Adult Day Care in Ohio

All states: adult day services map

Ohio adult day services at a glance

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

How is adult day care regulated in Ohio?

Ohio does not license adult day centers. Instead, the rules a center must follow depend on who pays for its participants. The Ohio Department of Aging (ODA) certifies centers that want to be paid through the PASSPORT Medicaid waiver, the Ohio Department of Medicaid (ODM) sets rules for centers serving the Ohio Home Care Waiver, and ODA sets a parallel rule for centers paid with Older Americans Act funds.

Several layers of rules can apply to an Ohio center, and each comes from a different agency:

• Licensing. None found. We did not find an Ohio statute or rule that licenses adult day centers. Ohio Revised Code 173.39 makes ODA certification a condition of payment, not of operating. Local fire, building and plumbing codes still apply.
• Medicaid, PASSPORT (ODA). PASSPORT is a Medicaid waiver for people 60 and older, run by ODA under an agreement with ODM. Centers are certified under Ohio Administrative Code (OAC) 173-39-02.1, plus ODA's general provider rules in OAC 173-39-02, 173-39-03 and 173-39-04.
• Medicaid, Ohio Home Care Waiver (ODM). ODM calls its version the adult day health center service, for waiver enrollees from birth through age 59. Its rule is OAC 5160-46-12, plus ODM's waiver provider rules in OAC 5160-44-31 and 5160-44-05.
• Medicaid, MyCare Ohio. MyCare Ohio plans cover adult day health services as set out in the ODA or ODM rules, but pay under their own contracts (OAC 5160-58-04).
• Medicaid, developmental disabilities (DODD). The Ohio Department of Developmental Disabilities pays for adult day support under its Individual Options, Level One and SELF waivers (OAC 5123-9-17). This is a separate skills-building day service, not the aging adult day model.
• Other funding. Older Americans Act adult day follows OAC 173-3-06.1 through area agency on aging provider agreements. The U.S. Department of Veterans Affairs also pays for adult day health care for some veterans.

Enhanced and intensive. Ohio does not split adult day care and adult day health care into separate licenses. ODA certifies one adult day service at two levels. Enhanced adult day covers supervision of all daily living activities, hands-on help with at least one activity other than bathing, help with medications and occasional health monitoring. Intensive adult day adds hands-on help with at least two activities including bathing, regular health monitoring, social work, and skilled nursing and rehabilitative services, and the center must have bathing facilities. The ODM Ohio Home Care Waiver uses a single adult day health center service that must include nursing or personal care aide services.

We did not find a dementia-specific adult day license or certification in the ODA or ODM rules.

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

No. Ohio has no adult day license, and ODA says its certification is not required to operate. You need ODA certification only if you want to be paid through PASSPORT, and you must meet ODM's rules to serve the Ohio Home Care Waiver. Either way, local fire, building and plumbing codes apply.

Getting ODA certified (PASSPORT). Under OAC 173-39-03:

• Apply through ODA's provider management system. An incomplete application expires after 90 days.
• ODA's regional designee does a pre-certification review, usually a site visit, within 60 days of a complete application.
• After approval, the regional designee signs a provider agreement that states its time period, region and unit rate.
• If you are denied, you cannot reapply for one year.

Inspections and reviews. ODA does a structural compliance review by the first anniversary of certification and every year after, and it may also review without notice (OAC 173-39-04). ODA-certified centers need an annual fire code inspection, another after any report of noncompliance, and local building department inspection as needed.

Ohio Home Care Waiver providers (ODM). Centers need a local or state fire marshal inspection when they apply and at least once every 365 days after, and must carry at least $1 million in commercial liability insurance (OAC 5160-46-12). ODM waiver providers must keep their contact information current in the PNM portal and tell ODM about changes within 7 calendar days (OAC 5160-44-31).

Older Americans Act funding. To be paid with these funds, a center signs a provider agreement with its area agency on aging and follows OAC 173-3-06.1.

What we did not find. We did not find application or certification fees, a certificate of need or moratorium, whether each site needs its own certification, a certification term or renewal period, or a change of ownership process. ODA-certified providers must report changes to phone, mail or email within 7 days, but the rule does not address a sale. If you are buying a certified center, ask ODA's regional designee or ODM how the certification and provider agreement carry over before you close.

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

Every payer layer that sets adult day rules in Ohio requires at least 1 staff member for every 6 participants at all times. ODA's PASSPORT and Older Americans Act rules also require at least 2 staff whenever more than one participant is present, one of them CPR certified. No layer sets a separate ratio for people with dementia.

• Licensing: no ratio specified, because there is no license.
• PASSPORT (ODA, OAC 173-39-02.1): 1:6 at all times, at least 2 staff when more than one individual is present, one CPR certified. The rule does not say whether volunteers count.
• Ohio Home Care Waiver (ODM, OAC 5160-46-12): 1:6 counting paid direct care staff only. This is the stricter rule on who counts.
• Older Americans Act (ODA, OAC 173-3-06.1): 1:6 at all times, and at least 2 staff when more than one consumer is present, one a paid aide and one CPR certified.
• DODD adult day support (OAC 5123-9-17): no general ratio. The small group arrangement is 1 direct support professional for no more than 4 participants.

Nurse and activity director. ODA requires an RN or LPN to be available for nursing tasks, though not necessarily on site, and the center must employ an activity director. We did not find nurse or social worker hours that increase with census.

Qualifications. Under the ODA rule, the activity director needs a degree in recreational therapy or a related field, two years of relevant experience, compliance with OAC 3701-17-07, or NCCAP certification. Activity assistants and personal care aides need a high school diploma or equivalent or two years of supervised relevant work, and aides may instead complete a health or human services vocational program. Licensed professionals must hold a current license. We did not find qualifications for a program director.

Training. ODA requires orientation under OAC 173-39-02.11 and task-based training for personal care aides before they provide adult day services, and 8 hours of continuing education or in-service training each calendar year for aides, activity directors and activity assistants. ODM requires 12 hours of in-service training every 12 months for non-licensed direct care staff, which is the stricter rule. The Older Americans Act rule requires 8 hours every 12 months for each staff member.

Background checks. ODA providers run criminal records checks under ORC 173.38 and 173.381 and OAC Chapter 173-9, and OAC 5160-1-17.8 for Medicaid-funded programs (OAC 173-39-02). ODM waiver providers follow OAC 5160-45-07 or 5160-45-08 and 5160-45-11.

Health screening. We did not find a staff TB test or vaccination requirement in the ODA or ODM adult day rules.

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

Certified Ohio centers provide recreational and educational activities and one to two meals a day, plus the personal care and health services required for their level. ODA-certified centers need at least 60 square feet per person and one toilet for every 10 people. Ohio Home Care Waiver centers must also meet detailed fire safety and emergency planning rules.

Services. Under OAC 173-39-02.1, enhanced and intensive centers provide the services listed for their level (see the first section). Daily and monthly activities must be announced through at least two media. ODM Ohio Home Care Waiver centers must provide waiver nursing or personal care aide services, recreational and educational activities and one to two meals a day. Skilled therapy and transportation are optional, and services the center delivers are not billed separately.

Meals. ODA centers serve at least one and no more than two meals a day. Lunch and snacks must be offered to everyone present at those times and meet home-delivered meal standards.

Transportation. An ODA-certified center transports participants under OAC 173-39-02.18 or subcontracts with a provider that meets that rule, and caregivers may also transport. Time spent in transport does not count toward attendance units. Older Americans Act centers follow OAC 173-3-06.6 for transportation.

Space and capacity. Ohio has no licensed capacity. Under the ODA PASSPORT and Older Americans Act rules:

• At least 60 square feet per individual served, not counting hallways, offices, restrooms or storage. The count includes everyone served, including private-pay participants, not only those in ODA programs.
• At least one working toilet for every 10 individuals, plus at least one wheelchair-accessible toilet. Intensive centers need bathing facilities.
• A center in a shared building needs separate, identifiable adult day space and staff during operating hours.

The ODM rule sets no square footage or restroom ratio, but it requires fire pull stations, fire extinguishers, smoke and carbon monoxide detectors on each level, a posted floor plan showing extinguishers and exits, and locked storage of chemicals and medications.

Hours. We did not find a minimum number of days or hours a center must be open.

Written policies. The rules require:

• A policy on self-administration of medications and a policy on documenting incidents (ODA).
• For ODA agency providers, policies that require employees to meet ethical and legal service standards.
• For Ohio Home Care Waiver centers (ODM): an emergency plan for weather, fire and other emergencies with a tornado shelter area and evacuation site, emergency drills at least every quarter with no more than 90 days between them, monthly smoke detector tests, yearly extinguisher service, an elopement policy that includes notifying law enforcement, a smoking policy, and a written procedure for liability claims.

We did not find a required policy review schedule or advisory committee.

What rules protect participants in Ohio adult day centers?

For certified centers, ODA requires an initial assessment by the end of the second day of attendance, a health assessment and activity plan within 30 days, and a care conference at least every six months. Both ODA and ODM require 30 days written notice before ending services and six years of record keeping. Incidents go to the case management agency within one business day.

Who can enroll. Medicaid participants need waiver eligibility and a case manager's authorization. PASSPORT serves people 60 and older with an intermediate or skilled level of care, and the Ohio Home Care Waiver serves people from birth through age 59 with a nursing facility level of care (OAC 5160-31-03).

Assessment and care plan (ODA and Older Americans Act).

• An initial assessment of functional, cognitive and social needs and a social profile by the end of the second day of attendance. The center may instead use a case manager assessment done no more than 30 days before the first day.
• A health assessment and activity plan within 30 days of first attendance or before the first 10 units, whichever comes first.
• A plan of treatment before giving medication, therapeutic diets, nursing, nutrition consultation or therapy, renewed at least every 90 days.
• An interdisciplinary care conference at least every six months, with invitations sent at least 7 days ahead.

Ending services. ODA-certified providers give the person and their designee written notice at least 30 days before ending services, with some exceptions (OAC 173-39-02). ODM waiver providers give at least 30 calendar days written notice, or verbal and written notice at least 10 days ahead if the person is hospitalized, institutionalized or incarcerated (OAC 5160-44-31). We did not find a list of permitted discharge reasons.

Records. Ohio Home Care Waiver centers keep a clinical record with identifying information, medical history, physician, service plans, advance directives, allergies and diet, each attendance date with arrival and departure times, and a discharge summary. ODA and ODM both require service records to be kept six years after payment and until any audit is resolved. ODA also requires staff qualification records for the employment or certification period plus six years.

Incidents and abuse. For the Ohio Home Care, PASSPORT, assisted living and MyCare Ohio waivers, providers first protect the person, then report the incident to the case management agency right away and no later than one business day after discovery (OAC 5160-44-05). ODA providers report suspected abuse, neglect or exploitation to county adult protective services and notify ODA or its designee within one business day.

What we did not find. We did not find a required physician order, physical exam or TB screening at enrollment, or required contents for an enrollment agreement. Families should ask a center for its written admission, discharge and fee terms.

How does Medicaid pay for adult day in Ohio?

Ohio Medicaid pays for adult day by the day and half day. PASSPORT pays up to $80.94 per day for enhanced and $106.26 per day for intensive adult day, with transportation billed separately. The Ohio Home Care Waiver pays up to $106.26 per day under code S5102. People with both Medicaid and Medicare are now served through MyCare Ohio plans, which pay under their own contracts.

PASSPORT (run by ODA). Maximum rates from the rate appendix to OAC 5160-1-06.1 (rule effective April 17, 2026; the adult day amounts are the same as in the 2024 appendix):

• Enhanced: $80.94 per day (4 to 8 hours), $40.48 per half day (under 4 hours), $2.54 per 15 minutes past 8 hours, up to 12 hours.
• Intensive: $106.26 per day, $53.11 per half day, $3.33 per 15 minutes past 8 hours.
• Transportation: billed separately at up to $28.61 per round trip, $23.21 per one-way trip or $3.12 per mile. Group trips for riders from the same household are paid at 75 percent of the rate.

The appendix lists no billing codes, and we did not find the codes ODA uses for PASSPORT adult day. Your regional provider agreement states your unit rate.

Ohio Home Care Waiver (run by ODM). The adult day health center service is billed as a full day (S5102, 5 or more hours) at up to $106.26 or a half day (S5101, under 5 hours) at up to $53.11 (OAC 5160-46-06, effective April 17, 2026). Transportation the center provides is not paid separately.

MyCare Ohio. The Next Generation MyCare program for people with both Medicaid and Medicare is now statewide. Members who were on PASSPORT or the Ohio Home Care Waiver when they enrolled are now in the MyCare Ohio Waiver, so their adult day claims go to the MyCare plan. Statewide plans are Anthem Blue Cross and Blue Shield, CareSource and Molina HealthCare of Ohio. We did not find the rates or units the plans pay, so ask each plan you contract with.

DODD waivers. Adult day support for people with developmental disabilities is billed in 15-minute units, or a daily unit when the same provider delivers 5 to 7 hours in person. Its rates are in an appendix to OAC 5123-9-17 that we did not review.

PACE. PACE serves its members at an approved PACE center and is paid a set amount per member, so adult day is not billed by the unit. ODA's PACE center listing and a legislative fiscal note show PACE active in nine counties: Ashtabula, Cuyahoga, Franklin, Hamilton, Lorain, Mahoning, Montgomery, Summit and Trumbull.

Attendance documentation. For each session, ODA requires the person's name, the date, arrival and departure times, mode of transportation and a unique identifier from the person confirming they received the service, and providers may bill only when these items are recorded. ODM requires dates, location, start and end times, and signatures of the provider and the person or their representative (the person may sign within three business days). The rules we read do not require a particular method or an electronic system for adult day attendance.

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

Yes. ODA states that a provider may offer adult day care paid privately, by insurance or by other non-Older Americans Act programs without ODA certification and without an area agency on aging provider agreement. We did not find any state rule that governs a private-pay-only center beyond local fire, building and plumbing codes.

What changes if you also take public funds. Once a center is ODA certified, its space and toilet minimums count every person served, including private-pay participants (OAC 173-39-02.1).

What we did not find. We did not find a state rule limiting what an uncertified private-pay center may do, such as personal care, nursing or medication help, or consumer protections specific to private-pay participants, such as contract or fee disclosure rules. Families choosing a private-pay center should ask whether it is ODA certified and request its written policies.

Other funding.

• Older Americans Act. Area agencies on aging buy adult day through provider agreements under OAC 173-3-06.1, in half-day (under 4 hours), day (4 to 8 hours) and 15-minute units from 8 to 12 hours.
• Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical criteria, at VA medical centers, State Veterans Homes or community organizations. A copay may apply.
• State grants. On March 11, 2024, ODA awarded about $6.0 million in federal ARPA funds to 22 adult day projects in 16 counties, for new and renovated facilities, expanded services, workforce, transportation and equipment.

We did not confirm a statewide Elderly Services Program that pays for adult day. Some counties may fund senior services locally, so ask your area agency on aging.

The market. We did not find a dedicated Ohio adult day association. Adult Day Ohio, a partnership of ODA and LeadingAge Ohio, offers consumer information and a directory of centers. Because Ohio does not license adult day centers, we did not find an official count of centers.

What is changing next for adult day in Ohio?

As of our last check on October 21, 2026, we did not find a confirmed upcoming change to Ohio's adult day rules or Medicaid adult day payment. Two possible PACE expansions are announced but not final, and two recent changes are already in effect.

• Proposed PACE expansion (not enacted). H.B. 750, reported by the House Health Committee, would require ODA to seek PACE proposals for unserved counties, with a target of December 31, 2026 for the request. The bill has not become law, and we could not confirm its status after committee.
• Possible Lucas County PACE center. ODA lists a BoldAge PACE center for Lucas County with a tentative opening around April 2027. That date may change.
• Revised ODA adult day rules, October 1, 2026. ODA's five-year review of OAC 173-39-02.1 (PASSPORT) and 173-3-06.1 (Older Americans Act) took effect October 1, 2026. ODA said the changes add no new requirements. They remove a separate ADA paragraph already covered by the Ohio Building Code, add references to the fire, building and plumbing codes with an annual fire inspection, keep 60 square feet per person and one toilet per 10, require each center's own medication self-administration policy, and allow toxic substances in a secured location or container.
• MyCare Ohio statewide, August 1, 2026. Next Generation MyCare began January 1, 2026 in 29 counties and reached the rest of Ohio by August 1, 2026. Adult day claims for dual-eligible members who were on PASSPORT or the Ohio Home Care Waiver now go to their MyCare plan.

Ohio adult day sources

• OAC 173-39-02.1: ODA adult day service certification (PASSPORT)
• ODA business impact analysis for OAC 173-3-06.1 and 173-39-02.1 (June 2026)
• Ohio Revised Code 173.39: ODA provider certification
• OAC 173-39-03: ODA provider certification process
• OAC 5160-46-12: Ohio Home Care Waiver adult day health center service
• OAC 5160-46-06: Ohio Home Care Waiver rates
• OAC 5160-1-06.1 appendix: PASSPORT and other waiver rates (April 2026)
• OAC 173-3-06.1: Older Americans Act adult day service
• Ohio Department of Medicaid: MyCare Ohio
• Ohio Department of Aging: Find a Local PACE Center

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
• Adult Day Care Activity Ideas to Keep Clients Engaged
• 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, North Dakota, 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.