Adult Day Care in North Dakota

All states: adult day services map

North Dakota adult day services at a glance

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

How is adult day care regulated in North Dakota?

North Dakota does not license adult day centers. Instead, North Dakota Health and Human Services (HHS) sets adult day standards for centers that serve people whose care is paid by the Medicaid Home and Community-Based Services (HCBS) Waiver or by the state-funded SPED and ExSPED programs. A center that serves only private-pay participants is not covered by those standards.

The rules that do apply come from HHS program layers, not a license:

• Medicaid (HHS Adults and Aging Services and Medical Services). The HCBS Policy Manual section 525-05-30-10 (revised June 1, 2025) sets the adult day standards, including the staff ratio, space and services. The qualified service provider rules in N.D. Admin. Code chapter 75-03-23 set who can be paid. HHS also oversees PACE, which includes an adult day center.
• State funding (SPED and ExSPED). SPED, Service Payments for the Elderly and Disabled, is a state program that pays for home and community services for people 65 and older and people with disabilities. Expanded SPED (ExSPED) also covers adult day care. Both use the same rule chapter and the same manual section as the Medicaid waiver, so the standards are identical for all three payers.
• Other funding. The U.S. Department of Veterans Affairs offers Adult Day Health Care through the Fargo VA Health Care System.

Centers and homes. HHS defines adult day care as a non-residential group program of health and social services offered at least 3 hours a day on a regular schedule, one or more days a week (HCBS Policy Manual 525-05-05). An adult day care center runs in a publicly accessible building. An adult day care home runs in a private residence and may serve no more than 4 participants at a time.

Adult day health care. State rules use only the term adult day care and do not define a separate adult day health care model or a social versus medical model. The VA uses the name Adult Day Health Care for its own program.

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

No state adult day license exists. If you plan to serve people on the Medicaid HCBS Waiver, SPED or ExSPED, you must meet the HHS adult day standards, pass a fire inspection and an on-site visit by an HCBS case manager, and enroll with HHS as a qualified service provider (QSP). A private-pay-only center goes through none of these steps.

Getting approved to serve publicly funded participants. Under HCBS Policy Manual 525-05-30-10:

• Complete the self-administered Adult Day Care Standards Compliance Checklist (SFN 1703).
• Send it to the HCBS Program Administrator with evidence of fire and safety inspections. The inspection is done by the local fire department or the State Fire Marshal.
• An HCBS case manager visits on site to verify that the program meets the standards.

Qualified service provider enrollment. A provider paid by SPED or the Medicaid waiver must apply to HHS to be designated a QSP, and it and its employees must meet any licensure, certification or competency rules that apply (N.D. Admin. Code 75-03-23-07). Agencies enroll through the HHS QSP enrollment portal. The QSP Hub, run by the UND Center for Rural Health with HHS funding, lists what agency enrollment needs:

• A National Provider Identifier (NPI), identification and direct deposit documentation.
• QSP onboarding training and Fraud, Waste and Abuse training.
• An SFN 749 Document of Competency for each direct care employee.
• An SFN 1168 form on controlling interest and convictions.

Facilities that already hold a license. Hospitals, nursing homes and basic care facilities are treated as meeting the adult day standards through their own licenses, and adult foster care homes licensed by HHS are treated as meeting the adult day home standards. Medicaid waiver funds cannot pay for adult day care in a nursing home or hospital, but SPED and ExSPED clients may attend there.

Each site. Each center or home completes its own SFN 1703 checklist and site visit.

Renewal and inspections. The compliance checklist is valid for no more than 2 years, after which the case manager reviews the program again. Centers need a fire inspection before approval and every 2 years after (every 3 years for adult day homes). QSP agencies revalidate their enrollment every 5 years.

What we did not find. We did not find application fees, a certificate of need or moratorium for adult day, local permit requirements beyond the fire inspection, or rules on change of ownership. HHS publishes a provider enrollment moratoria document, but we could not confirm whether it affects adult day care. Ask HHS Adults and Aging Services or the QSP Hub before you sign a lease or buy a center.

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

Adult day programs that serve Medicaid waiver, SPED or ExSPED participants must keep at least 1 staff member for every 8 participants. This ratio comes from the HHS HCBS Policy Manual, not from a license rule, so it does not apply to private-pay-only centers. We did not find a separate ratio for participants with dementia.

• Licensing: no licensing layer exists, so no ratio is set there.
• Medicaid waiver (HHS): 1:8 under HCBS Policy Manual 525-05-30-10.
• SPED and ExSPED (HHS): the same 1:8, from the same manual section.

Who counts. Full-time or full-time equivalent staff are those who spend 70 percent of their time in direct service with participants. A center inside another facility may share staff, but shared staff must meet the adult day staff standards. A relative who fits the Family Home Care definition may provide adult day care, but a guardian or legally responsible person (a spouse, or the parent of a minor) may not. We did not find whether volunteers count toward the ratio.

Minimum staff on site. We did not find a minimum number of staff on site regardless of census, or staffing that steps up with census beyond the 1:8 ratio.

Qualifications and competency. Under N.D. Admin. Code 75-03-23-07, QSPs must be at least 18, able to read, write and communicate, physically able to do the work, keep information confidential and complete a department-approved orientation. An adult day care QSP must show competency in tasks such as infection control, handwashing, handling body fluids, bathing, incontinence care, feeding, help with self-administered medication, dressing, toileting, positioning, transfers and walking. A physician, registered or licensed practical nurse, therapist or similar professional verifies competency in writing, unless the person holds a listed license or certification in good standing.

Training. Staff and volunteers must be trained in emergency and evacuation procedures, and agency enrollment includes onboarding and Fraud, Waste and Abuse training. We did not find a required number of training hours.

Background checks. People convicted of listed offenses that bear directly on the work are disqualified unless the rehabilitation rules apply, and agencies file an SFN 1168 conviction form. We did not find a fingerprint check requirement specific to adult day.

What we did not find. We did not find director, nurse, activity or social services staff qualifications, or staff TB or vaccination rules. Ask HHS if you need these answered for your program.

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

A program serving publicly funded participants must operate 3 to 10 hours a day, help with daily living activities, offer planned activities, and serve a meal and two snacks. Centers need at least 35 square feet of program space per participant and one toilet per gender for every 15 participants. These are HHS program standards under HCBS Policy Manual 525-05-30-10.

Services. Programs help with activities of daily living and offer planned individual and group activities. Participation in activities is never required. Shopping, housework and laundry are not allowed as part of adult day care.

Meals. Programs serve a nutritious meal at mealtime plus mid-morning and mid-afternoon snacks, keep food and fluids available at all times, and offer modified diets when needed.

Hours. Programs operate at least 3 and no more than 10 hours a day, and participants attend on a planned basis during set hours. We did not find a minimum number of days a week a program must be open.

Transportation. Non-medical transportation may be part of the adult day service and may already be included in the provider's rate. The HCBS Program Administrator confirms whether it is included for your program.

Space and capacity for centers:

• At least 35 square feet of program space per participant, not counting hallways, offices, restrooms and storage.
• At least one toilet per gender for every 15 participants, accessible to people with limited mobility, with at least one lockable restroom for privacy.
• Street-level access or elevators, at least two identified exits, a rest area that can separate an ill participant, locked medication storage, a telephone for participants, and lockers or closets.
• Separate, identifiable space when sharing a building with other services, and design that meets Section 504 and state and local barrier-free rules.

We did not find a maximum capacity for centers.

Adult day care homes. A home may serve no more than 4 participants at a time. It needs two exits at least 30 inches wide, working smoke detectors, an ABC fire extinguisher, and a heating unit inspection before service and every 2 years. Space heaters are not allowed.

Written policies and safety. Programs need a policy on helping with self-administered medications, a plan for emergency medical care, and posted emergency and fire safety procedures with evacuation routes. Fire drills are held twice a year, fire extinguishers are inspected and maintained, and first aid kits are kept in view. QSP agencies that employ people outside the family must have a department-approved quality improvement program that identifies, addresses and reduces harm to the people they serve (75-03-23-07). We did not find how often policies must be reviewed.

What rules protect participants in North Dakota adult day centers?

For publicly funded participants, HHS requires an eligibility assessment and prior authorization before services start, a written emergency care agreement in each file, and notes in the file when a participant's status changes. Critical incidents are reported to HHS through its Therap reporting system. We did not find adult day rules on care plan review timelines, discharge notice or record retention.

Who can enroll. Under HCBS Policy Manual 525-05-30-10, a participant must be eligible for the Medicaid HCBS Waiver, SPED or ExSPED, be able to function in an ambulatory setting and take part in group activities, and need help with daily living activities based on the comprehensive assessment. If the person does not live alone, they must have a caregiver who will benefit from the relief.

Authorization. Services must be authorized before they are billed, and HHS says claims for unauthorized services will be denied. Eligible people choose a provider from the department's QSP list, and an authorization is then issued (HHS QSP billing codes page).

Participant file and rights. Each file includes a written agreement with the participant or family about emergency care and ambulance transportation. Participants control their own schedules, and any limit on the setting requirements must be justified in the person-centered service plan. Changes in a participant's status are noted in the file and the right people are told.

Discharge. We did not find an adult day discharge notice period. A separate QSP rule requires 30 days written notice before an involuntary discharge for agencies serving people with 24-hour supports, but it is not specific to adult day care.

Incidents. HHS directs QSPs to report critical incidents through Therap General Event Reports and offers a critical incident reporting training module. We did not find a reporting time limit.

Billing integrity. HHS may end a provider's QSP status for a pattern of inaccurate billing or billing for services that are not covered (75-03-23-08.1).

What we did not find. We did not find a physician order, physical exam or TB screening at enrollment, required enrollment agreement contents beyond the emergency agreement, care plan review timelines, attendance record contents or a record retention period. Families should ask the center for its written policies, and operators should ask HHS what it expects.

How does Medicaid pay for adult day in North Dakota?

North Dakota Medicaid pays for adult day care through the Medicaid HCBS Waiver for the aged and disabled, and the state pays through SPED and ExSPED. The HHS fee schedule updated October 1, 2026 lists three codes: S5100 (15 minutes), S5101 (half day) and S5102 (per day). HHS sets each provider's rate rather than publishing one statewide rate. PACE also covers adult day center care for its enrollees.

Medicaid HCBS Waiver. This 1915(c) waiver is run by HHS Adults and Aging Services and the Medical Services Division. Adult day care is a covered waiver service for people who need help with daily living activities, can take part in group activities and, if not living alone, have a caregiver who benefits from relief (75-03-23-06). Room and board cannot be included in waiver payments.

• Codes and units: S5100 per 15 minutes, S5101 per half day and S5102 per day, all listed as covered in the Medicaid HCBS fee schedule (October 1, 2026).
• Rates: the fee schedule shows no general rate for these codes. HHS sets the adult day unit rate for each provider based on the hours of care, and the department sets monthly maximum payments per service and per person (75-03-23-09). HHS updated QSP rates on July 1, 2026, but we could not read the rate sheet, so ask HHS for your rate.
• Setting limit: waiver funds cannot pay for adult day care in a nursing home or hospital.
• Authorization: services must be authorized before billing.

SPED and ExSPED. These state-funded programs pay for adult day care under the same standards and the same QSP process (75-03-23-05). Unlike the waiver, SPED and ExSPED clients may attend adult day care in a nursing home or hospital.

Transportation. Transportation is not billed separately. Non-medical transportation may be part of the adult day service and may already be in the provider's rate, and the HCBS Program Administrator confirms whether it is.

PACE. HHS describes Northland PACE as the only PACE program in North Dakota, with sites in Bismarck, Dickinson, Minot and Fargo. Enrollees must be 55 or older, live in a PACE service area, meet nursing home level of care and be able to live safely in the community. Participants at a PACE day center can see PACE providers, have a meal and join activities. PACE is paid a set amount per enrollee, so adult day is not billed by the unit.

Attendance documentation. Participants attend on a planned basis during set hours, and the unit rate follows the hours of care received. The October 2026 fee schedule flags the 15-minute code (S5100) for electronic visit verification but not the half-day or per-day codes. HHS publishes sample service documentation forms for agency QSPs, but we did not find adult day sign-in, sign-out or attendance record rules. Ask HHS which code applies to your program and how to document attendance.

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

Yes. North Dakota has no adult day license, and the HHS adult day standards apply only to providers serving people on the Medicaid HCBS Waiver, SPED or ExSPED. We did not find any state standard for a center that serves only private-pay participants.

What we did not find. We did not find limits on what a private-pay program may do, such as nursing or giving medications, or required contract and fee disclosures for private-pay participants. Families choosing a private-pay center should ask for its written policies on fees, emergencies, medications and discharge, and ask whether it meets the HHS standards even if it is not required to.

Other funding.

• SPED and ExSPED. These state-funded HHS programs pay for adult day care for eligible people who are 65 and older or have disabilities. A center must meet the HHS standards and enroll as a QSP to be paid.
• VA. The Fargo VA Health Care System lists Adult Day Health Care for veterans who need help with daily activities, are isolated, or whose caregiver is under strain. The VA sets eligibility.
• Family Caregiver Support Program. This federally funded HHS program offers respite to caregivers providing 24-hour care. Its page does not say whether that respite may be provided in adult day care.
• Older Americans Act. We did not confirm that Older Americans Act funds pay for adult day care in North Dakota.

To learn what is available for a particular person, call the Aging and Disability Resource-LINK at 1-855-462-5465.

The market. We did not find a state count of adult day centers, since there is no license list, and we did not find a North Dakota adult day association.

What is changing next for adult day in North Dakota?

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

• QSP rates updated, July 1, 2026. HHS updated qualified service provider rates and the rural differential rate effective July 1, 2026 (HHS QSP page). Ask HHS for the adult day rate that applies to you.
• Adult day standards revised, June 1, 2025. HHS revised the HCBS manual adult day chapter, adding participant experience requirements such as access to food at all times and no required activities.
• Five-year revalidation. QSPs now revalidate their enrollment every 5 years instead of every 2. HHS did not publish a date for this change.

North Dakota adult day sources

• ND HHS HCBS Policy Manual 525-05-30-10: Adult Day Care
• ND HHS HCBS Policy Manual 525-05-05: Definitions
• N.D. Admin. Code 75-03-23-05: SPED covered services
• N.D. Admin. Code 75-03-23-07: qualified service provider requirements
• ND HHS: Information for Qualified Service Providers
• QSP Hub: Agency enrollment
• ND Medicaid HCBS Services Fee Schedule, October 1, 2026
• ND HHS: Licensing, Regulation and Certification
• ND HHS: Program of All-Inclusive Care for the Elderly (PACE)
• VA Fargo Health Care System: health services

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• Simplifying Payments with Electronic Billing for Adult Day Care
• Effective Transportation Tracking for Elder Day Centers
• Podcast: Adding Adult Day Services to Home Care Brings Synergy and Margins
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states with no state adult day license

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