Adult Day Care in Oklahoma

All states: adult day services map

Oklahoma adult day services at a glance

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

How is adult day care regulated in Oklahoma?

Oklahoma has one license for adult day care, the adult day care center license, issued by the Oklahoma State Department of Health (OSDH). There is no separate adult day health care license. Medicaid pays licensed centers for the service under two names: Adult Day Health in the ADvantage waiver and Adult Day Services in the developmental disability waivers.

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

• Licensing (OSDH). The Adult Day Care Act (63 O.S. 1-870 and following) and the Adult Day Care Centers rules, OAC 310:605, last amended effective September 11, 2022. These rules cover the license, staffing, space, services, records and participant rights for every center, whatever the payer.
• Medicaid, ADvantage (OHCA and OKDHS). The Oklahoma Health Care Authority (OHCA) runs SoonerCare, the state Medicaid program. Its ADvantage waiver rules (OAC 317:30-5-760 series) define Adult Day Health. Oklahoma Human Services (OKDHS) Community Living, Aging and Protective Services administers ADvantage day to day.
• Medicaid, developmental disability waivers (OHCA and OKDHS DDS). The Adult Day Services rule, OAC 317:40-5-113, covers Adult Day Services paid by the Community, Homeward Bound and In-Home Supports for Adults waivers, run by OKDHS Developmental Disabilities Services (DDS).
• State program (OKDHS). OKDHS also runs an Adult Day Services Program for functionally impaired older adults, generally 60 and over, through contracts with licensed centers.

The licensing rules define an adult day care center as a facility that provides basic day care services to unrelated impaired adults for more than four hours in a 24-hour period (OAC 310:605-1-2). The center must be a distinct program with its own verifiable staff, space, budget and participant records. It can be free-standing, or an "associated day care program" attached to another organization with its own space and staff. Both hold the same license. Retirement centers and senior citizen centers are outside the definition.

Health services such as health monitoring, medication administration and therapies are required only as the center's program goals and participants' needs call for, so the health side varies by center rather than by license type. We did not find a separate dementia or social-model license.

Licensing is the base layer for every center. A center that bills Medicaid takes on more: ADvantage adds federal home and community based settings requirements, and the DDS waivers add team and reporting duties.

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

Yes. Operating an adult day care center without a current OSDH license is unlawful, whoever pays for care and whatever other licenses the operator holds. Each site needs its own license. A new center starts with an initial license that lasts 180 days, and later licenses run 36 months.

How to apply. OSDH posts the application, ODH Form 712, and related forms on its Health Facility Systems page. Under the Form 712 instructions, an initial application includes:

• The $75 initial license fee and a notarized Form 712.
• Disclosure statement forms 953-B, C and D and a staffing projection form, 953-E.
• A letter from the local zoning authority saying the site is zoned for an adult day care center and stating the maximum participant capacity (occupancy load).
• A floor plan, a description of the programs and services you will offer, and a financial statement with a projected first-month budget.
• A report from the local building and fire inspector or the State Fire Marshal.

OSDH also posts affidavits of lawful presence (Forms 301 and 266) and a Notice of Change form (958) with the adult day care forms. A center that advertises a special unit or program for people with Alzheimer's disease or related disorders must also file the Alzheimer's Special Care Disclosure Form (ODH Form 613) under OAC 310:673-3-1.

Building and local approvals. The building must be approved by local building and fire inspectors or the State Fire Marshal, and new and newly licensed centers must meet the accessibility rules in Chapter 11 of the 2003 International Building Code (OAC 310:605-15-2). Food service follows the State Board of Health food establishment rules. We did not find a local health permit requirement beyond zoning, building and fire approval.

Certificate of need. The OSDH certificate of need program covers nursing homes. We did not find a certificate of need, moratorium or cap on new adult day care centers.

One license per site. The license covers only the premises named on it, must be posted, and cannot be transferred or assigned (OAC 310:605-5-1). To increase licensed capacity, you file a new application with disclosure and staffing forms and a fire inspection stating the approved occupancy load.

Buying a center. Because the license cannot be transferred, a new owner or operator must apply and get its own license before operating. We did not find an advance notice period for a change of ownership, so contact OSDH early in any purchase.

Renewal and inspections. Renewal applications are due at least 45 days before the license expires, with a fee of $75 per year of licensure. The OSDH fee list shows $225 for a three-year renewal (OAC 310:605-5-2). OSDH inspects each center at least once a year and whenever it sees a need. After a notice of violation, the center has 10 days to submit a plan of correction, with no more than 30 calendar days to correct.

Enforcement. OSDH may deny, suspend, refuse to renew or revoke a license with 30 days written notice, or immediately if health and safety are threatened. Administrative penalties can reach $500 per day of violation (OAC 310:605-5-4).

Exemptions. Sheltered workshops and senior recreational centers that receive no participant fees do not need a license.

Medicaid and state program approval. The license is only the first step for a center that wants public funding. ADvantage providers must be certified by the ADvantage Administration and hold a signed SoonerCare contract with OHCA. Certification checks licensure, training standards and financial stability, and the financial review is repeated at least once a year. DDS waiver providers must be approved by DDS and hold an OHCA contract. Centers in the OKDHS Adult Day Services Program need a contract with OKDHS.

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

Oklahoma licensing rules require at least one full time equivalent direct care staff person for every 8 participants present, plus one more for a major portion of 8 additional participants. At least two responsible persons, one of them a staff member, must be at the center whenever participants are there. We did not find a separate ratio for participants with dementia.

The ratio is in OAC 310:605-11-2, which also requires enough staff at all times to meet each participant's needs.

• Licensing (OSDH): 1 full time equivalent direct care staff per 8 participants present, plus 1 for a major portion of 8 more, and at least 2 responsible persons on site.
• Medicaid, DDS waivers: no ratio of its own. The DDS rule requires providers to follow OAC 310:605, so the licensing ratio applies.
• Medicaid, ADvantage: no ratio in the ADvantage service rules we read. The rules say provider qualifications are in the waiver document, which we could not read.
• OKDHS state program: we could not open the program rules, so we did not find any staffing standard.

Who counts toward the ratio. Direct care staff are paid and volunteer staff assigned to participants' direct needs. Volunteers counted in the ratio must be qualified by training or experience and have personnel records.

Required positions. Every center needs a director, an activity director, a social services coordinator or case manager, and a dietary supervisor. The dietary supervisor can be part time when food comes from a parent organization or contractor. A person who fills more than one position must meet the qualifications for each (OAC 310:605-11-1).

Qualifications.

• Director: a bachelor's degree and one year of supervisory experience in a social or health services setting, or a high school diploma and five consecutive years of supervisory experience in long term care or geriatrics.
• Social services coordinator: a bachelor's degree, or a high school diploma and five consecutive years in long term care or geriatrics.
• Aides: aides who give direct personal care must be certified at least to the adult day care level of nurse aide training, and the center must check the OSDH nurse aide registry before hiring. Paid direct care staff must be at least 18.
• Drivers: a valid license, a safe driving record, and first aid and CPR training.

Nurses. A nurse is not required unless the center gives medications. A center that administers medications needs an RN, LPN, certified medication aide or medication administration technician. Where an aide or technician gives medications, an RN or LPN must consult monthly. Nurses must hold an Oklahoma RN or LPN license and have experience with aging and chronically impaired adults. No minimum nurse hours are tied to census.

Training. All staff and volunteers get a general orientation on the program, policies, fire, safety and emergency procedures before they start. In-service training is held every quarter and documented. At least one CPR-trained staff person must be on duty at all times. The rules do not set a number of training hours.

Background checks and health screening. Centers must follow the criminal arrest check, training and registry requirements of 63 O.S. 1-1950.1, 1-1950.3, 1-1950.4 and 1-1951. Each paid staff member needs an employment examination, including a TB test following CDC 2019 guidelines, within 72 hours of being hired.

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

Every licensed Oklahoma center provides supervision, help with activities of daily living, planned activities, social services, nutritious meals, and emergency and first aid services. Participants who stay four hours or more get at least one meal a day. Centers also need 40 square feet of program space per participant and one toilet for every 12 participants.

Activities. Planned activities must fill at least half of the center's daily operating time, with at least four hours of planned activities. A monthly schedule is posted before the month starts, and daily activities are posted too (OAC 310:605-13-1).

Meals. Centers provide or arrange at least one meal a day that meets one-third of the recommended dietary allowance for participants present four hours or more. They also provide therapeutic diets when prescribed in writing and dietitian consultation, and use two-week menu cycles when meals are prepared on site. ADvantage adds that Medicaid members must have access to food at any time.

Health services and medications. Where indicated, centers check and document each participant's health, functional and psychosocial status at least monthly. Medications need a physician order, locked storage and a written administration record completed within one hour, and a licensed nurse reviews the medication system at least every three months (OAC 310:605-13-2).

Transportation. Transportation is not required. If you offer it, vehicles may not carry more than their design capacity, must accommodate mobility devices, must offer a rest stop on trips over an hour, and must be staffed for safety.

Space and capacity. Under OAC 310:605-15:

• At least 40 square feet per participant, not counting hallways, storage, offices, restrooms and kitchens, plus office space and space for special therapies and private areas.
• At least one toilet and hand washing facility for every 12 participants, within easy reach of activity areas, with hot water no hotter than 115 F.
• At least one bed in a quiet space away from activities, and a separate room or partitioned area for a participant who becomes ill.
• At least two exits usable as escape routes, smoke detectors, no portable space heaters, and room temperatures between 68 F and 85 F.

The rules give no capacity formula beyond the 40 square feet rule. Your licensed capacity also reflects the occupancy load set by zoning and the fire inspection.

Hours. Each center sets its hours and days by written policy. We did not find a minimum number of days or hours a center must be open.

Written policies. OAC 310:605-7-4 requires written policies on:

• Enrollment criteria, including admission criteria that exclude people whose needs are beyond what the program can handle
• Hours and days of operation
• Rates and payments for basic and extra fee-based services, with public disclosure of both
• Types of services, including specialized services and those arranged through community resources
• Medication storage and administration, and participant self-medication
• Admission and discharge, including emergency discharge, notice and causes for involuntary termination
• Personnel practices and personnel records
• General records and emergency services

Centers that allow pets need a pet policy, and every center needs a written emergency plan for medical and non-medical emergencies, posted where people can see it. Emergency drills for all staff are held at least every three months and documented. Each center also needs a governing body with full authority (a sole owner can serve alone) that names a director to run daily operations.

Medicaid settings rules. ADvantage Adult Day Health centers must also meet the federal home and community based settings standards, including community integration, choice of setting, privacy and dignity, and independence in daily activities (OAC 317:30-5-763).

What rules protect participants in Oklahoma adult day centers?

Oklahoma rules require a signed application and physician-verified medical information before admission, a physician's medical report within five days of entry, and a written plan of care within 10 days. Plans are reviewed at least every six months. Centers must give at least two weeks notice before ending services, unless continued attendance threatens others' safety.

Enrollment. Before admission, the center needs a signed application and current medical information verified by the participant's physician, including physician contact, last visit, illnesses, medications and diet restrictions (OAC 310:605-9-1). A physician's medical report and assessment is due within five days of entry (the policy rule says five working days). If a participant has no physician and takes no medications, an RN nursing assessment may take its place, but if it finds medical problems, the person cannot be admitted without a medical assessment.

Plan of care. An individualized written plan of care is due within 10 days of entry. It is reviewed at least every six months and updated as the participant's condition changes.

Discharge. The participant and family, guardian or representative get at least two weeks notice before the center ends services, unless continued attendance threatens the safety of others (OAC 310:605-9-2). An unplanned discharge needs a detailed report, a planned discharge needs an aftercare plan, and a transfer needs a discharge summary.

Participant rights. Participants have listed rights, including dignity regardless of race, color or creed, privacy, freedom from abuse, freedom from restraint unless a physician orders it in the care plan, access to a telephone, and freedom from coercion, discrimination or reprisal (OAC 310:605-3-1).

Records. Each participant file holds admission and history information, physician orders, health evaluations, a medication chart, the plan of care, examinations and progress notes, an emergency medical authorization, at least two emergency contacts and, when appropriate, the discharge plan. Employee and participant records are kept at least five years after discharge or termination, and may be electronic if they can be reached on site and are backed up.

Incidents. Centers keep a record of every incident or accident involving a participant, and illness or accidents that cause or may cause injury are reported to the director. Fires must be reported to the licensing agency within 72 hours, or immediately if they cause injury or death, with a written report after the phone report. We did not find a licensing rule that sets a deadline for reporting other participant incidents to OSDH.

Medicaid layers. DDS waiver members must be 18 or older, need ongoing support and supervision away from home, and not pose a threat to others. The center gives the DDS case manager a copy of the plan of care, keeps the member's Individual Plan, serves on the Personal Support Team, files incident reports under OAC 340:100-3-34 and files OKDHS Provider Progress Reports (OAC 317:40-5-113). DDS staff may make announced and unannounced visits during operating hours.

What we did not find. We did not find a required list of enrollment agreement contents, a reassessment timeline beyond the six-month plan review, or a daily attendance record rule in the licensing rules. Families should ask the center for its written enrollment, rates and discharge policies.

How does Medicaid pay for adult day in Oklahoma?

SoonerCare pays for adult day through four 1915(c) waivers. The ADvantage waiver pays for Adult Day Health, and the Community, Homeward Bound and In-Home Supports for Adults waivers pay for Adult Day Services. All bill code S5100 in 15-minute units at $2.86 per unit since October 1, 2024. PACE also covers adult day center care in four locations.

ADvantage (Adult Day Health). ADvantage serves older adults and adults with physical disabilities who meet nursing facility level of care. OKDHS Community Living, Aging and Protective Services administers it under OHCA. Adult Day Health is provided on a regular schedule one or more days a week and includes both health and social services, with most help with daily activities included in the basic rate (OAC 317:30-5-763).

• Billing code and unit: S5100 U1, per 15 minutes, limited to the units on the member's approved service plan and up to 8 hours (32 units) a day.
• Rate: $2.86 per 15 minutes since October 1, 2024, from the OKDHS ADvantage rate schedule. It was $2.60 from October 1, 2022.
• Add-on services, billed separately when on the service plan: personal care for bathing or hair care (S5105, $11.37 per session, one a day), therapy (S5105 TG, $14.63 per session, one a day) and laundry (S5175, $9.75 per session).
• Rate link: the ADvantage Adult Day Health rate is set equal to the OKDHS Adult Day Services Program rate for the same services.
• Assisted living: Adult Day Health is not paid separately for members who receive ADvantage assisted living.

Developmental disability waivers (Adult Day Services). The Community Waiver, the Homeward Bound Waiver and the In-Home Supports Waiver for Adults pay for Adult Day Services, a structured program of health, social and support services for part of a day, for members 18 and older. Centers must be approved by DDS, hold an OHCA contract and meet the OSDH licensing rules. The DDS rate table in Administrative Letter 24-02 lists S5100 at $2.86 per 15 minutes from October 1, 2024, up from $2.60. The table is not broken out by waiver.

PACE. OHCA's PACE program serves people 55 and older at nursing home level of care. OHCA lists four PACE centers: Cherokee Elder Care in Tahlequah, LIFE PACE in Tulsa, and Valir PACE in Oklahoma City and Shawnee. PACE organizations are paid a set monthly amount per member and provide transportation to the center within that payment, so adult day is not billed by the unit.

Transportation. We did not find whether transportation to adult day is billed separately under ADvantage or the DDS waivers. Ask OHCA or your DDS contact.

Attendance documentation. Under the ADvantage billing rule (OAC 317:35-17-22), providers must document the time spent on each service. Each 15-minute segment is one unit. Less than 8 minutes is not billable, and 8 to 15 minutes rounds up to one unit. Audits compare paid claims with service plan authorizations and documentation, and unsupported claims go to the OHCA Clinical Provider Audits Unit. The electronic visit verification list in that rule covers in-home services and does not include Adult Day Health. OKDHS also audits Adult Day Health providers, and a required plan of correction can stop new referrals until it is approved. We did not find a specific sign-in and sign-out rule in any layer, so ask the ADvantage Administration or DDS what attendance records they expect.

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

Yes, a center can be fully private pay, but it still needs an OSDH license. Oklahoma's licensing rules apply to every adult day care center regardless of who pays. Operating without a license is a misdemeanor, with each day counted as a separate violation, and can bring penalties of up to $500 a day.

What falls outside the license. The only listed exemptions are sheltered workshops and senior recreational centers that receive no participant fees. Retirement centers and senior citizen centers are outside the definition, which covers programs serving impaired adults for more than four hours in a 24-hour period (OAC 310:605-1-2 and 5-1). We did not find a rule that says what a program running four hours or less may or may not do, so ask OSDH before you plan a short-day program.

Protections for private-pay participants. Every licensed center needs a written rates and payments policy covering basic charges and extra fee-based services, with public disclosure of both. Participants have the rights listed in the rules, including freedom from discrimination. We did not find a rule that bars different treatment based on payment source.

Other funding.

• OKDHS Adult Day Services Program. OKDHS pays contracted, licensed centers to serve functionally impaired older adults, generally 60 and over, under an individualized plan of care. People apply through the center of their choice (OKDHS Adult Day Services). We could not open the program's rules, so its eligibility, rates and claim forms are not on this page.
• DDS state-funded rates. DDS Administrative Letter 24-02 lists state-funded "Adult Day" rates of $11.00 per full day and $6.60 per part day from October 1, 2024. The letter does not say which program those rates fund, so ask DDS.
• 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. We did not find Oklahoma-specific VA community contracts.
• Older Americans Act. We did not find Older Americans Act funding for adult day in Oklahoma. Your local Area Agency on Aging can tell you what is available in your region.

The market. We did not find a current count of licensed adult day care centers. OSDH publishes a quarterly ownership report through Health Facility Systems that can answer this. We also did not find an Oklahoma adult day association.

What is changing next for adult day in Oklahoma?

As of our last check on October 21, 2026, we did not find a confirmed upcoming change to Oklahoma's adult day licensing rules or Medicaid adult day payment. One proposed licensing change is still unresolved, and a few recent changes are already in effect.

• Proposed PACE exclusion (not confirmed as adopted). OSDH proposed amending the adult day care center definition in OAC 310:605-1-2 to exclude PACE organizations, to match a 2024 change to the Adult Day Care Act. A public hearing was held October 18, 2024, but the rules OSDH currently posts do not include the change, and we did not find an effective date. Ask OSDH whether it was adopted.
• ADvantage rule revisions, September 1, 2026. OHCA's ADvantage service and reimbursement rules (OAC 317:30-5-763 and 317:30-5-764) carry a September 1, 2026 revision date, and this page reflects that version.
• Medicaid rate increase, October 1, 2024. ADvantage Adult Day Health and DDS waiver Adult Day Services rates rose from $2.60 to $2.86 per 15-minute unit (S5100).
• 36-month licenses, September 11, 2022. Licenses now run 36 months instead of expiring each July 31, with renewal fees of $75 per year of licensure.

Oklahoma adult day sources

• OAC 310:605, Adult Day Care Centers (Oklahoma State Department of Health)
• OSDH Health Facility Systems: licensure forms and fees
• ODH Form 712: Adult Day Care License Application and instructions
• OHCA: ADvantage Program Waiver Services, description of services (OAC 317:30-5-763)
• OHCA: Billing procedures for ADvantage services (OAC 317:35-17-22)
• OHCA: DDS Adult Day Services (OAC 317:40-5-113)
• OKDHS: ADvantage rate schedule
• OKDHS DDS Administrative Letter 24-02: 2024 provider rate increases
• OKDHS: Adult Day Services
• OHCA: Programs of All-Inclusive Care for the Elderly (PACE)

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: 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 that license or certify every adult day center

California, Delaware, Florida, Georgia, Hawaii, Iowa, Kansas, Maine, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, 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.