Adult Day Care in North Carolina

All states: adult day services map

North Carolina adult day services at a glance

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

How is adult day care regulated in North Carolina?

North Carolina certifies adult day programs instead of licensing them, but certification is required for every program whatever the payer. The NC Department of Health and Human Services (NCDHHS) Division of Aging certifies programs, working with county departments of social services (DSS) and local health departments. The state recognizes two models with separate rule sets, adult day care and adult day health, plus combination programs that meet both.

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

• Licensing (Division of Aging). The certification law, G.S. 131D-6, requires the Department to inspect and certify all adult day care programs each year. The Social Services Commission rules set the standards: 10A NCAC 06R for adult day care (readopted effective September 1, 2019) and 10A NCAC 06S for adult day health (readopted effective November 1, 2019).
• Medicaid (NC Medicaid). NC Medicaid, the NCDHHS Division of Health Benefits, pays for adult day health through the Community Alternatives Program for Disabled Adults (CAP/DA) waiver under Clinical Coverage Policy 3K-2. It also runs PACE, whose centers include adult day health.
• Other funding (Division of Aging). The Home and Community Care Block Grant (HCCBG), which combines Older Americans Act and state money, pays for adult day care and adult day health for eligible people 60 and older under its own service standards.

The program types.

• Adult day care center: the social model, certified under 06R.
• Adult day care home: a program for up to 16 participants in a single-family dwelling.
• Adult day health center or home: adds health services under 06S, including a nurse health care coordinator on site at least 4 hours a day, a treatment room, 60 square feet per participant and a 1:5 ratio.
• Combination program: serves both day care and day health participants, meets both rule sets, with a 1:6 ratio and 50 square feet per participant.
• Special care services: a designation for programs or units that serve people with Alzheimer's disease or other dementias, mental health disabilities or other special needs. It is not a separate license type.

Only adult day health or combination programs may serve participants who need intravenous, intramuscular or subcutaneous medications while attending. Where the layers overlap, the Division's certification rules set the operating standards. Medicaid is narrower because it pays only for adult day health, and it adds its own enrollment rules and the federal home and community based settings rule.

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

You need state certification, which works like a license and is mandatory. Every adult day program must be certified by the NCDHHS Division of Aging, whether participants pay privately, through Medicaid or another way. You apply through your county department of social services, and the certificate lasts 12 months.

Who is exempt. Under G.S. 131D-6, programs serving 3 or fewer people, programs where every participant is related to the operator, and programs licensed under another statute do not need certification. Violations can bring civil penalties of up to $100 per violation, with each day counted as a separate violation.

How to apply. The Division of Aging Adult Day Services page lists a contact for opening a new program. Under 10A NCAC 06R .0601 (06S .0501 for adult day health):

• You apply to the county DSS. A county social worker studies the program and sends the package to the Division.
• The package includes your policies, an organizational diagram, job descriptions, a 732a-ADS daily rate sheet with planned expenses and revenue, and a floor plan.
• It also includes fire, building and sanitation inspection reports dated within 30 days, staff medical statements, proof of CPR and first aid training, and 5-year statewide criminal checks for the owner and direct care staff.
• Division staff make a pre-certification visit and give written notice of the decision within 14 business days.

Local approvals. The building and grounds must meet the requirements of the local environmental health specialist, the local fire safety inspector, the county DSS and the Division, and must comply with zoning laws (06R .0401).

Fees. We did not find a certification fee in the statute, the rules or the Division's adult day page. Ask the Division whether one applies.

Certificate of need. We did not find a certificate of need requirement or a moratorium in G.S. 131D-6, 06R or 06S.

One certificate per site. Certification ends automatically when a program moves to another location, so each site is certified on its own. The certificate must be posted where anyone entering can see it (06R .0801, .0803).

Buying a center. Certification ends automatically when a for-profit program's ownership is transferred in its entirety, or when a nonprofit or public agency board is dissolved, so a buyer needs its own certification. When the program director or operator changes, the new person's qualifications must be documented in writing to the county DSS by the date of the change, and the Division's adult day care consultant must be told in writing (06R .0602).

Renewal and inspections. Programs are inspected and certified every year (06R .0102). The county DSS sends the renewal package no more than 90 days before the certificate expires, including a fire inspection and sanitation report from the past 12 months, and the certification report must reach the Division at least 30 days before expiration. If renewal materials are not received by the expiration date, certification ends. A provisional certificate, used while violations are being corrected or when renewal papers are late, lasts no more than 6 months.

What are the staffing rules for adult day centers in North Carolina?

North Carolina's certification rules set the ratio by program type: at least 1 full-time equivalent direct care staff member for every 5 participants in adult day health, 1 for every 6 in combination programs and adult day care homes, and 1 for every 8 in adult day care centers. Neither Medicaid nor the HCCBG sets a tighter ratio. There is no separate ratio for dementia care.

• Licensing (Division of Aging): 1:8 in adult day care centers and 1:6 in adult day care homes (10A NCAC 06R .0305); 1:5 in adult day health centers and homes and 1:6 in combination programs (10A NCAC 06S .0203).
• Medicaid (CAP/DA): no ratio specified. Policy 3K-2 relies on the 06R and 06S rules.
• Other funding (HCCBG): no ratio specified.

Keeping the ratio. When staff are absent, the program must use substitutes with the same qualifications, or trained volunteers, to keep the ratio. Programs must keep a written plan for substitute staff.

Minimum staff on site. A program director or substitute director who meets the director qualifications must be on site during all operating hours. In a day care home where the operator is the only staff person, at least one qualified staff person must be present at all times and relief staff must be available. We did not find a minimum number of direct care staff on site regardless of census.

Dementia and special care. A special care services unit must meet the ratio for its program type, such as 1:8 in an adult day care center. Special care staff must show knowledge of participants' needs within a month of hire and complete 3 training experiences specific to the population within 6 months, then 2 a year, under a written training plan reviewed each year (06R .0907, .0908; 06S .0607). Special care programs must also give written disclosures in 9 areas, including their staffing ratios.

Nurses in adult day health. Adult day health programs need a health care coordinator, an RN or LPN licensed in North Carolina, on site at least 4 hours a day plus any added hours the service plans require. An LPN coordinator must be supervised by an RN, with on-site RN supervision at least every two weeks. In programs with a capacity of 10 or fewer, the director may also be the coordinator. In larger programs the director may stand in as coordinator for no more than 3 weeks in a row (06S .0204).

Director. The program director must be at least 18 and have 2 years of education after high school (or a high school diploma plus 5 years of combined experience and training) and 2 years of supervisory and administrative experience, and must provide a medical statement and three references.

Training. All physically able direct care staff must hold current first aid and CPR certification from the American Heart Association, American Red Cross, National Safety Council or American Safety and Health Institute. New employees get orientation and training under a written plan. In adult day health, personal care staff need a nurse aide, home health aide or equivalent course, or 1 year of experience caring for impaired adults. We did not find a required number of training hours for aides.

Background checks. New employees and the owner need a statewide criminal history check covering the past 5 years, from an agency contracted with the NC Administrative Office of the Courts. CAP/DA providers also attest to criminal background and health care registry checks.

Health screening. New employees need a medical statement from within the prior 12 months. We did not find a staff TB test or vaccination requirement in 06R or 06S.

What does an adult day center in North Carolina have to provide?

Every certified North Carolina program must be open at least 6 hours a day and 5 days a week, offer daily cognitive, physical and social activities, and serve a midday meal plus two snacks. Programs must meet space minimums of 40 square feet per participant for day care, 50 for combination and 60 for day health. Transportation is optional, but it comes with rules if you offer it.

Hours. Programs operate at least 6 hours a day and provide supervision at least 5 days a week, except for holidays, hazardous weather, emergencies and vacations. They must tell the county DSS about late openings or early closings (10A NCAC 06R .0506). For Medicaid billing, CAP/DA adult day health must be provided at least 4 hours a day on a regular schedule.

Activities. Programs offer daily cognitive, physical and psychosocial activities and post a written activity schedule each week or month (06R .0501).

Meals. Programs serve a midday meal that provides at least one third of daily nutritional needs, from a menu approved by a licensed dietitian or nutritionist, and offer mid-morning and mid-afternoon snacks. Therapeutic diets are provided when prescribed (06R .0502).

Medications. Programs need a written medication policy, a medication record updated at least every quarter, original labeled pharmacy containers and locked storage (06R .0505).

Transportation. Programs do not have to provide transportation. If they do, they need a transportation policy, a seat and seatbelt for each rider, a rest stop offered at least every 30 minutes, and a first aid kit, fire extinguisher and copy of the policy in the vehicle (06R .0503).

Space and capacity.

• Adult day care: at least 40 square feet of indoor space per participant, not counting hallways, offices and restrooms, with space for group activities and separate space for privacy and quiet (06R .0401).
• Adult day health: 60 square feet per participant, and combination programs 50. In a building with other uses, a 40 square foot core area plus 20 square feet of other designated space is allowed with a fire-rated separation. Adult day health programs also need an enclosed, equipped treatment room (06S .0301).
• Restrooms: at least one male and one female toilet, 1 toilet for every 12 adults including staff, and 1 sink for every 2 toilets.
• Rest: cushioned chairs or sofas so at least half of participants can rest at once (all of them, if everyone rests at the same time), and a quiet room with at least one bed or cot (06R .0403).
• Special care units inside a larger center must be separated by closed doors, placed so others do not pass through, and have at least one toilet in the unit.
• Day care homes serving 16 or fewer adults in a single-family dwelling follow the home construction rules, and owners of homes certified after January 1, 2003 must live in the home.

Written policies. Under 06R .0501, programs need written policies on enrollment (including the population served), discharge, medications, participant rights, family grievances, advance directives, non-discrimination, confidentiality, abuse and neglect reporting, the geographic area served and inclement weather. A copy goes to the participant or family at enrollment. Programs also need personnel policies covering 15 listed items, a written staff orientation and training plan, a substitute staff plan, a transportation policy if they transport, and a written plan for an annual internal program evaluation (06R .0509).

Safety. Programs need a fire safety and evacuation plan approved by the State Fire Marshal or a designee, a written emergency plan on display, and an evacuation plan posted in each room. Fire drills are held monthly and other emergency drills (medical emergencies, natural disasters, security) every quarter, and all drills are documented (06R .0504).

What rules protect participants in North Carolina adult day programs?

North Carolina rules require a personal interview before the first day, a medical exam within 30 days of enrollment, and an assessment and service plan within 30 days that is reviewed at least every 6 months. Programs keep daily attendance by name and keep records for at least 6 years. Injuries and missing participants are reported to the county DSS within 72 hours.

Enrollment. Before the first day, the program holds at least one personal interview and has the needs determination and application signed. A medical exam completed within the prior 3 months must be obtained within 30 days of enrollment and updated each year (10A NCAC 06R .0501, .0508). CAP/DA serves adults 18 and older who meet nursing facility level of care. HCCBG participants must be 60 or older and frail, meaning they need help with 2 daily living activities or have a cognitive impairment that requires supervision.

Participant file. Each file holds a signed application (arrival and departure times, travel arrangements, two emergency contacts and a medical provider), authorizations to release information and for emergency care, a photo consent and a signed acknowledgment of program policies.

Care plan. A comprehensive assessment and service plan are due within 30 days. In adult day health, the health part is written and signed by an RN. Plans are reviewed at least every 6 months, with progress notes at least every 3 months.

Discharge. Each program sets its own discharge criteria, notice period and procedures in its written discharge policy, including referral or follow-up. The rules do not set a specific notice period, so families should ask for the program's policy.

Attendance and records. Programs keep a daily attendance record by name, find out and document the reason for an unscheduled absence the same day, and have participants who leave during the day sign out (or be signed out by a responsible person if they need supervision). Program records, including attendance, activity schedules, income and expense records, accident reports, staff absences, drill records and personnel records with criminal checks, are kept at least 6 years. Participant records are kept in a locked file.

Incidents. Sickness and incidents with injury or suspected injury, including a missing participant, are reported to the director, the family is notified, and a report goes to the county DSS within 72 hours. Each participant has a portable emergency information file (06R .0504). CAP/DA providers also report critical incidents to Medicaid within 72 hours, and since the 2024 waiver renewal falls and missed services count as Level II incidents.

What we did not find. We did not find a TB screening requirement at enrollment or a required written contract or fee disclosure for private-pay participants. Families should ask the program for its written enrollment, discharge and fee policies.

How does Medicaid pay for adult day in North Carolina?

NC Medicaid pays for adult day health, not social adult day care, through the CAP/DA waiver. Centers bill code S5102 at a daily rate for the days a participant attended. PACE organizations also provide adult day health to their members.

CAP/DA. The Community Alternatives Program for Disabled Adults is a 1915(c) home and community based waiver run by NC Medicaid under Clinical Coverage Policy 3K-2. It serves adults 18 and older who meet nursing facility level of care. The waiver was renewed for November 1, 2024 through October 31, 2029.

• Who can bill: adult day health providers certified by the Division of Aging under 06R and 06S that also meet the federal home and community based settings rule.
• Billing code and unit: S5102, per day, for days the participant attended. If a participant attends only part of the day and the center has a partial-day rate, that rate is billed.
• Minimum service: at least 4 hours a day on a regular schedule at a certified facility.
• Rate: $41.99 per day on the CAP/DA fee schedule updated March 29, 2022. The 18 percent rate increase that took effect August 1, 2026 covered CAP/DA personal care codes and does not list S5102.

Transportation. Non-medical transportation (A0090) is a separate CAP/DA service, not part of the adult day rate, with a combined annual cap of $800.

PACE. NC Medicaid lists 11 PACE organizations at 14 locations, and PACE centers include adult day health. The Division's September 2026 directory shows 15 certified adult day health sites run by PACE organizations. We did not find a published billing unit for adult day within PACE, since PACE organizations are paid for their members as a whole.

Attendance documentation. CAP/DA pays only for days attended, so the daily attendance record by name, same-day absence notes and sign-out records that the certification rules require are the records behind each claim. We did not find a rule requiring electronic attendance tracking for adult day in 06R, 06S, Policy 3K-2 or the HCCBG standards.

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

Yes, a program can be fully private pay, but it still needs Division of Aging certification. Certification applies whoever pays, unless the program serves 3 or fewer people, serves only relatives of the operator or is licensed under another statute. Private-pay programs follow the same rules for staffing, space, meals and records as every other program.

Protections for private-pay participants. Every certified program must have written policies on participant rights, grievances and non-discrimination and give them to the family at enrollment. Programs file a 732a-ADS daily rate sheet with planned expenses and revenue with the state at application and each renewal, and keep monthly records of fees collected and owed (10A NCAC 06R .0501, .0507, .0508, .0601). We did not find a required written contract or fee disclosure for private-pay participants.

Exempt programs. G.S. 131D-6 lists who is exempt but does not say what an uncertified program may or may not do, such as personal care or giving medications. We did not find those limits, so ask the Division before you plan a small program.

Home and Community Care Block Grant. The HCCBG, which combines Older Americans Act and state funds, pays for adult day care and adult day health for people 60 and older who meet its frailty rules, through Area Agencies on Aging and county providers. Under the HCCBG service standards:

• Adult day health clients must also need medical monitoring, medication or treatment.
• Payment is by day of enrollment on scheduled days rather than actual attendance. Up to 10 absent days in a row may be billed, but holidays and closed days may not.
• Transportation is billed separately from the daily care rate.
• Clients register through the DAAS-101 form and the state ARMS system, which is also used to report units.
• Clients may be asked for consumer contributions.

We did not find current HCCBG adult day rates. Your local Area Agency on Aging can tell you whether HCCBG adult day funding is available in your county.

Social Services Block Grant. The record rules require a DSS-5027 control file for participants whose care is claimed under the Social Services Block Grant (Title XX). Ask your county DSS how those claims work locally.

Veterans. We did not research VA adult day health care in North Carolina from a VA source. Veterans should ask their VA medical center.

The market. The NCDHHS certified provider directory dated September 2, 2026 lists 92 certified centers in 47 counties with 5,826 certified slots: 21 adult day care, 55 combination and 16 adult day health programs, 15 of them PACE sites. Some carry special care designations for developmental disabilities or Alzheimer's disease. We did not find a currently active North Carolina adult day services association.

What is changing next for adult day in North Carolina?

As of our last check on October 21, 2026, we did not find an upcoming change to North Carolina's adult day certification rules or to Medicaid adult day health payment. The most recent changes below are already in effect.

• Personal care rate increase, August 1, 2026. NC Medicaid raised personal care rates by 18 percent, including CAP/DA codes S5125 and S5150. The adult day health code S5102 is not on the list.
• CAP rate cut reversed, December 10, 2025. NC Medicaid cut rates for CAP services other than personal care by 3 percent on October 1, 2025, then restored them to September 30, 2025 levels as of December 10, 2025. The NC Medicaid questions and answers do not name adult day health specifically.
• CAP/DA waiver renewed, November 1, 2024. CMS renewed the waiver through October 31, 2029. The renewal added services and made falls and missed services Level II incidents, and did not announce adult day health changes.
• Certification rules readopted, 2019. The 06R adult day care rules were readopted effective September 1, 2019 and the 06S adult day health rules effective November 1, 2019. We did not find newer rulemaking for either subchapter.

North Carolina adult day sources

• NCDHHS Division of Aging: Adult Day Services
• N.C. Gen. Stat. 131D-6: certification of adult day care programs
• 10A NCAC 06R: Adult Day Care Standards for Certification (NC Administrative Code)
• 10A NCAC 06S: Adult Day Health Services Standards for Certification (NC Administrative Code)
• NC Medicaid Clinical Coverage Policy 3K-2: CAP/DA
• NC Medicaid CAP/DA fee schedule, updated March 29, 2022
• NC Medicaid: Program of All-Inclusive Care for the Elderly (PACE)
• NCDHHS: HCCBG Adult Day Care and Adult Day Health Service Standards
• NCDHHS: Adult Day Care and Day Health Provider Directory, September 2, 2026
• NC Medicaid: August 2026 rate increase for personal care services and CAP

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
• Adult Day Care Activity Ideas to Keep Clients Engaged
• Effective Transportation Tracking for Elder Day Centers
• 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, Nebraska, Nevada, New Mexico, 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.