Adult Day Care in New Jersey

All states: adult day services map

New Jersey adult day services at a glance

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

How is adult day care regulated in New Jersey?

New Jersey has two adult day models. Adult day health services, also called adult medical day care or medical day care, are licensed by the New Jersey Department of Health and provide care under medical and nursing supervision. Social adult day care is a non-medical group program, and we did not find a state license for it.

Three layers of rules can apply to a New Jersey center, and each comes from a different agency:

• Licensing (Department of Health). The Standards for Licensure of Adult Day Health Services Facilities, N.J.A.C. 8:43F, apply to every facility that provides adult day health services, whatever the source of payment. They cover the license, staffing, space, services, records and incident reporting.
• Medicaid (Department of Human Services). The Division of Medical Assistance and Health Services pays for adult day health services under N.J.A.C. 10:164 and the Medicaid State Plan. The Division of Aging Services handles clinical eligibility and prior authorization. Medicaid providers must meet both 8:43F and 10:164.
• Other funding (Division of Aging Services). The Adult Day Services Program for Persons with Alzheimer's Disease or Related Disorders, N.J.A.C. 10:164A, subsidizes care at social adult day agencies and adult day health facilities that sign a Letter of Agreement with the Department.

The licensing rules define an adult day health services facility as a facility, or a distinct part of one, that provides preventive, diagnostic, therapeutic and rehabilitative services under medical and nursing supervision to adults with functional impairments (8:43F-1.2). The Department of Health's facility types list calls this license Adult Day Care Services and lists Pediatric Day Health Care Services as a separate type. The Medicaid chapter also recognizes HIV adult day health services facilities for adults 18 and older with HIV who need outpatient drug abuse treatment (10:164-1.5).

Where the layers overlap, Department of Health licensing sets the operating standards for medical day care. Medicaid adds clinical eligibility, prior authorization and stricter attendance records. We did not find a separate dementia license type.

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

Yes, if your center will provide adult day health services (medical day care). The Department of Health licenses these facilities whether participants pay privately, through Medicaid or some other way, and you may not admit anyone until the license is issued. We did not find a state license requirement for a social adult day program.

How to apply. Under N.J.A.C. 8:43F-2.1, anyone who wants to operate, expand or relocate a facility applies on Department forms. The main steps are:

• Current and prospective owners and administrators get prior clearance from the Department's Criminal Background Investigation Unit, and the Department reviews the applicant's track record.
• Plans for construction or renovation go to the Department of Community Affairs Health Care Plan Review unit before work starts. The building must meet the Uniform Construction Code, the Uniform Fire Code and the Barrier-Free Subcode (8:43F-14.1). The license application for a new, renovated or expanded facility must include written approval of final construction.
• The Division approves a project proposal, including staffing hours for each shift, holds a preliminary conference and surveys the facility (8:43F-2.5). The license is issued after that.

Fees. The rule sets these fees:

• Initial license and each annual renewal: $1,500 plus $10 per slot.
• Adding services or slots: $1,500 plus $10 per slot.
• Reducing services or relocating: $375.
• Transfer of ownership: $1,500.
• Inspection: $450 every other year.

Medicaid enrollment is a separate step. A licensed facility that wants to bill Medicaid must also submit the Medicaid provider application, a participation agreement and a written narrative on the facility, and be approved as a Medicaid adult day health provider (10:164-1.3).

Certificate of need. We did not find a certificate of need requirement or a moratorium in the adult day health licensing rules. New Jersey's separate certificate of need rules (N.J.A.C. 8:33) were not checked, so confirm with the Department of Health before you sign a lease.

License terms and sites. Licenses run one year, must be posted and cannot be assigned to someone else. A license becomes void if the facility closes, changes ownership or moves to a different site, and a facility may not serve more than its licensed capacity (8:43F-2.6). Renewal can be refused if local rules are not met. We did not find a list of local health or occupancy permits beyond the construction and fire code approvals.

Buying a center. A proposed change of ownership must be reported to the Department in writing at least 30 days before it happens. The buyer must apply, pass a track record review and criminal background clearance, and receive a new license before operating (8:43F-2.12).

Inspections. The Department may survey a facility at any time, evaluates facilities through on-site visits and may require a plan of correction. The rule does not set a fixed inspection schedule. A December 2025 federal audit by the HHS Office of Inspector General found 348 instances of noncompliance with health, safety and administrative rules across all 20 adult day health facilities it reviewed and said state inspections were not enough. Its three recommendations were marked closed and implemented on February 28, 2026.

What are the staffing rules for adult day centers in New Jersey?

Licensed adult day health facilities in New Jersey need at least one full-time or full-time equivalent direct care staff member for every nine participant equivalents, based on the daily census. They must add staff as participants' needs require and keep enough staff on hand at all times. Medicaid and the Alzheimer's program do not set their own ratios, and we did not find a separate dementia ratio.

The ratio is in N.J.A.C. 8:43F-6.2. A participant equivalent is five hours of attendance. For example, two people who each attend 2.5 hours make one participant equivalent (8:43F-1.2). This means the ratio compares staff hours to total attendance, not a head count at every moment.

• Licensing (Department of Health): 1 full-time equivalent direct care staff per 9 participant equivalents, more as acuity requires.
• Medicaid (Department of Human Services): no ratio specified. The Medicaid chapter requires the services needed for licensure as a condition of payment (10:164-1.4).
• Alzheimer's program (Division of Aging Services): no ratio specified in the sections reviewed. Centers submit a staffing plan with their application (10:164A-4.1).
• Social adult day care: we did not find a state ratio.

Who counts toward the ratio. Transportation staff count only for the hours they spend giving care inside the facility. Driving time never counts. We did not find a rule on whether volunteers count.

Staff on site. The administrator must be a full-time employee, and the administrator or a named alternate must be on the premises whenever care is provided (8:43F-3.1). We did not find a fixed minimum number of staff regardless of census.

Required roles and qualifications.

• Administrator: a master's degree plus one year of health facility administration or supervision, a bachelor's degree plus three years of health facility work (one of them supervisory), or a New Jersey health professional license plus one year of supervisory experience, along with experience serving elderly and disabled people (8:43F-3.2).
• Director of nursing: a registered nurse with at least one year of full-time nursing supervision or management in a licensed health care facility. Nursing services are provided in the facility under RN responsibility, and an RN administers and supervises prescribed medications and treatments (8:43F-7.4). We did not find required RN hours tied to census.
• Social worker: at least 30 minutes of social work services per week for each participant equivalent, based on daily census (8:43F-12.2).
• Activities director: certified, or eligible for certification, as an Activity Director Certified by the National Certification Council for Activity Professionals (8:43F-13.2).
• Food service supervisor: a dietitian, or someone who meets the alternatives in the rule.

Training. All staff get orientation and ongoing in-service training on emergency plans, infection control, participant rights and elder abuse (8:43F-6.3), and at least yearly training on identifying and reporting abuse, sexual abuse and domestic violence. We did not find required training hours or competency testing for aides.

Background checks. Owners and administrators need clearance from the Department's Criminal Background Investigation Unit. For direct care staff, facilities must make good-faith screening efforts, including criminal history questions, reference checks and background checks when needed.

Health screening. Each new employee gets a two-step Mantoux tuberculin skin test on hire, with listed exceptions, and employees are tested every year after that (8:43F-16.2).

What does an adult day center in New Jersey have to provide?

A licensed New Jersey adult day health facility must provide nursing, dietary, activities, pharmacy and social work services on site, and provide or arrange physical, occupational and speech therapy. It must be open at least five days a week for at least five consecutive hours a day, serve at least one meal, and provide transportation for participants who need it.

Services. Under N.J.A.C. 8:43F-6.1, nursing, dietary, activities, pharmaceutical and social work services are provided in the facility. Occupational therapy, physical therapy and speech-language pathology are provided or arranged, and the facility makes dental, laboratory, medical and radiology referrals.

Hours. Services run at least five consecutive hours and no more than 12 hours a day, not counting transportation, at least five days a week. Going past 12 consecutive hours needs prior written approval.

Meals. At least one meal a day plus snacks, together supplying at least one third of daily calorie and protein needs, with three or more menu items including a high-quality protein (8:43F-10.1).

Transportation. The facility provides safe transportation, directly or by contract, between home and the facility for participants who need it, with no more than two hours of total ride time a day, plus transportation to off-site therapy. Vehicles must be maintained and insured (8:43F-17.1). Centers in the Alzheimer's program have a stricter limit of one hour each way.

Space and capacity. Licensed capacity is counted in slots and may not be exceeded. The physical plant rules require:

• A total of 30 square feet per person for activities and dining, with a dining area that seats everyone at once (8:43F-14.8).
• A quiet room or area for resting, separate from activity and dining space, with at least one bed, lounge or recliner per 10 participant equivalents of licensed capacity and at least 40 square feet for each (8:43F-14.10).
• One toilet and one sink for every 10 adult participants, including at least one accessible single-occupant toilet room. Urinals may replace up to 20 percent of toilets, and visitors need a toilet room that staff may share (8:43F-14.3).
• A nursing office (at least 100 square feet if it also serves as the pharmacy area) and an exam or private treatment room of at least 80 square feet (8:43F-14.9).

Facilities approved before December 19, 2005 do not have to upgrade to the current physical plant rules. We did not find a formula that turns square footage into a number of licensed slots, or separate space rules for dementia care.

Written policies. The facility keeps a policy and procedure manual on site, available to participants, staff and the public, and reviews it on the schedule the manual sets (8:43F-3.3). Required policies include:

• Program philosophy and services, an organizational chart, hours and days of service, referrals, personnel records and employee physical exams.
• Reporting of abuse, elopement, communicable disease, poisonings and suspicious deaths.
• Participant care policies on staffing by census and acuity, emergency care and family notice, health education, advance directives, no smoking, discharge and transfer, pets and exclusion of participants with a communicable disease (8:43F-3.6).
• Participant rights, posted in English and in participants' main languages (8:43F-4.1).
• Infection prevention and control, reviewed at least yearly, and a restraint-free environment.
• A written quality improvement plan with a named coordinator, including at least yearly review of staff credentials, participant and family evaluations, pharmacist review of medication errors and record audits (8:43F-18.1).

The facility must also document participants' yearly flu shot (by November 30) and pneumococcal vaccination for those 65 and older, unless refused or not medically advised. We did not find a required fire drill frequency in the sections reviewed, so ask the Department of Health and your local fire official.

Alzheimer's program centers. Centers in the state's Alzheimer's subsidy program must also offer a structured program based on each person's care plan and reviewed every quarter, at least five hours of programming a day, a hot meal and snacks, caregiver counseling or support groups, and family education on dementia (10:164A-4.1).

What rules protect participants in New Jersey adult day centers?

New Jersey licensing rules require a home assessment before admission, an RN assessment on the first day, a full care plan within 30 days and reviews at least every quarter. An involuntary discharge needs 30 days written notice. Serious events must be reported to the Department of Health right away and confirmed in writing within 72 hours.

Who can enroll. Participants must be 16 or older. Before admission, a member of the care team assesses the person's home environment. People who are a danger to themselves or others, or whose only problem is substance use, may not be admitted or kept (8:43F-5.1).

Medicaid eligibility. For Medicaid, adult day health services need prior authorization based on a state clinical assessment before services start, at least once a year and when the person's condition changes (10:164-1.5). The person must need at least one of the following:

• Limited help with two activities of daily living (ADLs), such as bathing or dressing.
• A skilled service every day.
• Time-limited rehabilitation.
• Supervision or cueing with three ADLs, plus problems with memory and decision making.

People are not eligible if adult day would duplicate another Medicaid service they chose, if they live in a residential health care facility, or if they are hospital or nursing home inpatients. Medicaid participants may ask to transfer to another center for listed reasons, and the state decides within 30 days (10:164-1.7).

Assessment and care plan timelines. Under 8:43F-5.3 and 8:43F-5.4:

• Day of admission: an RN completes an initial assessment, and a physician, advanced practice nurse or physician assistant provides orders.
• Within 5 business days: an initial plan of care.
• Within 14 days of first attendance: a comprehensive assessment.
• Within 30 days of first attendance: a written plan of care from the full care team.
• At least every quarter: reassessment for adults. Discharge planning is part of the plan.

Fees. Participants must be told about fees in writing and get copies of their financial arrangements. A center may not charge more than the rate in the admission agreement without written approval (8:43F-3.5). We did not find a full list of required enrollment agreement contents.

Discharge. An involuntary discharge requires 30 days written notice from the administrator, giving the reason and the right to appeal to the administrator (8:43F-3.8).

Attendance and records. The facility keeps a daily attendance record and a running list of admissions and discharges with where each person went (8:43F-3.13). Medical records are kept 10 years after the most recent discharge, a summary sheet 20 years and X-rays five years. A closing facility must tell the Department where records will be stored at least 14 days before it closes (8:43F-15.4).

Incidents. Under 8:43F-3.4, the facility calls the Department of Health right away, then confirms in writing within 72 hours, for:

• Unplanned service interruptions of three hours or more.
• The departure of the administrator or director of nursing.
• Epidemic outbreaks, fires and disasters.
• Deaths caused by accidents.
• Alleged crimes, which also go to local police.

Suspected abuse during the program is reported to the Long-Term Care Ombudsman for participants 60 and older, or to the Department of Health for those under 60. Abuse found outside the program goes to Adult Protective Services. We did not find a required TB screening for participants at enrollment.

How does Medicaid pay for adult day in New Jersey?

New Jersey Medicaid pays licensed medical day care centers a daily rate (per diem) for at least five hours of service, not counting travel time, up to five days a week. Transportation between home and the center is included in that rate. Adult day can also be covered through NJ FamilyCare managed long-term services (MLTSS) and through PACE.

Medicaid State Plan adult day health services. The Division of Medical Assistance and Health Services pays for the service, and the Division of Aging Services handles clinical eligibility and prior authorization. As a condition of the per diem, the center provides the services required for licensure, the services that made the person clinically eligible, at least five hours of service a day and transportation (N.J.A.C. 10:164-1.4).

• Billing unit: per day, for at least five hours of service not counting transportation.
• Weekly limit: no more than five days per person in a Sunday to Saturday week, even across several centers. Medicaid does not pay for adult day on a day the person receives partial care or partial hospitalization (10:164-1.6).
• Codes: the Medicaid rule lists W9002 for an adult day health visit, Z1860 for ACCAP visits and J9002 for JACC participants (10:164-2.2). We did not confirm the codes on the current fee schedule, so check before you bill.
• Rate: the State Plan sets one daily rate for all adult medical day care providers. CMS approved State Plan Amendment NJ-25-0009 on December 3, 2025, which raised the per diem effective July 16, 2025. We could not read the dollar amount from the amendment, so get the current rate from the Division of Medical Assistance and Health Services.
• Transportation: included in the per diem, not billed separately. Physical, occupational and speech therapy are billed separately.
• Medicaid rate limit: the rate paid for a Medicaid, JACC or HCEP participant may not be higher than what the center charges people outside those programs.

NJ FamilyCare MLTSS. MLTSS is New Jersey's managed long-term services program under its 1115 demonstration, run by the Division of Medical Assistance and Health Services through contracted health plans. We did not find a published MLTSS service definition, billing code or rate for adult day, so ask each health plan you contract with how it authorizes and pays for medical day care and social adult day care.

PACE. The Program of All-Inclusive Care for the Elderly serves people 55 and older who meet nursing home level of care, and its services include adult day health care and transportation. As of January 8, 2026, PACE organizations were funded to cover all 21 counties, though some were still building centers (DHS press release). PACE is paid a set monthly amount per person, so adult day is not billed separately.

Attendance documentation. Medicaid is stricter than licensing here. Licensing requires a daily attendance record but does not say what goes in it. Medicaid requires a daily record with each participant's printed name and arrival and departure times, signed by the participant. If a participant cannot sign, the administrator or a designee attests to the times in writing. The center must submit the monthly Day Health Services Attendance Roster (form CSS-11) when asked (10:164-1.3). Medicaid centers also prepare a yearly cost report and a CPA-signed financial statement. We did not find a state requirement for electronic attendance tracking or MLTSS plan attendance rules.

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

Yes. A medical day care center can serve only private-pay participants, but it still needs a Department of Health license, because N.J.A.C. 8:43F applies whatever the source of payment. A social adult day program is a different case: we did not find a state license for it, so ask the Department of Health and the Division of Aging Services what applies before you open.

Protections for private-pay participants. Licensed centers must disclose fees in writing, describe any third-party payer agreements, sliding fee scales and payment plans, and may not add charges beyond the agreed rate without written approval (8:43F-3.5). We did not find a rule on what an unlicensed social program may or may not do, such as nursing care or giving medications.

Help for families of people with dementia. The Alzheimer's Adult Day Services Program pays 20 to 100 percent of adult day costs for people with a physician-documented dementia diagnosis who have an unpaid caregiver. The Division of Aging Services lists 21 participating centers in 14 counties. For a single applicant, the 2025 limits are $50,256 in income and $40,000 in liquid assets. The program page says up to five days a week, while the program rule authorizes up to three days a week depending on funding (10:164A-3.2), so ask the Division what applies now. Centers that want to join submit a cost proposal, statement of need, staffing and programming plans, a budget and census data, and sign a Letter of Agreement (10:164A-3.1).

Other state programs. Jersey Assistance for Community Caregiving (JACC) is a state-funded program for people 60 and older who meet nursing home level of care, and it can pay for adult day health services. The Statewide Respite Care Program can pay for adult day care to give unpaid caregivers a break (DHS aging programs).

Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical rules, through VA medical centers, State Veterans Homes or community organizations. A copay may apply.

What we did not find. We did not confirm whether Older Americans Act funds pay for adult day in New Jersey, a state adult day association with an official website, or a published count of licensed adult day health facilities. Your county Area Agency on Aging can tell you what local funding is available, and the Department of Health facility search lists licensed facilities.

What is changing next for adult day in New Jersey?

Bills in the New Jersey Legislature would add Medicaid coverage of social adult day care for people 60 and older and ease eligibility for medical day care. Neither has passed, and neither has an effective date. The licensing rules also come up for renewal in 2028.

• Social adult day care in Medicaid (proposed). Senate Bill 2815, pre-filed for the 2026 session, would require Medicaid to cover social adult day care for beneficiaries 60 and older who meet MLTSS clinical and financial rules, even if they are not enrolled in MLTSS. It would take effect only after federal approval. It has not passed.
• Easier eligibility for medical day care (proposed). Assembly Bill 4306, introduced February 19, 2026, would make Medicaid enrollees eligible for adult medical day care if they need help or supervision with one activity of daily living and have a physician's letter and a current physical exam. That is looser than the current criteria. It has not passed.
• Licensing rules expire in 2028. N.J.A.C. 8:43F was readopted with technical changes in late 2021 and is set to expire on November 18, 2028 unless the Department of Health readopts it (notice of readoption). Watch for a readoption proposal, which could change the rules on this page.
• Recent rate increase. The Medicaid per diem for adult medical day care was raised effective July 16, 2025 under State Plan Amendment NJ-25-0009, approved December 3, 2025.

New Jersey adult day sources

• N.J.A.C. 8:43F-1.1: Standards for Licensure of Adult Day Health Services Facilities (scope)
• N.J.A.C. 8:43F-2.1: license application and fees
• N.J.A.C. 8:43F-6.2: staffing
• N.J.A.C. 8:43F-6.1: required services and hours
• N.J.A.C. 10:164-1.3: Medicaid provider requirements and attendance records
• N.J.A.C. 10:164-1.4: Medicaid per diem conditions
• CMS: New Jersey State Plan Amendment NJ-25-0009 (adult medical day care rate)
• NJ Division of Aging Services: Alzheimer's Adult Day Services Program
• NJ Department of Health: notice of readoption of N.J.A.C. 8:43F
• NJ Department of Health: health facility types

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Effective Transportation Tracking for Elder Day Centers
• Podcast: How Adult Day Services Let You Serve 50 Clients with Just 8 Staff
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states with no state adult day license

Alabama, Alaska, Colorado, Connecticut, District of Columbia, Idaho, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, 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.