Supports (ECS). DHS lists ECS among the programs that pay for adult day. We did not review its billing details.

PACE. As of January 2025, DHS reported that Minnesota had no operating PACE program. We did not confirm any later change.

Transportation. We did not find a separate transportation billing code for adult day. The Elderly Waiver rate formula includes a transportation factor.

Attendance documentation. State licensing law already requires centers paid by a government program to record each participant's full name and drop-off and pick-up times on the actual day of attendance, available to DHS during operating hours. Remote services must record start and end times and whether audio or video was used. DHS reports that its Office of Inspector General looks for billing outliers, watches centers for activity and attendance, and contacts participants or visits sites on tips. A 2026 law will add electronic recording of start and end times for Medicaid adult day on a date DHS has not set (see the last section).

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

A center can be fully private pay, but it still needs a DHS license if it gives functionally impaired adults the coordinated health, social and nutrition services that define adult day care. The license is not tied to Medicaid. Programs that mainly offer socializing, education, supervision, caregiver respite, religious activities, exercise or meals fall outside the definition and do not need this license.

Outside the license. Under Minn. Stat. 245A.02, subd. 2a and 245A.03, subd. 2, programs serving adults without a functional impairment, programs run by a relative, and programs mainly for socialization, education, supervision, respite, religion, exercise or meals are not licensed as adult day. We did not find a list of specific services an unlicensed program may not provide, so ask DHS before you design a program to stay outside licensure. Note that the licensing moratorium applies to private-pay centers too.

Protections for private-pay participants. Every participant, whoever pays, must get written fee, billing and payment information, a grievance procedure and a statement that admission complies with the Minnesota Human Rights Act, and must sign a service agreement that covers payment (Minn. R. 9555.9640).

Other funding. The Minneapolis VA Health Care System offers Adult Day Health Care through community programs to enrolled veterans who qualify for community care and meet clinical criteria, and a copay may apply. Alternative Care, described above, is a state-allocated program for people close to Medicaid eligibility. We did not find Older Americans Act funding set aside for adult day in Minnesota. Your local Area Agency on Aging can tell you what is available in your region.

The market. We did not find a current count of licensed centers from a state source. DHS told a House committee in December 2025 that over the past 10 years licensed adult day capacity grew about 43 percent while the number of people served grew about 7 percent, leaving room for nearly 3,000 more people than are served. That gap is part of the background to the moratorium. You can look up individual licensed centers through the DHS Licensing Information Lookup.

What is changing next for adult day in Minnesota?

DHS has paused new adult day care licenses through January 31, 2028, with exceptions only at the request of a county, health plan or Tribal Nation. Two other changes from a 2026 state law are coming but do not yet have firm start dates. Check with DHS for the current status of each.

• Licensing moratorium, February 1, 2026 to January 31, 2028. DHS stopped accepting new adult day care license applications and cancelled pending ones for a planned 24 months (DHS bulletin, December 16, 2025). Watch for DHS guidance on what happens to applications when the pause ends.
• Electronic attendance verification for Medicaid adult day (date not set). Laws 2026, chapter 121, signed May 27, 2026, adds adult day services to the Medical Assistance services covered by Minnesota's electronic visit verification law. Start and end times would be recorded electronically at the time of service, and DHS and health plans could use the data to check claims. DHS will set the start date, and the rules for outside systems are planned for January 1, 2027 or federal approval. Ask DHS when this will apply to adult day.
• Disability waiver redesign (planned). The same law directs DHS to move the disability waivers that pay for adult day into a two-waiver structure with individual budgets, phased in starting January 1, 2027 or on federal approval. Timing depends on federal approval, so watch DHS announcements.

Minnesota adult day sources

• Minn. R. 9555.9600 to 9555.9730: adult day care center licensing (Rule 223)
• Minn. R. 9555.9690: staffing ratios and training
• Minn. Stat. 245A.03: license required
• Minn. Stat. 245A.10: license fees
• DHS Licensing bulletin, December 16, 2025: adult day care licensing moratorium
• DHS presentation to the House Fraud Prevention and State Agency Oversight Committee, December 2025
• Minn. Stat. 256S.12: Elderly Waiver adult day services
• Minn. Stat. 256B.4914: disability waiver rate system
• Minn. Stat. 245A.14: attendance records for publicly funded participants
• Laws of Minnesota 2026, chapter 121

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: 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 where licensing depends on size, services or payer

Arizona, Arkansas, Louisiana, New Hampshire, Virginia. 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.