All states: adult day services map
In short: One state license (He-P 818) covers every adult day program; staffing is about 1 per 8 participants; Medicaid pays adult medical day per diem. Change ahead: The adult day licensing rule must be readopted or extended by about June 2027, and the Choices for Independence waiver that pays for adult day expires June 30, 2027.
| License or certification | Yes. A DHHS adult day program license for programs giving medical supervision or care, or help with daily living, to 3 or more people, any payer. |
|---|---|
| Who licenses or certifies | NH Department of Health and Human Services (DHHS), Health Facilities Administration |
| Adult day care vs adult day health | One license type (He-P 818). "Adult medical day" is the Medicaid name for services a licensed program bills, not a separate license. |
| Strictest staffing ratio | 1 paid staff under 8 participants, 2 staff for 8 to 16, plus 1 more per each additional 8 or part of 8 (DHHS licensing) |
| Dementia ratio | No ratio specified. Dementia training and a security system for people who wander are required. |
| Medicaid programs | Choices for Independence (CFI) waiver; state plan adult medical day care |
| Medicaid billing unit | Per day for state plan adult medical day care (S5102 in one health plan's policy). CFI waiver unit not confirmed. |
| Licensed centers | Not confirmed |
Last verified against state sources: 2026-10-21.
New Hampshire has one license for adult day care, the adult day program (ADP) license under rule He-P 818, issued by the Department of Health and Human Services (DHHS) Health Facilities Administration. There is no separate adult day health care license and no separate dementia or social-model license. "Adult medical day" is the name Medicaid uses for services a licensed program bills after it enrolls as a Medicaid provider.
Important: New Hampshire's Medicaid rule for adult medical day care, He-E 803, is printed with a note saying it expired October 28, 2019, yet the current Choices for Independence rule and a 2025 health plan policy still point to it. We could not confirm whether DHHS treats it as in force, so this page does not rely on its details. If you plan to bill Medicaid, ask DHHS which adult medical day requirements apply.
Three layers of rules can apply to a New Hampshire program, and each comes from a different part of DHHS:
He-P 818 defines an adult day program as one that provides one or more of supervision, help with daily living, nursing care, rehabilitation, recreational and social activities, and nutrition, for fewer than 12 hours a day, to people 18 and older (He-P 818.03(f)).
Where the layers overlap, He-P 818 is the rule that sets how a program operates. The Medicaid and funding layers add provider enrollment or a state contract, longer record retention, and their own eligibility rules.
Yes, if your program offers medical supervision, care or treatment, or help with daily living activities, to 3 or more people, whether or not it runs for profit and whoever pays (RSA 151:2, I(f)). DHHS issues the license only after an inspection shows full compliance. The annual license fee set by statute is $200.
How to apply. Under He-P 818.04, you file the Application for Residential or Health Care License with:
Public notice. Programs newly licensed on or after July 1, 2016 must publish a notice of intent to apply in a newspaper, in at least 2 issues, at least 10 business days before filing. They must also notify, by registered mail, any critical access hospital within 15 miles.
Certificate of need. We did not find a certificate of need requirement or a moratorium in He-P 818 or RSA 151:2.
Building and construction. Plans for new construction or alterations go to DHHS at least 60 days ahead. Programs built under the 2017 rules must follow the adult day care chapter of the FGI Guidelines (2014 edition) and the day care chapter of the life safety code, NFPA 101 (He-P 818.07).
One license per site and owner. A license is issued after a clinical and life safety code inspection and cannot be transferred to another person or location (He-P 818.05 and 818.08). Each site, and each new owner, needs its own license.
Buying a center. The program must give DHHS written notice at least 30 days before a change of ownership, location, address, name or capacity. A change of ownership or location, or an increase in participants, requires a new application and license before operating. An inspection is required unless one was done within 90 days of an ownership change. A new administrator must be reported at least 5 days ahead, and closing a program requires 30 days written notice.
Renewal and inspections. Licenses run one year. Renewal applications are due at least 120 days before the license expires, and DHHS inspects before renewal (He-P 818.06). Water testing for bacteria and nitrates is documented every 3 years. We did not find a set schedule for routine inspections beyond the initial and renewal inspections, so ask the Health Facilities Administration what to expect.
Medicaid and state contracts. To be paid by Medicaid, a licensed program must also enroll as a New Hampshire Medicaid provider (CFI or adult medical day). To be paid with Title XX or Title III funds, it must hold a contract with DHHS.
New Hampshire licensing requires at least 1 paid staff member present whenever fewer than 8 participants attend, at least 2 staff (one of them paid) for 8 to 16 participants, and one more staff member for each additional 8 participants or part of 8. That works out to about 1 staff per 8 participants, and staffing must still be enough to meet every participant's needs. No layer sets a separate ratio for dementia.
The ratio is in He-P 818.15(d)(2).
Who counts toward the ratio. Nursing and activities staff may count. Under He-P 818, "personnel" includes paid staff, volunteers and independent contractors, but the first staff member (under 8 participants) and one of the two (8 to 16) must be paid.
Required positions.
Minimum staff on site. Besides the ratio, at least one person with current adult CPR certification must be on duty whenever the program is open. Direct care staff must be 18 or older unless they are licensed nursing assistants or supervised students.
Training. Staff complete orientation within their first 3 days and annual continuing education on participant rights, infection control, fire and emergency procedures, and mandatory reporting. The rules set no total number of training hours, except a 4-hour medication supervision course for unlicensed staff who help with medications or receive nurse delegation (oral medications only).
Dementia care. Staff who care for participants with dementia, Alzheimer's disease or mental illness must be trained in their special needs. A security system is required for participants who have wandered in the last 60 days, whose wandering behavior has changed, or who are a danger (He-P 818.14(p)).
Background checks. Employees (other than board of nursing licensees), volunteers and contractors with direct contact, and household members need a New Hampshire Department of Safety criminal records check and checks of the adult protective services state registry and the nursing assistant registry. Disqualifying convictions or findings bar employment unless DHHS grants a waiver (He-P 818.19).
Health screening. Before any contact with participants or food, personnel, including volunteers and contractors, provide a physical exam or health screening and a 2-step TB test done within the past 12 months. The licensee arranges flu shots for staff who consent.
Every licensed New Hampshire program provides a set of core services: administrative, nursing, recreational activities, personal care, health and safety protective care, social services and dietary services. Core services must be part of the basic rate and cannot be charged separately. Each program serves at least one meal a day, and capacity is set by the fire code number shown on the license.
Core services. Under He-P 818.15, nursing services include medication administration, wound care, nutritional monitoring, and care management or referral.
Medicaid services. CFI adult day services cover supervision, personal care, monitoring and counseling, referrals, and the He-P 818 health and safety, dietary, nursing, social, rehabilitative and recreational services, for non-acute needs (He-E 801.15). CFI does not pay for adult day for people living in residential care or adult family care. Title XX adult day services cover supervision in a protected setting plus the He-P 818.15 services.
Meals. At least one meal that provides one third of adult daily dietary allowances, with snacks and fluids so no more than 3 hours pass between meals and snacks.
Transportation. We did not find a licensing rule that requires a program to provide transportation. Medicaid transportation duties are tied to the He-E 803 rule whose status is unclear, so ask DHHS if you plan to serve Medicaid participants.
Space and capacity.
Hours. A program runs for fewer than 12 hours a day by definition. We did not find a minimum number of days or hours a program must be open.
Written policies. He-P 818 requires written policies and procedures for operations and all services, reviewed every year, including:
Quality and safety. A quality improvement committee meets at least every quarter, tracks incidents, complaints, falls and medication delivery, and keeps minutes for 2 years. Evacuation drills are held every month at varied times, each staff member joins at least one drill a quarter, and the program takes part in an annual community disaster drill. The license, 12 months of inspection reports, the patients' bill of rights, the complaint procedure and the evacuation floor plan must be posted.
New Hampshire requires a physical exam before or soon after admission, a nursing assessment within 7 days, and a care plan within 30 days that the nurse reviews at least every 6 months. Participants get their rights and a full list of charges in writing at admission. Serious incidents go to DHHS within 48 hours, and a missing participant is reported to police and family right away.
Enrollment. Under He-P 818.16, a licensed practitioner completes a physical exam no more than one year before, or within 72 hours after, admission. Title XX and Title III participants also need a practitioner exam within 60 days and a referral, and those programs exclude people living in nursing or other licensed facilities or adult family care, and people seeking services mainly for mental illness or developmental disability.
What participants receive at admission. Verbal and written rights, the scope of services, the complaint procedure and program rules, and a list of all charges and what they include. Fee increases need 30 days written notice.
Assessment and care plan.
Discharge. Discharge follows RSA 151:26 and RSA 151:21, V, with a discharge plan developed with the participant. He-P 818 itself sets no notice period, and we did not review those statutes, so ask DHHS what notice is required.
Records. Licensing requires dated notes for care and services and a daily medication record. Participant records are kept at least 4 years after discharge, and for 4 years after a program closes. We did not find a specific daily attendance log requirement in He-P 818.
Incidents. Reportable incidents, meaning an unexpected death, a suspicious injury, or an elopement or unexplained absence, are reported to DHHS within 48 hours, with a written follow-up within 5 days. Deaths are reported immediately. For an unexplained absence, the program notifies police and the participant's family or representative right away. Fires and emergencies are phoned in immediately, with written notice within 72 hours.
New Hampshire Medicaid pays licensed adult day programs through two routes: the Choices for Independence (CFI) waiver and the state plan adult medical day care benefit. The state plan pays a per diem (a daily rate) from a DHHS fee schedule, with rates last set January 1, 2024. We did not find the current rate amounts or the CFI billing unit.
Choices for Independence waiver. CFI is a 1915(c) home and community based waiver run by DHHS. CMS lists it (0060.R08.00) as approved from July 1, 2022 through June 30, 2027, with adult day services among its services. It serves people 65 and older and adults 18 to 64 with disabilities who meet nursing facility level of care. DHHS sets CFI rates under RSA 161:4, VI(a). We could not read the waiver application or the DHHS rate pages, so we did not confirm the CFI adult day billing unit, code or rate.
State plan adult medical day care. Under the Medicaid State Plan (Attachment 4.19-B, TN 24-0015), adult medical day care in a licensed facility is paid per diem from a DHHS fee schedule, with rates set as of January 1, 2024. Medicaid managed care health plans also cover it for their members.
Transportation. CFI includes non-medical transportation as a separate service, but we did not confirm whether it can be used for trips to adult day, or whether adult medical day transportation is billed separately. Ask DHHS.
Documentation needed to bill. CFI providers must document each claim with the specific service, the number of units, the employee's name, and the date and time of service, and keep those records for at least 6 years from the date of service (He-E 801.33). DHHS can take back payments that are not documented. That is longer than the 4-year licensing retention, so keep the longer period. We did not find an electronic attendance or sign-in and sign-out requirement for adult day.
Yes, a program can be fully private pay, but it still needs a DHHS license if it offers medical supervision or care, or help with daily living, to 3 or more people. The licensing statute applies whether or not the program runs for profit and has no exception by payer. No one may advertise or present a program as an adult day program unless it is licensed.
Programs that are not adult day programs. He-P 818 defines a senior center as a community program offering meals, recreation, wellness or transportation without any services that require a license. We did not find clear state guidance on whether a purely social program with supervision but no hands-on help needs a license, because the statute and the rule word this differently. Ask the Health Facilities Administration before you open one.
Protections for private-pay participants. Licensed programs must give a written list of all charges at admission, include core services in the basic rate, give 30 days written notice of fee increases, get written permission before handling a participant's money, and follow the patients' bill of rights (He-P 818.14).
Other funding. DHHS pays contracted, He-P 818 licensed programs through:
We did not confirm whether the U.S. Department of Veterans Affairs buys or runs adult day health care in New Hampshire. Veterans can ask the VA Manchester health care system. We also did not find a PACE program in the state.
The market. We could not get the DHHS list of licensed adult day programs, so we do not give a count. The Health Facilities Administration can provide it. We did not find a state adult day association with a website.
Two deadlines in 2027 matter for New Hampshire adult day programs. The adult day licensing rule must be readopted or extended by about June 2027, and the Choices for Independence waiver that pays for adult day expires June 30, 2027. As of our last check on October 21, 2026, we did not find a published proposal for either.
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Questions about New Hampshire adult day rules are best put to the state. Start with He-P 818 Adult Day Programs (NH Code of Administrative Rules, He-P 800 chapter). The state lists this contact: DHHS Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301; complaints 1-800-852-3345 (as published in He-P 818.14(q)(4)).
Arizona, Arkansas, Louisiana, Minnesota, Virginia. See every state on the adult day services map.
This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.
Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.
