Adult Day Care Virginia

All states: adult day services map

Virginia adult day services at a glance

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

How is adult day care regulated in Virginia?

Virginia has one license for adult day care, the adult day center license, issued by the Virginia Department of Social Services (VDSS). There is no separate adult day health care license. Adult day health care (ADHC) is a Medicaid service that the Department of Medical Assistance Services (DMAS) pays to a VDSS-licensed center that also meets extra Medicaid standards.

Three layers of rules can apply to a Virginia center, and each comes from a different agency:

• Licensing (VDSS). The Standards and Regulations for Licensed Adult Day Centers, 22VAC40-61, adopted under Code of Virginia 63.2-1700 and following. Related rules cover licensing procedures (22VAC40-80), license fees (22VAC40-160) and background checks (22VAC40-90). These rules cover staffing, space, services, records and incident reporting for every licensed center, whatever the payer.
• Medicaid (DMAS). The Commonwealth Coordinated Care Plus (CCC Plus) Waiver rules in 12VAC30-120, the CCC Plus Waiver application and the CCC Plus Waiver Provider Manual set the extra standards a center must meet to bill Medicaid for ADHC. Most members get the service through Cardinal Care managed care organizations (MCOs), which authorize it. DMAS also runs PACE.
• Other funding. The U.S. Department of Veterans Affairs pays for adult day health care for some veterans, and local Area Agencies on Aging may offer adult day care under contracts with the Virginia Department for Aging and Rehabilitative Services (DARS).

Under Code of Virginia 63.2-100, an adult day center is a facility, run for profit or that chooses to be licensed, that gives supplementary care and protection for part of the day to four or more aged, infirm or disabled adults who live elsewhere. Facilities licensed by the State Board of Health or the Department of Behavioral Health and Developmental Services (DBHDS), and homes caring only for relatives, are excluded. Virginia has no separate social-model or dementia-specific license type.

Where the layers overlap, the licensing rules set the base for how every licensed center operates. Medicaid ADHC adds nursing, care coordination, a shorter care plan review cycle and more detailed daily documentation on top of the license.

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

It depends on who owns the center. A for-profit center that cares for four or more adults must be licensed by VDSS whether or not it bills Medicaid. A nonprofit center needs a license only if it chooses licensure, but Medicaid ADHC is paid only to licensed centers. A center that serves only PACE enrollees does not need a license.

How to apply. VDSS takes applications online through the Virginia Enterprise Licensing Application (VELA) and recommends its Introduction to Licensing and Introduction to Adult Day Centers videos first (VDSS Adult Day Centers page). Under the General Procedures and Information for Licensure (22VAC40-80):

• File the initial application at least 60 days before you plan to open.
• Complete a prelicensure orientation. The Commissioner may waive it or make the license conditional on finishing it, and adult day center applicants are exempt if VDSS says the training is not available.
• A new building, a building not used before for this purpose, or renovated space needs VDSS approval of its functional design and a valid certificate of occupancy before licensure.

Fees. Application and renewal fees are set by licensed capacity and collected each license year (22VAC40-160-10):

• 1 to 12 participants: $14
• 13 to 25: $35
• 26 to 50: $70
• 51 to 75: $105
• 76 to 200: $140
• 201 and up: $200

Local approvals. We did not find a separate local health permit in the licensing standards, other than local health department approval of catered or contract food service and an annual fire inspection. Ask your city or county about zoning and occupancy.

Certificate of need. We did not find a certificate of need, moratorium or cap on new adult day centers in Code of Virginia Chapter 17 of Title 63.2 or in 22VAC40-80.

One license per site. Each license is issued on a separate form that names the operating name, sponsor, physical location and the maximum number of people the center may serve, and it must be posted (Code of Virginia 63.2-1701). One owner may hold several licenses.

Buying or closing a center. A license cannot be transferred when ownership or location changes, so a buyer needs its own license. The current licensee must notify the licensing office at least 60 days before a sale or closure (22VAC40-80-60 and -70). If the center bills Medicaid, DMAS must also be told at least 15 calendar days before a change of ownership (12VAC30-120-930).

Renewal and inspections. Licenses run six months, one, two or three years (Code of Virginia 63.2-1706). Minimum inspections depend on the term:

• Six-month license: two inspections, one unannounced.
• One-year license: three a year, two unannounced.
• Two-year license: two a year, one unannounced.
• Three-year license: one unannounced inspection a year.

Renewal applicants are also inspected. A July 29, 2026 VDSS provider memo reminds licensees to give inspectors immediate access to the premises and to produce requested records within one hour except in extraordinary circumstances.

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

Virginia licensing rules require at least one direct care staff person on duty for every six participants, or portion of six, and at least two staff on duty whenever any participant is present. The CCC Plus Waiver sets the same 1:6 ratio for Medicaid adult day health care, so the two layers tie. We did not find a separate ratio for participants with dementia.

"Portion of six" means a center with 7 participants needs 2 direct care staff, and a center with 13 needs 3. The ratio applies on field trips too, and more staff may be needed based on the services offered, participant needs and the building layout.

• Licensing (VDSS): 1:6 or portion of six, computed for the whole center, at the center and on field trips (22VAC40-61-200). At least two staff on duty whenever one or more participants are present, and a director or designated staff member (not a volunteer) in charge during operating hours (22VAC40-61-190).
• Medicaid (CCC Plus Waiver): 1:6, counting Medicaid and all other participants, with at least two staff awake and on duty whenever Medicaid participants attend. In a center that shares space with another facility, only the center's own identifiable staff count. This ratio appears in the CCC Plus Waiver application, not in 12VAC30-120-935 or the provider manual.
• Other funding: no ratio specified. The DARS aging services rule lists adult day care as an allowed service but sets no staffing standard.

Who counts toward the ratio. Volunteers count only if they meet staff qualifications and training, and only with at least one paid staff member counted for each volunteer. Staff counted in the ratio must be at least 18 unless certified as a nurse aide. The Medicaid layer uses the same volunteer rule.

Director. The director (or a qualified assistant director) must be on site at least 51 percent of weekly operating hours, be at least 21, and hold a bachelor's degree plus two years of experience with older adults or people with disabilities. A Virginia nursing home or assisted living administrator license, or an RN license with the experience, also qualifies. Directors need 24 hours of continuing education a year (22VAC40-61-130).

Activities. Licensing requires a designated staff person to coordinate activities, qualified as a therapeutic recreation specialist, activities professional, occupational therapist or OT assistant, holder of an associate degree in adult activities, or with one year of full-time activities work in an adult care setting in the last five years. For Medicaid ADHC, the activities director needs 48 semester (72 quarter) hours of postsecondary education with a degree in recreational therapy, occupational therapy or a related field, plus one year of experience.

Nurses. The licensing standards set no nurse hours. Medicaid ADHC requires an RN on site at least eight hours each month (DMAS may require more) and available in person or by phone whenever the center is open. The RN evaluates each member's nursing needs at least every 90 days (12VAC30-120-935). A director, activities director, RN or therapist serves as the ADHC coordinator.

Aide qualifications and training. Under licensing, direct care staff must, within 2 months of hire, hold nurse aide certification or complete an approved nurse aide, personal care aide, geriatric or home health aide program, the 40-hour assisted living direct care course, or at least 40 hours of training by a licensed health care professional. They need at least 12 hours of training a year, including 2 hours of infection control and, where it applies, 4 hours on mental impairment. Medicaid ADHC aides must be 18 or older and be a registered CNA, a graduate of a Board of Nursing approved curriculum, or have finished a provider curriculum of at least 40 hours taught by an RN.

Orientation, first aid and CPR. Staff need orientation in seven safety topics before working with participants and 11 more topics within 3 weeks (6 weeks for part-time staff). At least one staff member with current first aid certification (unless an RN or LPN is on duty) and at least two direct care staff with current adult CPR must be on the premises at all times. New staff need first aid within 60 days of hire.

Background checks. Licensing requires a sworn disclosure statement and a Virginia State Police criminal history record report obtained within 30 days of employment and not dated more than 90 days before employment (22VAC40-90). Until the report comes back, a new employee may have direct participant contact only under direct supervision by a cleared employee. Barrier crimes follow Code of Virginia 19.2-392.02. Medicaid adds screening against the federal exclusion list, and DMAS will not pay for services by someone without a clearance.

Health screening. Staff and counted volunteers need a TB evaluation within 30 days before or 7 days after starting, and TB screening every year. We did not find a required vaccination in the licensing standards.

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

Every licensed Virginia center must offer planned activities throughout the day, meals and snacks based on its hours, and enough space and restrooms for its licensed capacity. Centers that bill Medicaid for adult day health care must also provide nursing, help with daily living activities, therapy coordination, social services and at least one meal a day.

Activities. Activities must cover physical, social, cognitive, creative, productive, sensory, reflective, outdoor and nature categories, with a monthly schedule posted and kept for two years (22VAC40-61-330).

Meals. What a center serves depends on its hours. A center open 8 a.m. to 5 p.m. serves a morning snack, a midday meal and an afternoon snack. At least 45 minutes is allowed for each meal, and menus must meet USDA guidance. Catered or contract food service needs local health department approval.

Transportation. Licensing does not require transportation, but if a center transports participants, vehicles need heat and air conditioning, a lift or ramp for wheelchair users, insurance, a first aid kit and a person aboard with current first aid and CPR (22VAC40-61-380). Every Medicaid ADHC center must provide transportation home in an emergency.

Medicaid ADHC services. Under 12VAC30-120-924, ADHC must include at least:

• Help with activities of daily living.
• Nursing, including an evaluation every 90 days and medication administration or supervision.
• Coordination of physical, occupational and speech therapy.
• One or more meals a day meeting one third of USDA requirements.
• Social services, recreation and socialization, and plan of care coordination.

A center without on-site professional nursing may not admit Medicaid members who need skilled nursing, such as tube feedings or sterile dressing changes.

Space and capacity. Under the licensing standards:

• Centers licensed after July 1, 2000 need at least 50 square feet of indoor program space per participant (40 for older centers). Hallways, offices, restrooms, storage and rooms not used for program activities do not count (22VAC40-61-440).
• One accessible toilet with grab bars for every 10 participants or portion of 10, and one sink for every two toilets. Hot water at participant taps must stay between 105 and 120 degrees F.
• A separate rest area with one bed, cot or recliner for every 12 participants, plus more as needs require.
• A large group room, small-group space, a private space and accessible, supervised outdoor space.
• A doorbell or door alarm if the center serves participants who wander.

Hours. We did not find a minimum number of days or hours a center must be open in the licensing standards. For Medicaid, see the billing section below.

Written policies. Every program, plan and policy the standards require must be written and put into practice (22VAC40-61-20). They include:

• A statement of purpose and scope, including who the center can and cannot serve, a staffing plan and schedule, an organizational chart, and volunteer selection, supervision and duties.
• Written admission criteria, and a discharge policy with an appeal process for center-initiated discharges.
• Health care supervision, infection prevention and occupational health, and medication management.
• A field trip policy.
• An emergency preparedness and response plan reviewed at least once a year, a fire and evacuation plan approved by the fire official, a plan for participant emergencies (including missing participants and vehicle breakdowns), and a plan for heat or cold if heating or cooling fails.

Evacuation drills must be unannounced and follow the Statewide Fire Prevention Code, with records kept two years. Participant rights must be posted in at least 14-point type with contacts for the licensing office, Adult Protective Services, the Long-Term Care Ombudsman and the disAbility Law Center. Medicaid ADHC centers must also meet the federal HCBS settings rule.

What rules protect participants in Virginia adult day centers?

Virginia licensing rules require a physician exam before admission, a written assessment and care plan, a signed participant agreement, a daily attendance log and at least 30 days written notice before a planned discharge. Serious incidents must be reported to VDSS within 24 hours. Medicaid adds a care plan review every three months and immediate reporting of critical incidents.

Who can enroll. Participants must be at least 18 and meet the center's written admission criteria. A licensed physician must examine the participant within 30 days before admission, including a TB evaluation, and an exam report is required every year. For Medicaid ADHC, the member must meet nursing facility level of care through Virginia's long-term services and supports screening, and the service must be authorized in advance.

Participant agreement. A signed agreement must list services and extra fees, payment terms, deposits and refunds, the notice given before price increases, refunds on closure, transfer or discharge, and the conditions for discharge (22VAC40-61-240).

Assessment and care plan.

• Licensing: a written assessment on or before admission, updated at least every six months. A preliminary plan of care by admission, reviewed within 30 days and updated at least every six months.
• Medicaid: an interdisciplinary plan of care (DMAS-301) by the fifth visit, reviewed by interdisciplinary staff at least every three months, with progress notes every 30 days. Each ADHC member also gets a yearly in-person Individual Experience Survey from the MCO care coordinator or another approved entity.

Discharge. Licensing requires at least 30 calendar days written notice before a planned discharge, except when a participant poses an immediate and serious risk, plus an appeal process (22VAC40-61-270). Medicaid allows a center to discharge a waiver member from the center with 10 calendar days notice unless safety is at risk (12VAC30-120-924). Because the licensing rule is stricter, a licensed center should plan on 30 days.

Attendance records. Every licensed center keeps a daily attendance log with each participant's name and arrival and departure times (22VAC40-61-190).

Record retention. Licensing requires participant records to be kept at least two years after the participant leaves and staff records two years after termination. Medicaid requires records to be kept at least six years from the last date of service, longer if an audit is open (12VAC30-120-930).

Incidents. Under licensing, major incidents that threaten a participant's life, health, safety or welfare are reported to the regional licensing office within 24 hours, followed by a signed written report within 7 days, and copies are kept at least two years (22VAC40-61-90). Reportable disease outbreaks go immediately to the local health department and the regional licensing office. For Medicaid members, critical incidents (medication errors, severe injury, falls, theft, suspected abuse or neglect, and death) are reported immediately to the member's MCO, or to DMAS for fee-for-service members.

How does Medicaid pay for adult day in Virginia?

Virginia Medicaid pays for adult day health care through the CCC Plus Waiver, run by DMAS and authorized for most members by their Cardinal Care managed care plan. Under the DMAS fee schedule effective July 1, 2026, code S5102 is paid by the hour: $11.55 in Northern Virginia and $10.70 in the rest of the state. Routine transportation is billed separately. PACE also covers adult day center care for eligible people in parts of the state.

CCC Plus Waiver adult day health care.

• Who runs it: DMAS. Service authorization comes from DMAS's contractor for fee-for-service members or from the member's Cardinal Care MCO.
• Who can provide it: a center with a VDSS adult day center license that gives DMAS a current copy and enrolls as a Medicaid provider.
• Billing code and unit: S5102, per hour, since July 1, 2026. Before that it was a per diem ($69.30 Northern Virginia, $64.17 rest of state, effective July 1, 2025). The hourly rates equal the old daily rates divided by six.
• Rate: $11.55 per hour Northern Virginia, $10.70 per hour rest of state (CCC Plus Waiver fee schedule effective 7/1/2026). We did not find what MCOs pay centers, so ask each plan you contract with.
• Daily limit: the 2025 Appropriation Act, Item 288 HHHHH authorized the hourly rate on the condition that it pay no more than six hours a day and stay budget neutral. See the last section for the related waiver amendment.
• Transportation: a center that routinely transports members may bill A0120 at $1.98 per trip.

Attendance documentation. Medicaid pays only for services authorized in advance. ADHC centers keep a daily log (DMAS-302) of services delivered with actual arrival and departure times, completed on the day of service, signed each week by the director, activities director, RN, social worker or therapist, with a weekly copy given to the member or family (CCC Plus Waiver Provider Manual, Chapter IV). Records may not use copied or re-dated notes or signatures. This is on top of the licensing attendance log every center keeps.

PACE. DMAS lists 14 PACE sites, run by AllCare, Blue Ridge Independence at Home, Centra (3 sites), Cherry Blossom, InnovAge (4 sites), Mountain Empire, Mount Rogers and Sentara (2 sites) (DMAS PACE page). PACE is paid a set amount per enrollee, so adult day is not billed per visit. New PACE programs can start only through a DMAS Request for Applications.

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

Yes. In Virginia, licensing depends on who owns the center, not who pays. A for-profit center serving four or more adults must be licensed even if every participant pays privately, while a nonprofit center may operate without a license, but then it cannot bill Medicaid.

What an unlicensed nonprofit program may do. We did not find a rule that limits what an unlicensed nonprofit adult day program may do, such as giving personal care or medications. Ask VDSS before you plan services around that option.

Protections for private-pay participants. In a licensed center, every participant gets a written agreement disclosing fees, deposits, refunds, notice before rate increases and discharge terms, plus posted rights and at least 30 days notice before a planned discharge. We did not find a rule barring discrimination by payment source.

Small home-based centers. SB 677 and HB 840 (2026) exempt adult day centers caring for 12 or fewer adults in a home from Department of Health restaurant requirements, effective July 1, 2026 (VDSS 2026 legislation memo).

Other funding.

• Veterans: the U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical and community care rules, at VA medical centers, State Veterans Homes or community organizations, with copays based on service connection and finances.
• Older Americans Act and Area Agencies on Aging: Area Agency on Aging plans, which become the scope of each agency's contract with DARS, may include adult day care (22VAC30-60-80). DARS lists adult day centers among the in-home care services offered through local agencies, which may be free or low cost for people with limited incomes. We did not find a DARS service standard for adult day care, so ask your local Area Agency on Aging what it funds and what it expects.
• State programs: we did not find a state general fund adult day program.

The market. VDSS does not publish a count of licensed adult day centers, and its Adult Day Center Search tool does not show a total. We did not find a Virginia adult day association with a website.

What is changing next for adult day in Virginia?

Medicaid proposes capping hourly adult day health care at six hours a day. The fee schedule already pays by the hour, but the cap and related rule changes are not yet approved. As of our last check on October 21, 2026, we did not find a confirmed start date.

• Six-hour daily limit (proposed). DMAS submitted a CCC Plus Waiver amendment stating that ADHC is furnished for no more than six hours a day. It would also drop the old rule that a member stay at least six hours for the day to be billed, and members who attended longer would be steered to personal care hours. The amendment listed a proposed effective date of January 1, 2026, but we did not find a federal (CMS) approval, and the regulation and provider manual still describe a daily rate. Ask DMAS when the limit applies to your claims.
• Hourly rate, July 1, 2026 (in effect). DMAS changed S5102 from a daily rate to an hourly rate of $11.55 in Northern Virginia and $10.70 in the rest of the state.
• Home-based center exemption, July 1, 2026 (in effect). SB 677 and HB 840 exempt adult day centers caring for 12 or fewer adults in a home from Department of Health restaurant requirements.
• License fee review (pending). The State Board of Social Services held a periodic review of the license fee regulation (22VAC40-160), with comments closing March 30, 2026. We did not find an outcome, so the fees above are current until VDSS says otherwise.

Virginia adult day sources

• Virginia Department of Social Services: Adult Day Centers (ADC)
• 22VAC40-61: Standards and Regulations for Licensed Adult Day Centers
• Code of Virginia 63.2-100: definitions (adult day center)
• 22VAC40-80: General Procedures and Information for Licensure
• 12VAC30-120-935: CCC Plus Waiver adult day health care provider requirements
• DMAS: CCC Plus Waiver fee schedule effective July 1, 2026
• DMAS: CCC Plus Waiver Provider Manual, Chapter IV (updated September 2, 2026)
• 2025 Appropriation Act, Item 288 (HHHHH): adult day health care hourly rate
• DMAS: CCC Plus Waiver amendment draft (proposed effective January 1, 2026)
• DMAS: Program 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 where licensing depends on size, services or payer

Arizona, Arkansas, Louisiana, Minnesota, New Hampshire. 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.