Adult Day Care in Oregon

All states: adult day services map

Oregon adult day services at a glance

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

How is adult day care regulated in Oregon?

Oregon does not license adult day programs. State law sets up a voluntary registry kept by the Oregon Department of Human Services (ODHS), and a program that wants to be paid by Medicaid must be certified by ODHS Aging and People with Disabilities (APD). Oregon has one program type, the adult day services (ADS) program, and does not separate adult day care from adult day health care.

The rules come from three layers, each with a different source:

• Licensing (none). ORS 410.485 to 410.495 directs ODHS to keep a registry of adult day care programs and says its rules are to be followed voluntarily. No state license is created. Listing on the registry (OAR 411-066-0010) is optional.
• Medicaid (ODHS APD). The Registration and Certification Standards for Adult Day Services Programs, OAR chapter 411, division 66, set the operating standards for programs that enroll with APD as Medicaid providers. Payment rules and the rate are in OAR 411-027-0020 and 411-027-0170.
• Other funding. Oregon Project Independence, a state program run by APD and the local Area Agencies on Aging, may pay for adult day under OAR 411-032-0010. The U.S. Department of Veterans Affairs pays for adult day health care for some veterans.

The rules define an ADS program as a community-based group program for adults with functional impairments that provides health, social and related support services in a protective, non-residential setting for less than 24 hours a day (OAR 411-066-0005). Health-related services, such as nursing consultation, are provided when a participant's service plan lists them. The rules do not use the terms social model, medical model or adult day health care, and we did not find a separate program type for dementia care.

Because there is no license, the APD certification standards are the only state adult day standards that are mandatory, and only for Medicaid-certified programs.

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

No. Oregon has no adult day license, so a private-pay program can open after meeting local building, zoning, fire and health codes. A program that wants to bill Medicaid must first be certified by ODHS APD and then enroll as a Medicaid provider. Any program may also ask to be listed on the voluntary state registry.

Registry (voluntary). A program joins the ADS registry by giving APD its name, address and a checklist showing how far it meets the certification standards in OAR 411-066-0020 (OAR 411-066-0010).

Medicaid certification steps. Under OAR 411-066-0015, a program:

• Contacts APD to set up an initial on-site visit.
• Sends a cover letter describing its qualifications.
• Completes the certification self-assessment.
• Takes part in an on-site inspection. Every standard must be rated met, or the application is denied.

A denied program may fix the unmet standards and ask for a reassessment within 30 calendar days. After that it may ask for an informal conference within 10 business days and a contested case hearing within 90 days.

Medicaid enrollment. Once certified, a program enrolls with APD by sending a copy of its current certification, its current Oregon Secretary of State business registration (and assumed business name, if any), the ADS Medicaid Provider Enrollment Application and Agreement, and proof of the insurance that agreement requires. The APD Provider Relations Unit handles enrollment at 800-241-3013 or apd.providerenrollment@odhs.oregon.gov. A provider must give at least 30 days notice before it stops providing adult day services.

Local codes. Certified programs must meet state and local building, zoning, fire and health codes and have an on-site fire inspection (OAR 411-066-0020). Administrative records include certificates of the fire and health inspections required every two years by local ordinance.

Renewal and inspections. Certification lasts up to two years. Renewal takes a new self-assessment and an on-site inspection, and APD may keep a certification in effect past its end date if the self-assessment arrives before it expires. APD may make unannounced on-site reviews at any time.

What we did not find. OAR 411-066 sets no certification fee, and we did not find a certificate of need or moratorium in the adult day rules or statute. The rules do not address what happens to certification when a program is sold, and they do not say whether each site needs its own certification (though each physical location needs its own emergency plan). Anyone buying a certified program or opening a second site should ask APD early.

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

Medicaid-certified programs in Oregon must have at least 1 staff person for every 6 participants. When more than half of participants need full help with three or more activities of daily living (such as bathing, dressing, eating or toileting), the ratio tightens to 1 staff person for every 4 participants. We did not find a separate ratio for participants with dementia.

The ratios are in OAR 411-066-0020(6). By layer:

• Licensing: no ratio specified, because there is no license. Private-pay programs that do not seek certification have no state ratio.
• Medicaid (APD certification): 1:6, or 1:4 when more than 50 percent of participants need full help with three or more daily activities.
• Other funding: no ratio specified. The Oregon Project Independence rule sets no adult day staffing standard.

Who counts toward the ratio. Volunteers count only if they meet the same standards and job qualifications as paid staff and have designated duties, a signed job description and a documented schedule.

On site. Staff trained in first aid and CPR must be available whenever participants are present, and qualified substitutes must be available. A program located in a host facility, such as a hospital, nursing facility, senior center, church or community-based care facility, must be separate and have its own designated staff. We did not find a minimum number of staff on site regardless of census, or nurse or social work hours that grow with census.

Director. The program director must be at least 21 and hold a bachelor's degree in health care or management, or a high school diploma plus two years of professional or management experience within the past five years.

Nurses and medications. The rules do not require a nurse on staff. If the program gives medications, it needs a written medication policy approved by a registered nurse or pharmacist that names the trained staff allowed to give them.

Training. Paid staff and volunteers need orientation and ongoing in-service training on the program's mission, fire safety and evacuation, abuse reporting, infection control, CPR and first aid, body mechanics and transfers, personal care, behavioral intervention, and each participant's service plan. The rules set no number of training hours.

Background checks and health screening. All staff and volunteers need criminal history and abuse checks under OAR 407-007-0200 to 407-007-0380, repeated every two years. Staff must follow local public health standards for TB testing and hepatitis immunization.

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

A Medicaid-certified Oregon program provides help with daily activities, supervision, health monitoring, nutrition and therapeutic activities, plus health-related and social services listed in each participant's service plan. It must serve at least one meal a day to participants present at a typical mealtime and meet space and restroom minimums. The rules do not require the program to provide transportation.

Services. Under OAR 411-066-0020(3), certified programs provide help with and supervision of activities of daily living, health monitoring, discharge planning, referrals, nutrition screening, therapeutic activities, and social and health-related services as the service plan lists them.

Meals. At least one meal a day for participants present at a typical mealtime, plus snacks. Menus are prepared a week ahead, posted and kept for one month. Programs serving 16 or more participants must meet the Oregon Health Authority food sanitation rules (OAR 333-150). Smaller programs, and those serving purchased or prepared meals, must meet that division's preparation, storage and serving requirements but do not need commercial equipment. Food staff need food handler cards.

Transportation. Each participant's file must include a transportation plan for travel to and from the program and for outings. The rules do not require the program itself to provide rides.

Space and restrooms. Under OAR 411-066-0020(4):

• At least 60 square feet of common floor space per participant, not counting hallways, offices, restrooms and storage. The minimum is 80 square feet if 25 percent or more of participants are cognitively impaired or use adaptive equipment.
• At least one toilet for every 10 participants, in accessible bathrooms with a sink, grab bars and a call system.
• At least two marked exits, space for private consultation, participant rest, telephone use and storage, and a utility sink for programs serving 16 or more.

We did not find a formula for a stated maximum capacity or a separate space rule for dementia care.

Hours. The rules set no minimum days or hours. The program's plan of operation must state its hours and days.

Written policies. Certified programs need:

• A plan of operation covering target population, service area, services, hours and days, admission and discharge policies, staffing, participant rights and grievances, rates, abuse reporting, a wandering policy and emergency policies, reviewed each year.
• Discharge, grievance, personnel (staff and volunteers), records and confidentiality policies.
• A written emergency plan for each physical location, covering fire, natural and human-caused events and closure notice, posted with extinguisher locations and exit routes.
• A protocol for sick or injured participants and a medical emergency procedure.
• A medication policy approved by an RN or pharmacist, if medications are given.
• Procedures for soiled items, handwashing and sanitizing, and written procedures for employment decisions based on background check results.
• A quality assurance plan. Each year the program surveys employees, participants, families, providers and referral sources and sends a written summary to its advisory committee or board of directors and to the state ADS coordinator.

Safety. Fire and evacuation drills are held at least every six months, with records kept.

What rules protect participants in Oregon adult day programs?

Certified Oregon programs must screen each person before admission, sign an enrollment agreement, give a disclosure statement on care, admission, discharge and fees, and write an assessment and service plan. Participants are reassessed at least every six months, and a discharge needs at least two weeks notice in most cases. These protections are required only in Medicaid-certified programs.

Enrollment. Under OAR 411-066-0020(1), each participant gets:

• Intake screening before admission.
• An application or enrollment agreement covering identifying, health, safety and emergency information and the services to be provided.
• A written assessment and a service plan.
• A disclosure statement covering the range of care, admission and discharge criteria, and fees and payment.

The rules do not require a physician order or physical exam before enrollment, and we did not find a TB screening requirement for participants (TB testing applies to staff).

Service plan reviews. Progress notes are written at least every quarter and reflect a review of the service plan. Participants are reassessed at least every six months and after any significant change, and medical information is reviewed every six months.

Discharge. A discharge requires written reasons, a discharge summary and at least two weeks notice while an alternative plan is developed. Shorter notice is allowed when the participant's needs go beyond what the program can safely meet or the participant poses an imminent danger. The program's discharge policy must cover timeframes, criteria, notice and appeal.

Attendance and records. Programs keep a roster with admission and discharge dates and a daily attendance record showing the date and time each participant attends. Clinical records are kept seven years, and financial and other records at least five years from the date of service.

Incidents and abuse. Incident reports are kept with the program's administrative records, and staff must follow Oregon's mandatory abuse reporting rules. Certification can be ended for violating the abuse rules (OAR 411-020 and OAR 407-045). We did not find a deadline or a named agency for reporting other incidents, so ask APD what it expects.

How does Medicaid pay for adult day in Oregon?

Oregon Medicaid pays certified adult day programs through ODHS APD, with each participant's services prior authorized by an ODHS or Area Agency on Aging case manager. Payment is by half day (4 hours or fewer) or full day (more than 4 hours). The APD rate rule lists adult day services at $122.16 from July 1, 2026, but does not say whether that amount is per full day.

APD Medicaid services. OAR 411-027-0020 ties these payments to Oregon's Medicaid State Plan K Option home and community-based services and lists adult day services among them. Key points:

• Authorization: every service payment must be prior authorized by ODHS or Area Agency on Aging staff from the rate schedule. The case manager uses the ADS Payment Authorization form (SDS 0546AD, updated September 9, 2026), which records the provider number, the authorized start and end dates and the number of full days per month.
• Unit: a half day is 4 hours or fewer; a full day is more than 4 but fewer than 24 hours. Adult day is not paid if another provider is authorized for the same service.
• Codes: APD's service chart lists Adult Day Services as S5101 under the APD and K Plan benefits, and the payment authorization form counts full days under state service code OH112.
• Rate: OAR 411-027-0170 (amended June 24, 2026) lists Adult Day Services at $122.16 for July 1, 2026 to June 30, 2027, up from $115.24 on January 1, 2026. Neither the rule nor the rate schedule says whether this is a full day rate or how half days are paid, so confirm with APD.
• Private-pay cap: Medicaid payment cannot be more than the program charges private-paying participants for the same service.

Oregon Project Independence-Medicaid (OPI-M). CMS approved this program under an 1115 waiver on February 13, 2024, and ODHS lists adult day services among its services (ODHS 1115 waiver page). APD's service chart lists adult day under OPI-M as code OH112. We did not find a separate OPI-M adult day rate.

PACE. ODHS APD oversees PACE, with programs run by Providence ElderPlace and PacificSource PACE (APD Other Programs page). PACE is paid a monthly amount per enrollee, so adult day is not billed by the day. The January 1, 2026 rate schedule lists Providence ElderPlace at $10,434.94 a month for Medicaid-only enrollees and $7,305.16 for people with both Medicare and Medicaid.

Transportation. We did not find whether transportation to adult day is billed separately. Ask APD or your local Area Agency on Aging.

Attendance documentation. Certified programs must keep a daily attendance record with the date and time each participant attends, and payment follows the number of days the case manager authorizes. We did not find a requirement for an electronic sign-in or sign-out system in the adult day rules.

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

Yes. Because Oregon has no adult day license, a program that does not bill Medicaid can operate without state certification. It still has to meet local building, zoning, fire and health codes, and it may choose to join the voluntary ODHS registry. State law says the adult day rules are to be followed voluntarily by these programs.

What the rules leave open. We did not find any state limit on hands-on care, nursing or medication help in a program that is not registered or certified. We also did not find adult day contract or fee disclosure rules for private-pay programs, since the disclosure statement is a certification standard. Families choosing a private-pay program can ask whether it is registered or certified and ask to see its written policies.

Oregon Project Independence. This state program, run by APD and the local Area Agencies on Aging, may spend its funds on adult day services as one of its home care supportive services (OAR 411-032-0010). APD's service chart shows it buys adult day through local contracts, and the rule sets no adult day provider standards of its own. Contact your local Area Agency on Aging to ask about contracts in your area.

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 where available. We did not confirm an Oregon VA facility that offers it.

Older Americans Act. We did not find Older Americans Act funding for adult day in Oregon. Your Area Agency on Aging can tell you what is available locally.

The market. Oregon has no licensed centers because it has no license. The ODHS list of adult day services providers, dated April 22, 2020, shows 22 Medicaid-certified program locations and 2 registered non-Medicaid programs. We did not find a newer count; APD announces newly certified programs by information memo. State law names the Oregon Association of Adult Day Care Services, but we did not find a website for it.

What is changing next for adult day in Oregon?

As of our last check on October 21, 2026, we did not find an upcoming change to Oregon's adult day certification rules or adult day payment. The most recent change, a Medicaid rate increase, took effect July 1, 2026.

• Rate increase, July 1, 2026. APD's adult day rate rose from $115.24 to $122.16 for July 1, 2026 to June 30, 2027 (OAR 411-027-0170, amended June 24, 2026).
• Waiver renewal (not final). ODHS has proposed renewing its 1915(c) Aged and Physically Disabled waiver and 1915(b)(4) waiver for a period planned to begin in 2027. Public comments closed in May 2026, and we did not confirm CMS approval. Adult day services are not among the 1915(c) waiver's services, so this renewal is not expected to change how adult day is paid.

Oregon adult day sources

• OAR 411-066: Registration and Certification Standards for Adult Day Services Programs (ODHS)
• OAR 411-066-0020: certification standards
• ORS 410.495: adult day care registry
• OAR 411-027: Payment Limitations and Rate Schedule (ODHS)
• ODHS SDS 0546AD: Adult Day Service Payment Authorization
• OAR 411-032: Oregon Project Independence (ODHS)
• ODHS: 1115 Demonstration Waiver (OPI-M)
• ODHS APD: Other Programs (adult day and PACE)
• ODHS: Adult Day Services Providers, Certified and Registered, April 22, 2020
• ODHS: Resources for APD Providers and Partners

Related reading

• Ensuring Compliance with Adult Day Services Software
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Simplifying Payments with Electronic Billing for Adult Day Care
• Podcast: How Adult Day Services Let You Serve 50 Clients with Just 8 Staff
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states with no state adult day license

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