Adult Day Care in Nebraska

All states: adult day services map

Nebraska adult day services at a glance

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

How is adult day care regulated in Nebraska?

Nebraska has one license for adult day care, the adult day service license, issued by the Nebraska Department of Health and Human Services (DHHS) Licensure Unit. There is no separate adult day health care license. Adult Day Health is the name Nebraska Medicaid uses for the waiver service that a licensed adult day service can provide if it also meets Medicaid's added standards, such as a licensed nurse on staff or under contract.

Several layers of rules can apply to a Nebraska center, and each is set by a different agency or division:

• Licensing (DHHS Division of Public Health). The Health Care Facility Licensure Act (Neb. Rev. Stat. 71-401 to 71-475), with the definition of adult day service in 71-404, and two sets of rules: 175 NAC 5 (Adult Day Services, amended effective March 20, 2024) and 175 NAC 1 (general rules for licensed facilities and services, amended effective January 20, 2025). These cover the license, staffing, space, services, records and incident reporting for every center, whatever the payer.
• Medicaid, aged and disability waivers (DHHS). 480 NAC 4 (waiver provider requirements) and 480 NAC 5 (covered waiver services) set the rules for Adult Day Health Services under the Aged and Adults and Children with Disabilities (AD) Waiver and TBI Adult Day Health under the Traumatic Brain Injury (TBI) Waiver.
• Medicaid, developmental disability waivers (DHHS Division of Developmental Disabilities). The Comprehensive Developmental Disabilities (CDD) and Developmental Disabilities Adult Day (DDAD) waivers include a separate Adult Day service for people 21 and older, offered by DHHS-certified DD agency providers (DD Adult Day service summary).
• Other funding. The state Social Services for the Aged and Disabled program pays for adult day under 473 NAC 4-002, and Area Agencies on Aging may fund adult day under the Nebraska Community Aging Services Act.

Under 71-404, an adult day service is a person or entity that gives care and social, medical or other support services, for less than 24 consecutive hours, in a community-based group program to 4 or more people who need them because of age or functional impairment. The definition excludes PACE centers and entities certified as specialized programs providing community-based waiver services under the Developmental Disabilities Services Act. The licensing rules recognize two settings: a free-standing adult day service, and an adult day service inside a licensed health care facility that serves 4 or more people who do not live there (175 NAC 5-003.01).

Where the layers overlap, Medicaid is the stricter layer for services and staffing. Licensing sets one general standard, while the AD waiver adds required nursing, personal care and meal components. We did not find a dementia-specific adult day license or model in any layer.

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

Yes, if your program will serve 4 or more people. DHHS licenses adult day services whether participants pay privately, through Medicaid or some other way, and the DHHS licensure page says an adult day service may not operate without an active license. Licenses are annual, and every license expires July 31.

When a license is needed. A license is required when 4 or more people receive adult day services at a location not licensed as another type of health care facility (175 NAC 5-003.01). A licensed health care facility, such as a nursing home, that serves 4 or more non-residents needs its own adult day license and separate identifiable space during service hours. The adult day rules do not apply to adult day services a licensed facility gives its own residents or patients.

How to apply. Under 175 NAC 1-003, a first-time applicant submits a complete application with:

• Schematic plans of the space.
• State Fire Marshal occupancy approval.
• A current zoning permit.
• Secretary of State registration, if the applicant is a foreign corporation.
• For new construction, an architect or engineer certification and a completion certificate. For an existing building, a local operational permit or an architect or engineer safety statement.

No construction may begin without written DHHS approval. After the application is complete, DHHS makes an announced initial on-site inspection. The DHHS Adult Day Service page says DHHS has 30 working days to do so unless the applicant asks for a later date.

Fees. Initial and renewal fees depend on licensed capacity (175 NAC 5-003.02):

• $200 for a capacity of 4 to 16.
• $250 for 17 to 50.
• $300 for 51 or more.

DHHS also lists a $10 fee for a duplicate license, and it keeps a $25 administrative fee from a denied application when no inspection was done.

Certificate of need. No. Nebraska's certificate of need law (Neb. Rev. Stat. 71-5829.03) covers long-term care and rehabilitation beds, and adult day services are not among the items it lists. We did not find a moratorium on new adult day services.

One license per site. A license covers only the premises and people named in the application and cannot be transferred, so each location needs its own license.

Buying a center. A change of ownership or premises ends the license (175 NAC 5-005). The licensee must notify DHHS at least 30 calendar days before a sale, lease, closing or move (175 NAC 1-005.01). A new owner at the same address does not need a new inspection, but a new location does. The DHHS licensure page still mentions a shorter 10-day notice, so go by the 30-day rule and confirm with DHHS.

Other changes that need notice. The licensee must notify DHHS at least 30 working days before increasing capacity or changing its location or building use.

Renewal and inspections. Every adult day service license expires July 31 each year. An expired license can be reinstated within 90 days, but the service may not operate in the meantime. DHHS may make unannounced compliance inspections at any time it considers necessary, including when 5 years have passed without one (175 NAC 1-004).

Medicaid enrollment. To provide Adult Day Health under the waivers, a center must meet all applicable laws, including 175 NAC 5, before Medicaid will enroll it. DHHS also makes an annual in-person review of each waiver provider that includes registry screening (480 NAC 4-002.09), which goes beyond licensing's as-needed inspections.

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

No layer of Nebraska's rules sets a numeric staff-to-participant ratio. Licensing requires staff levels sufficient to meet participants' needs, with the administrator or a back-up on site during all hours at a free-standing site. Medicaid is stricter: an Adult Day Health center must have at least one full-time trained staff person on site during all operating hours and a licensed nurse on staff or under contract. We did not find a separate ratio for participants with dementia.

• Licensing (DHHS Licensure Unit): no ratio specified. Staff levels must be sufficient to meet consumers' needs, and the licensee must set supervision policies (175 NAC 5-010).
• Medicaid AD and TBI waivers (DHHS): no ratio specified. The direct care staff ratio must be sufficient to meet participant needs, and at least one full-time trained staff person must be on site at all times during operating hours (480 NAC 4-003.01).
• Social Services for the Aged and Disabled: no ratio specified. Staff must be present with recipients at all times during activities (473 NAC 4-002).

Administrator. At a free-standing site, the administrator or an equally qualified back-up administrator must be on site during all hours of operation. The licensee writes the administrator's duties and qualifications; the rule sets no degree or experience minimum. Under the Medicaid waiver rules, staff in director or administrator roles must be 19 or older.

Nurses. Licensing does not require a nurse, apart from its medication rules. For Adult Day Health, Medicaid requires a licensed nurse on staff or under contract to do the health assessment and nursing component and to supervise help with activities of daily living.

Who counts toward staffing. We did not find a rule on whether volunteers, or a director who is also the nurse, count toward staffing, or any staffing that must increase with census. When an adult day service shares space with another entity, staff may not be on duty in both at the same time.

Qualifications and training.

• Licensing: before giving direct care, staff complete an orientation on 10 listed topics, including job duties, consumer rights, service plans, infection control, special care needs, emergency procedures and advance directives, abuse and neglect reporting, and disaster plans. Ongoing in-services are required, with records. No minimum number of training hours is set.
• Medicaid: direct care staff need training or one year of experience working with adults in a health or social service setting, plus CPR and first aid knowledge. The July 2026 AD and TBI service summary requires current certificates in abuse, neglect and exploitation, state reporting law, and CPR and first aid. TBI Adult Day staff also need DHHS TBI training. Supportive counseling may be provided only by a certified social worker, certified professional counselor or certified master social worker.
• Medications: staff who give medications without a nursing license must be registered medication aides under the Medication Aide Act.

Background checks. Licensing requires, before hire, a criminal background check for each direct care staff member and checks of the Nurse Aide Registry, the Adult Protective Services Central Registry, the Central Registry of Child Protection Cases and the Sex Offender Registry. A person with an adverse finding on the Sex Offender Registry or the Nurse Aide Registry may not be employed. For waiver providers, the July 2026 service summary adds criminal history screening, including Nebraska Data Exchange Network screening, for employees and volunteers before they have contact with participants.

Health screening. Each staff person needs a health screening before contact with participants; a physical exam is up to the licensee. We did not find a staff TB test or vaccination requirement in 175 NAC 5. The Social Services for the Aged and Disabled rule says staff must be free of communicable disease.

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

Licensing leaves most services to the center's own written program description, which must include hours, days of service and ongoing planned activities. Medicaid Adult Day Health is stricter: every participant gets personal care supervised by a licensed nurse, a health assessment and nursing service, and meal service. Licensing sets the only numeric space rule we found, one toilet for every 10 participants.

Services and activities. Under 175 NAC 5-010.07, the licensee publishes a program description with its hours and days of service and planned activities that meet participants' interests, support physical, mental and psychosocial wellbeing, and are ongoing. For Adult Day Health, 480 NAC 5-003.01 also requires structured social and health activities, plus recreational therapy, supportive services and other activities when they are in the person-centered plan. The July 2026 service summary says Adult Day Health does not include physical, occupational or speech therapy.

Hours. Licensing covers care for less than 24 consecutive hours and leaves hours to the program description. We did not find a minimum number of days or hours a center must be open in any layer. For Medicaid billing, see the section on how Medicaid pays.

Meals.

• Licensing: food service is provided as the service plan specifies. When food is served, menus follow the Food Guide Pyramid or an equivalent and food handling follows the Food Code.
• Medicaid Adult Day Health: each participant present at mealtime gets a noon meal with at least one third of the daily dietary allowance, and full-day participants get two snacks.
• Social Services for the Aged and Disabled: a recipient there more than 4 hours who is served a meal must get one third of daily nutritional needs. If no meal is provided, a meal cost is taken off the daily rate.

Transportation. Licensing does not address transportation. For AD and TBI waiver participants, transportation is not part of Adult Day Health and must be authorized under the separate Transportation service.

Space and capacity.

• A center may not serve more people at one time than its licensed capacity, or more than the State Fire Marshal's maximum occupancy approval.
• One toilet for every 10 participants, with hand washing sinks nearby. In new construction, toilet rooms must be within 40 feet of program areas (175 NAC 5-007).
• Dining and activity areas may not be used for sleeping, offices or corridors.
• A service inside a licensed facility or sharing space needs its own unique physical address and a separate entrance.
• For Adult Day Health, Medicaid adds a rest area, space for therapies, a place to separate a participant who becomes ill, dining space, accessible outdoor space, at least two well-identified exits and a telephone participants can use.

We did not find a square footage per participant rule or a separate dementia space requirement in any layer.

Written policies. The licensing rules require written policies and procedures to show compliance, available to staff and participants. These include:

• A program description covering goals, hours, who is served, staff composition and qualifications, the abuse reporting and investigation system, planned activities, the emergency care plan, admission and discharge criteria, and the assessment process.
• Administrator duties and qualifications, personnel policies, job descriptions and service policies.
• Abuse, neglect and exploitation reporting procedures, supervision policies and consumer rights policies.
• Medication self-administration, medication error and adverse reaction reporting, and medication disposal.
• Complaints and grievances, a quality assurance and improvement program, an infection control program and a disaster preparedness program.
• Routine maintenance of equipment and furnishings, linen handling, and a system for identifying participants.

The program description must be reviewed at least once a year using quality assurance findings. Quality assurance results are recorded quarterly and reported to the governing authority each year. Policies and forms carry effective and revision dates, and old versions are kept at least 7 years. The license must be displayed, and the latest inspection report and any active disciplinary notices must be available to the public. We did not find a required emergency drill frequency. Medicaid waiver providers must also let DHHS review their hiring and abuse reporting policies.

What rules protect participants in Nebraska adult day centers?

Before services start, a Nebraska center must assess each participant, sign a written agreement of participation and write a service plan. Licensing requires those to be updated as needed, while Medicaid sets a fixed review at least every six months. Certain serious events must be reported to DHHS within 24 hours, and records are kept at least 7 years.

Enrollment. Under 175 NAC 5-010.08, a qualified staff member assesses the person before services begin. The center then prepares:

• A written agreement of participation, which lists the services within the center's scope and the participant's or designee's responsibilities.
• A service plan covering health, psychosocial and functional needs.

Licensing does not require a physician order or physical exam for enrollment in general; a physician order is kept only when the person's level of care requires one. We did not find a TB screening requirement for participants.

Medicaid participants. Waiver services need a completed service authorization, for up to 12 months, before they are delivered. The provider, the participant and the services coordinator write an Adult Day Health plan that lists medications, emergency contacts, diet and activity limits, and review it at least semiannually.

Social Services for the Aged and Disabled participants. Progress notes should be recorded at least every three months. Services may be authorized up to 5 days a week for the first six months, then up to 3 days a week unless an exception is approved.

Rights. Participant rights under licensing include being told about changes in policies, procedures and charges, freedom from restraints, and service without discrimination based on race, color, religion, sex or national origin.

Discharge. Discharge must follow the center's written discharge criteria. We did not find a required notice period or a list of allowed discharge reasons in any layer, so families should ask for the center's written criteria.

Attendance and records. Each participant's record must include daily documentation of care, services and supervision, any unusual event, the agreement of participation and service plan, and medication administration records. Entries are dated, timed and signed. Records are kept at least 7 years from each service date, and documentation of record destruction is kept permanently (175 NAC 1-008). Medicaid requires waiver documentation for six years, so the 7-year licensing rule is the one to follow.

Incidents. Under 175 NAC 1-005, the licensee notifies DHHS within 24 hours of:

• Suspected abuse, neglect or exploitation.
• A death from suicide, violence, drowning or restraint.
• A participant who needs supervision leaving without staff knowing.
• A fire, or a disaster that damages the building.

Medication errors and adverse reactions are reported right away to the participant, the designee and the practitioner. Medicaid waiver providers also report suspected abuse, neglect or exploitation to law enforcement and DHHS.

How does Medicaid pay for adult day in Nebraska?

Nebraska Medicaid pays for adult day through four programs: Adult Day Health under the AD and TBI waivers, Adult Day under the CDD and DDAD developmental disability waivers, and PACE. Under the AD and TBI waivers, DHHS pays a statewide daily rate for 6 or more hours and an hourly rate for shorter stays. DD waiver Adult Day is paid hourly, and PACE pays a set amount per member. We did not find published rate amounts we could confirm.

AD Waiver and TBI Waiver (DHHS). The Aged and Adults and Children with Disabilities Waiver (NE.0187) and the Traumatic Brain Injury Waiver (NE.40199) are 1915(c) home and community-based waivers run by DHHS.

• Billing unit: a daily rate for 6 or more hours (under 24), and an hourly rate below 6 hours. A participant who leaves early for an unplanned need counts as a full day (July 2026 service summary).
• Codes: Nebraska's NFOCUS service code 9245 for AD waiver Adult Day Health and 3336 for TBI Adult Day Health. We did not find HCPCS codes in the sources we read.
• Rate: DHHS sets a statewide rate. We could not read the current fee schedule, so ask DHHS for the rate in effect.
• Authorization: services must be authorized before delivery, for up to 12 months at a time.
• Payment in full: providers accept the Medicaid payment as payment in full and may not charge participants the difference between the waiver rate and their private pay rate (480 NAC 4-002.06).

DD waiver Adult Day (DHHS Division of Developmental Disabilities). The CDD and DDAD waivers pay Adult Day by the hour (NFOCUS service code 6221) for participants 21 and older, purchased within the person's annual individual budget and provided by DD agency providers (DD Adult Day service summary). We did not confirm the current hourly rate.

PACE. DHHS lists one approved PACE organization, Immanuel Pathways in Omaha, serving Douglas and Sarpy counties and parts of Cass, Dodge, Saunders and Washington counties. PACE is paid a set amount per enrollee, so adult day is not billed by the unit. PACE centers are excluded from adult day licensure.

Transportation. For AD and TBI waiver participants, transportation is authorized and billed as a separate Transportation service. Under the DD waivers, transportation during Adult Day is included in the rate, but transportation to the start site and from the end site is not.

Attendance documentation. Licensing requires daily documentation of each participant's care, services and supervision. Medicaid waiver providers may bill only services that are authorized and actually provided, must deliver services before billing, and must keep documentation supporting each payment request for six years (480 NAC 4-002). The July 2026 service summary says providers must be able to use the state's web-based case management system. We did not find a requirement for electronic attendance tracking or time-stamped sign-in and sign-out in any layer.

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

Yes, a center can be fully private pay, but it still needs a DHHS license if it serves 4 or more people. Nebraska's licensing rules apply the same way to private-pay and Medicaid centers. A program serving 3 or fewer people falls outside the legal definition of an adult day service.

Small programs. Under Neb. Rev. Stat. 71-404, the license applies to programs serving 4 or more people. We did not find rules that limit what a program serving 3 or fewer people may do, such as personal care, nursing or medication help. Ask DHHS before starting a small unlicensed program.

Protections for private-pay participants. Participants have the right to be told about changes in charges, policies and procedures, and the licensing rules ban discrimination based on race, color, religion, sex or national origin. We did not find a required written fee disclosure beyond notice of changes in charges.

Other funding.

• Social Services for the Aged and Disabled (DHHS). This state program pays for adult day for adults 19 and older who receive SSI or the State Supplement or who are low-income aged or disabled (473 NAC 4-002). It covers activities for at least 3 hours a day in an adult day services center (4 or more adults) or an adult day services home (fewer than 4 adults), and also defines in-home adult day services. It pays by the hour or by the day (6 or more hours) at a statewide rate built from federal and state adult day funding. We did not find the current rate.
• Area Agencies on Aging. The Nebraska Community Aging Services Act (Neb. Rev. Stat. 81-2210) lists adult day services as a community aging service that area agency plans may fund. The DHHS State Unit on Aging oversees Older Americans Act and Community Aging Services Act funds, which go out through the Area Agencies on Aging. We did not find Nebraska-specific Older Americans Act standards for adult day, so ask your local Area Agency on Aging what it funds.
• 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. We did not find a Nebraska-specific VA program page.

The market. We could not confirm how many licensed adult day services operate in Nebraska. DHHS publishes a roster of licensed adult day services, and the Licensure Unit can give a current count. We did not find a Nebraska adult day services association.

What is changing next for adult day in Nebraska?

As of our last check on October 21, 2026, we did not find an upcoming change to Nebraska's adult day licensing rules or Medicaid adult day payment. Several recent changes matter for operators, and all are already in effect.

• Waiver renewal and amendment, July 1, 2026. CMS approved a five-year renewal of the AD waiver (NE.0187.R08.00), which keeps Adult Day Health Services as a waiver service, and an amendment to the TBI waiver (CMS approval letter). Both took effect July 1, 2026. DHHS also published a July 2026 Adult Day Health service summary that sets a 6-hour billable day, which differs from the 4-hour day still in 480 NAC. Ask DHHS whether the rule will be updated.
• DHHS-set waiver rates, July 1, 2026. DHHS began setting maximum AD and TBI waiver rates itself instead of negotiating them, for the services listed in its provider bulletin. Adult Day Health was not on that list.
• Narrower developmental disability exclusion, April 15, 2026. LB1057 amended the definition in Neb. Rev. Stat. 71-404. Now only entities certified as specialized programs providing community-based waiver services under the Developmental Disabilities Services Act are excluded from adult day licensure, instead of any service under that Act. If you run a DD day program, ask DHHS whether you now need an adult day license.
• Rewritten licensing rules, March 20, 2024. 175 NAC 5 was rewritten, adding pre-employment registry checks, the required orientation topics and the medication aide rules described on this page.

Nebraska adult day sources

• Nebraska DHHS: Adult Day Service licensure
• Neb. Rev. Stat. 71-404: adult day service definition
• 175 NAC 5-003: adult day service licensure requirements
• 175 NAC 5-010: adult day service standards (staffing, services, records)
• 175 NAC 1-005: general licensee duties and incident reporting
• 480 NAC 4-003: HCBS waiver provider requirements (Adult Day Health)
• 480 NAC 5-003: covered waiver services (Adult Day Health)
• DHHS AD/TBI Waivers Service Summary: Adult Day Health (July 2026)
• DHHS Division of Developmental Disabilities Service Summary: Adult Day
• 473 NAC 4-002: Adult Day Services (Social Services for the Aged and Disabled)

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 that license or certify every adult day center

California, Delaware, Florida, Georgia, Hawaii, Iowa, Kansas, Maine, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Wyoming. 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.