Adult Day Care in Texas

All states: adult day services map

Texas adult day services at a glance

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

How is adult day care regulated in Texas?

Texas has one license for adult day care, the Day Activity and Health Services (DAHS) facility license, issued by the Texas Health and Human Services Commission (HHSC). There is no separate adult day health care license. Because every licensed center must have a nurse on site part of each day, all Texas centers provide health services as well as social ones. HHSC also runs the Medicaid side, so both the licensing rules and the Medicaid contract rules come from the same agency, but they are separate rule sets.

The state law behind the license is Human Resources Code Chapter 103, which uses the older name "adult day care." The licensing rules define a DAHS facility as a place that provides day activity and health services, daily or regularly but not overnight, to four or more elderly persons or persons with disabilities who are not related to the owner (26 TAC 559.3).

Several layers of rules can apply to a Texas center:

• Licensing (HHSC). The Day Activity and Health Services Requirements, 26 TAC Chapter 559, most of which were amended effective July 10, 2024. These cover the license, staffing, space, services, records and incident reporting for every center, whatever the payer.
• Medicaid contract (HHSC). Centers that contract with HHSC to serve Medicaid (Title XIX) or Title XX clients also follow the DAHS contract rules in 26 TAC Chapter 211 (sections 211.200 to 211.212) and the DAHS Provider Manual. STAR+PLUS managed care members get DAHS through their health plan under the STAR+PLUS Handbook.
• Waiver day services (HHSC). Individualized skills and socialization (ISS) is a day service for people in the HCS and TxHmL waivers, which serve people with intellectual and developmental disabilities. ISS providers are licensed as DAHS facilities but follow their own licensing subchapter (26 TAC Chapter 559, Subchapter H) and the waiver program rules.
• Other funding. Title XX (Social Services Block Grant) contracts through HHSC, Older Americans Act funds through Area Agencies on Aging, and the U.S. Department of Veterans Affairs.

Where the layers overlap, licensing sets the entry rules, staffing and space for everyone. The Medicaid contract layer is stricter on operating hours, meals, activities, transportation, assessments and attendance records, and it will not pay for days when a center breaks the staff ratio or goes over its licensed capacity.

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

Yes. No one may open or run a DAHS facility in Texas without an HHSC license, and the license applies whether clients pay privately, through Medicaid or some other way. The license costs $75 and lasts three years. You apply online, then pass a Life Safety Code inspection and a health inspection before HHSC issues the license.

How to apply. Applications and forms go through the Texas Unified Licensure Information Portal (TULIP), as listed on the HHSC DAHS page. Under 26 TAC 559.11 and 559.21:

• You submit the application and fee and show that the building meets the Life Safety Code (NFPA 101, 2000 edition) and the construction standards in Subchapter C.
• HHSC reviews the background and qualifications of the applicant, anyone with a disclosable ownership interest, affiliates and controlling persons. An application still incomplete after 120 days may be denied.
• HHSC reviews the application within 30 days. You request the Life Safety Code inspection with the application or within 120 days.
• After you pass that inspection and admit one to three clients, you request a health inspection. Each inspection stage must be passed within 120 days or the application is denied.
• HHSC issues the license within 30 days after it finds you in compliance.

Fees. Under 26 TAC 559.37, the license fee is $75 for a three-year license (initial, change of ownership or renewal), plus a $25 late renewal fee. Plan review for a new building or a conversion costs $12 per client, with a $500 minimum and $1,000 maximum. Plan review for an addition or remodel costs 2 percent of construction cost, with a $250 minimum and $750 maximum.

Capacity. A center may not serve more clients than its license states. Raising capacity needs HHSC approval after a Life Safety Code survey; lowering it is done by notice through the portal (559.35).

Certificate of need and local permits. We did not find a certificate of need requirement or a moratorium in the licensing rules. Beyond the annual local fire marshal inspection needed at renewal, we did not find local health or zoning permits listed as licensing steps. Check with your city or county before you sign a lease.

One license per site. The rules define a facility as a site licensed to provide DAHS, but we did not find a rule that says outright that each location needs its own license, and we did not review the relocation rule. Ask HHSC before opening a second location or moving.

Buying a center. Licenses cannot be transferred (559.25). The new owner submits an application, the fee and a notarized Change of Ownership Transfer Affidavit (Form 1092) at least 30 days before the change. The new owner then gets a 90-day temporary license, followed by an initial three-year license after an on-site health inspection or a desk review. Adding an owner with a disclosable interest, without a change of ownership, must be reported within 30 days.

Renewal and inspections. Licenses are not renewed automatically. The renewal application is due at least 45 days before the license expires and must include the most recent annual local fire marshal inspection report. Filing late within that window adds the late fee, and no renewal is accepted after the license expires (559.23). HHSC inspects each center at least once every two years after the first inspection. Inspections and complaint investigations are generally unannounced. Abuse, neglect or exploitation complaints are inspected within 14 days, and other complaints within 45 days (559.81).

Medicaid contract. A license does not by itself let you bill Medicaid. To provide DAHS under an HHSC contract, a licensed center enrolls with HHSC and follows the community services contracting rules in 26 TAC Chapter 49 (26 TAC 211.202).

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

Texas licensing rules require at least 1 direct service staff member for every 8 clients during all services except facility-provided transportation. A licensed nurse (RN or LVN) must work at the center at least 8 hours a day, and the director and activities director must each work at least 40 hours a week. There is no separate ratio for people with dementia, but staff who care for them need specialized training.

The ratio and nurse rules are in 26 TAC 559.61. By layer:

• Licensing (HHSC): 1:8 direct service staff to clients, except during facility transportation, with enough attendants on duty whenever clients are present.
• Medicaid contract (HHSC): the same 1:8 ratio. The DAHS Provider Manual counts every person served, HHSC-funded and private pay, and requires the ratio at outing destinations too. A contracted center is not paid for any day it did not keep the ratio (26 TAC 211.211).
• HCS and TxHmL waivers, off-site ISS: ratios set by each person's level of need (LON): 1:8 for LON 1 or 5 without enhanced staffing, 1:2 for LON 6 or 8, and 1:1 for LON 9, with 1:2 or 1:1 under enhanced staffing. A mixed group uses the ratio of the person with the highest need (26 TAC 263.2017; 262.917 for TxHmL).
• ISS-only providers on site: no numeric ratio. They must keep enough staff on duty at all times, and no nurse is required on staff (26 TAC 559.227).
• Other funding: we did not find a separate ratio from Title XX, Older Americans Act or VA funding.

Minimum staff on site. Licensing requires an RN or LVN at the center at least 8 hours a day, with enough nurses on site at all times to meet clients' nursing needs. The Medicaid provider manual adds that a professional staff member (the nurse, director or activities director) must be on site whenever clients are present.

Staff that scale with the center. When the facility nurse is an LVN, an RN consultant must provide at least 4 hours of documented consultation each week while clients are present. A dietitian consultant must provide at least 4 hours a month (559.65).

Who counts toward the ratio. Direct service staff are the director, the licensed nurse, the activities director and attendants. Attendants include drivers, aides, food service workers, janitors, housekeepers and laundry workers. Dietitian consultants do not count. Under the Medicaid provider manual, trained volunteers aged 18 or older count, and volunteers under 18 do not.

Qualifications. Under 559.59:

• Director: a four-year degree plus one year of human service or medical program experience, an associate degree or 60 semester hours plus three years, an RN license plus one year, or nursing facility administrator qualifications, plus 12 hours of continuing education a year. A written policy must say who is in charge when the director is away.
• Nurse: a Texas-licensed RN or LVN.
• Activities director: a high school diploma plus a bachelor's degree and one year of experience, 60 semester hours and two years, or an activities director course and two years.
• Attendants: at least 18. Drivers need the right class of Texas driver license.
• One person may not serve as nurse, activities director and director at the same time.

Training. New direct service staff get fire, disaster and evacuation training within three workdays, and at least 18 documented hours in the first three months covering adult CPR, first aid, health care orientation, abuse and neglect reporting and infection control. After that, staff complete at least 3 hours each quarter. Staff who care for clients with Alzheimer's disease or related disorders must complete specialized training under a written facility policy (559.67). ISS-only providers have a shorter requirement of at least 8 hours in the first three months.

Background checks. Centers must search the Employee Misconduct Registry and the Nurse Aide Registry before hiring and every year after, may not hire or keep anyone listed as unemployable, and must keep copies of the results. Since March 2026 both searches are done in TULIP (HHSC PL 2026-03). HHSC also lists Health and Safety Code Chapter 250, which covers criminal history checks, among the laws that govern DAHS facilities. We could not read the statute text, so ask HHSC exactly which criminal history checks apply to your staff.

Health screening. New employees must be screened for tuberculosis within two weeks of starting work, following CDC guidelines, and get TB education every year (559.63; PL 2026-02). We did not find a staff vaccination requirement.

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

Every licensed Texas center provides nursing oversight, a daily activity program and personal care, and must meet space and restroom minimums. Centers with a Medicaid contract must do more: stay open at least 10 hours a day on weekdays, serve a hot noon meal and two snacks, offer at least three social activities a day, and provide or arrange transportation.

Services under licensing. The nurse assesses needs, develops plans of care, gets prescriber orders and writes monthly progress notes. The activities director runs the daily activity program, including exercise, and attendants provide personal care and supervision (26 TAC 559.65). Only staff with a current state license that allows it may give medication to clients who cannot or choose not to take it themselves (559.69).

Services under a Medicaid contract. Under 26 TAC 211.206 and the DAHS Provider Manual, required services are:

• Nursing and physical rehabilitation.
• Nutrition: a hot noon meal served between 11:00 a.m. and 1:00 p.m. that supplies one third of the adult recommended daily allowance, plus a mid-morning and a mid-afternoon snack.
• At least three social activities a day, with a monthly calendar posted a week ahead, at least two activities in each category every week, and at least one trip, special event or cultural activity each month.
• Transportation to and from the center, or coordination of other transportation. A center may not charge clients for transportation it provides.

Hours. The licensing rules require a center to post its hours and holidays but set no minimum. Medicaid-contracted centers must be open at least 10 continuous hours a day, Monday through Friday, except published holidays, must serve eligible clients unless they are full, and must take part in the Child and Adult Care Food Program (211.202).

Meals under licensing. Centers that prepare meals follow posted menus planned and dated at least two weeks ahead, and prescribed special diets must be labeled (559.73).

Space and capacity. Under 559.42 and 559.43:

• Licensed capacity is figured at 40 square feet per client. Kitchens, restrooms, bath areas, offices, corridors, stairways, storage and outdoor space do not count. Centers licensed before October 1, 2000 may keep older standards until they add capacity, change owners or move.
• At least one toilet and one sink for every 15 clients or part of 15, separate men's and women's restrooms, and at least one bathing unit. At least half of client restrooms must meet ADA standards; centers licensed for 45 or fewer may use one accessible unisex restroom.
• A rest area, separate from the treatment room, with reclining lounge chairs or beds, and at least one treatment or exam room.
• Centers licensed on or after May 1, 1999 need private bedroom space for at least 5 percent of capacity and outdoor space of 400, 600 or 800 square feet depending on capacity, at least 20 percent of it shaded.

We did not find separate secure-space or dementia-unit requirements.

Written policies. The licensing rules require written policies on client rights (with a written list of rights given to each client and posted in English and Spanish), advance directives, who is in charge when the director is absent, infection prevention and control, specialized dementia training, and an emergency preparedness and response plan with a fire safety plan. The emergency plan is reviewed at least once a year, within 30 days after an emergency and after remodeling, and staff are retrained each year. Fire drills are held monthly with all occupants, plus unannounced drills for severe weather and other likely emergencies (559.79).

Postings. Centers post the license, the HHSC complaint procedure sign, a notice that inspection reports are available with the HHSC toll-free number, the latest inspection report, a brochure of hours, holidays and activities, and emergency numbers, including the abuse hotline, near all phones (559.57).

What rules protect participants in Texas adult day centers?

Texas centers may not admit or keep clients whose needs they cannot meet, may not discharge anyone for filing a complaint, and must give each client a written statement of rights. Client records are kept at least five years after services end, and abuse, neglect and other serious incidents go to HHSC within 24 hours. Medicaid adds a physician order, a nurse assessment within 14 days of referral and rules for suspending services.

Who can enroll. Under licensing, a center may admit only clients whose needs it can meet (26 TAC 559.61). For Medicaid DAHS, the person must be 18 or older, live in the community, have a chronic medical condition with related functional limits, have a prescription from a doctor or other authorized provider, and have an assessment showing medical need. The ordering physician may not own the center or have a significant financial tie to it (HHSC). In STAR+PLUS, a health plan may not authorize DAHS based on a primary mental health disorder, intellectual disability or related condition.

Rights. Under 559.52, clients must be treated without regard to source of payment, may complain anonymously without retaliation, and must be told within 30 days of admission whether they are entitled to Medicare or Medicaid and which items and services are covered. Medicaid-contracted centers must explain rights in a language the person understands, give a signed copy and keep the original in the record.

Assessment and care plan. The licensing rules have the nurse assess each client, develop a plan of care and write monthly progress notes. For Medicaid clients referred by a caseworker, the facility nurse completes the Client Health Assessment and Plan of Care and requests physician orders and prior approval within 14 days of the referral date, and services must start within seven days of the authorized start date (26 TAC 211.203). In STAR+PLUS, the health plan authorizes DAHS from a physician's assessment and forms dated within 90 days, and authorizations usually run 12 months and must be renewed at least every 12 months.

Discharge and suspension. We did not find a discharge notice period in the licensing rules. For Medicaid clients, services must be suspended in listed cases, such as a hospital or nursing home admission, loss of Medicaid eligibility, a threat to health and safety, or 15 days in a row of absence. The caseworker must be told by the next workday and in writing within seven workdays (211.207).

Client TB screening. Centers need an infection prevention program with a client TB screening policy based on risk factors, such as exposure to infectious TB, rather than a test for every client (PL 2026-02).

Records. Licensing requires client records to be kept confidential for five years after services end. Clients may see their records within 24 hours of asking and get copies within 48 hours (559.75). Medicaid-contracted centers keep records longer, at least six years after the end of the federal fiscal year in which services were given, and longer if an audit, claim or lawsuit is open.

Attendance. Medicaid-contracted centers keep a daily attendance log on HHSC forms showing when each client started and stopped receiving services, arrival and departure times for clients who do not ride center transportation, and driver transportation and mileage logs (211.209). We did not find an attendance record rule in the licensing layer.

Incidents. Abuse, neglect, exploitation, a suspicious injury of unknown source, a missing client, drug diversion, a fire causing injury or death, a threatening emergency, a death under unusual circumstances, or an abnormal outbreak of communicable disease must be reported to HHSC Complaint and Incident Intake right away and no later than 24 hours, followed by Form 3613-A by the fifth calendar day (PL 2026-01, revised June 8, 2026). Reports can be made online or at 1-800-458-9858. The licensing rule text (559.55) gives the follow-up deadline as the fifth working day, so meeting the earlier calendar-day date covers both. Fire damage to the building is reported within 72 hours (Form 3707). For an accident, injury, sudden illness needing urgent care, or a death, the center notifies the physician and responsible party right away and writes a separate incident report (559.71). Medicaid-contracted centers also tell a relative the same day about an illness or injury and contact absent clients the same day (211.208).

What we did not find. We did not find required contents for an enrollment agreement or a licensing discharge notice period. Families should ask a center for its written admission, discharge and fee policies.

How does Medicaid pay for adult day in Texas?

Texas Medicaid pays for DAHS as a state plan service, either directly through an HHSC contract (fee-for-service) or through STAR+PLUS managed care health plans. Fee-for-service DAHS is billed in half-day units under HCPCS code S5101, at $18.59 per unit since September 1, 2025, with transportation built into the rate. The HCS and TxHmL waivers pay for individualized skills and socialization, and PACE covers adult day care in three areas of the state.

DAHS, fee-for-service. HHSC contracts directly with licensed centers and pays claims through TMHP.

• Unit: half day. The HHSC rate sheet counts 3 to 5 hours as one unit and 6 hours or more as two units. No more than 10 units a week may be authorized.
• Codes: state bill code C0200 (Title XIX), which HHSC's bill code crosswalk maps to HCPCS S5101.
• Rate: $18.59 per unit, effective September 1, 2025. HHSC breaks it into attendant ($7.62), other direct care ($3.55), facility ($2.36), and administration and transportation ($5.06).
• Payment holds: no payment for days a center did not keep the 1:8 ratio, for clients over licensed capacity, or when monthly claims do not match service authorizations and the attendance and transportation records (26 TAC 211.211).

STAR+PLUS. HHSC contracts with managed care organizations (MCOs) to run STAR+PLUS, and all STAR+PLUS members may receive DAHS when it is medically and functionally necessary. The health plan authorizes hours, within a limit of 10 hours a day and 230 hours a month; 3 to 6 hours a day is typical (STAR+PLUS Handbook 10100). We did not find the claim codes, units or rates STAR+PLUS plans use for DAHS. Ask each plan you contract with.

HCS and TxHmL waivers. These 1915(c) waivers pay for individualized skills and socialization, delivered on site or off site by providers licensed as DAHS facilities. HHSC's crosswalk maps ISS to HCPCS H2014 (H2038 for consumer directed services), with level-of-need modifiers. We did not find a primary source for the ISS billing unit or current rates. HCS participants may also receive DAHS if they meet DAHS eligibility.

PACE. HHSC contracts with PACE organizations under 26 TAC Chapter 270. PACE serves people 55 or older as an alternative to nursing facility care, includes adult day care, and is available in the Amarillo, Lubbock and El Paso areas (HHSC PACE page). PACE is paid a set amount per enrollee, so adult day is not billed by the unit.

Transportation. In fee-for-service DAHS, transportation is part of the rate and is not billed separately, and time on center transportation counts toward the unit. We did not find whether STAR+PLUS plans or the waivers bill it separately.

Attendance documentation. Units billed come from HHSC Form 3683, the Daily Attendance Record, with Form 3682, the Daily Transportation Record, for clients the center transports (DAHS Provider Manual 6000). We did not find an electronic sign-in requirement, and we did not review STAR+PLUS plan rules on attendance records, so ask each plan what it expects.

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

Yes, a center can be fully private pay, but it still needs an HHSC DAHS license if it provides day activity and health services to four or more unrelated elderly persons or persons with disabilities. The licensing rules do not depend on who pays, and private-pay clients count toward the 1:8 ratio. The Medicaid contract rules on hours, meals and activities apply only to centers that contract with HHSC.

Smaller or unlicensed programs. We did not find a rule that describes a lawful unlicensed adult day program or what it may not do. The license definition covers four or more unrelated clients, but we could not read the state statute, so ask HHSC before running any group day program without a license.

Protections for private-pay clients. Every licensed center must treat clients without regard to how they pay, give them a written list of rights in English and Spanish, and let them complain anonymously without retaliation (26 TAC 559.52). We did not find rules on fee disclosure or written contracts for private-pay clients.

Other funding.

• Title XX. Centers with an HHSC Title XX contract may serve people who meet Social Services Block Grant income and resource limits, as each region's funding allows (DAHS Provider Manual 3100). Title XX DAHS (bill code C0202) pays the same $18.59 per half-day unit as Medicaid.
• Older Americans Act. An Area Agency on Aging may buy adult day services only from a licensed adult day facility, for people 60 or older who are at least moderately impaired in daily activities or who qualify under the Title III-E caregiver program (26 TAC 213.211). We did not find which agencies fund it or how much, so contact your local Area Agency on Aging.
• 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, sometimes with a copay.

We did not find a state general revenue adult day program.

The market. HHSC's provider directories listed 1,134 DAHS facilities with an active license on October 20, 2026. Of these, 389 are traditional DAHS centers (341) or DAHS centers that also offer ISS (48), and 745 offer only ISS for waiver participants. We did not find a currently active Texas adult day association.

What is changing next for adult day in Texas?

As of our last check on October 21, 2026, we did not find an upcoming change to Texas adult day licensing rules or DAHS payment. Several recent changes matter for operators, and all are already in effect.

• New registry check process, March 2026. Employee Misconduct Registry and Nurse Aide Registry searches moved into TULIP (PL 2026-03).
• Incident reporting update, June 2026. HHSC revised PL 2026-01, which lists the incidents providers must report to HHSC and replaces earlier provider letters PL 14-22 and PL 2019-23.
• New provider letter on SEMARC, October 2026. HHSC issued PL 2026-10 on October 2, 2026, about provider duties for the Search Engine for Multi-Agency Reportable Conduct. We did not review its details, so read it on the HHSC DAHS provider letters page.
• DAHS rate update, September 1, 2025. Fee-for-service and Title XX DAHS rates became $18.59 per half-day unit, alongside the end of HHSC's attendant compensation rate enhancement program.
• Rule rewrite, July 2024. HHSC amended most of the Chapter 559 licensing rules effective July 10, 2024, and moved the DAHS Medicaid contract rules from 40 TAC Chapter 98 to 26 TAC Chapter 211 effective July 31, 2024. Some older documents still cite the former rule numbers.

Texas adult day sources

• HHSC: Day Activity and Health Services (DAHS)
• 26 TAC Chapter 559: Day Activity and Health Services Requirements
• 26 TAC 559.11: licensing requirements
• 26 TAC 559.61: staffing
• 26 TAC Chapter 211: DAHS contractual requirements
• HHSC Day Activity and Health Services Provider Manual
• STAR+PLUS Handbook 10100: Long Term Services and Supports
• HHSC DAHS payment rates effective September 1, 2025
• HHSC PL 2026-01: incident reporting
• HHSC directory of licensed DAHS facilities

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• Effective Transportation Tracking for Elder Day Centers
• Podcast: How Adult Day Services Let You Serve 50 Clients with Just 8 Staff
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• 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, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, 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.