Adult Day Care West Virginia

All states: adult day services map

West Virginia adult day services at a glance

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

How is adult day care regulated in West Virginia?

West Virginia licenses one kind of adult day program, the medical adult day care center, through the Office of Health Facility Licensure and Certification (OHFLAC). Day programs that are primarily social and recreational are outside the licensing rule and have no state adult day license. West Virginia Medicaid pays only for the licensed medical model, under the name Adult Medical Day Care.

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

• Licensing (OHFLAC). W. Va. Code R. 64CSR2, Licensure of Medical Adult Day Care Centers, adopted under W. Va. Code 16-5B. It treats a medical adult day care center as a special type of ambulatory health care center and covers licensing, staffing, space, services, records and incident reporting for every center, whatever the payer.
• Medicaid (Bureau for Medical Services). The Bureau for Medical Services (BMS), part of the West Virginia Department of Human Services, covers Adult Medical Day Care through the Aged and Disabled Waiver (waiver WV.0134.R08.00). The waiver requires the center to be licensed by OHFLAC and to follow 64CSR2, and adds its own enrollment, background check and billing rules. The Bureau of Senior Services is listed in the waiver as an operating agency contact.
• Other funding (Bureau of Senior Services). Under the Older West Virginians Act (W. Va. Code 16-5S-8), adult day care is one of the supportive services that federal aging funds may pay for. We did not find adult day program standards from this layer.

The rule defines a medical adult day care center as an ambulatory health care facility that offers an organized day program of therapeutic, social, health maintenance and restorative services, as an alternative to 24-hour institutional care for elderly or disabled adults (64CSR2 section 3.27). It applies to for-profit and nonprofit operators, including day programs run by nursing homes, hospitals and other licensed facilities. It does not apply to programs that are primarily social and recreational, even if they hold an occasional medical screening clinic, or to certain behavioral health center programs (section 2.2). We did not find a separate dementia license.

Licensing sets the operating standards. Medicaid adopts them and is stricter in one place: a Medicaid full day requires at least 7 hours of service.

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

Yes, if you will run a medical adult day care center. You need an OHFLAC license before you open, operate or even advertise the center, whoever pays for care. You apply at least 90 days before opening with a $100 nonrefundable fee, and a satisfactory inspection comes before the initial license.

Who can apply. The applicant must be at least 21 and provide two letters of reference (64CSR2 section 4.1).

How to apply. Under section 4.2 and the OHFLAC Initial or CHOW License Application for Medical Adult Day Care:

• Send OHFLAC the application with a notarized signature, the $100 nonrefundable fee, and a preliminary operating plan with a budget, at least 90 days before your planned opening.
• The application form also asks for a criminal background check card, proof of the director's education, photos of the center, any lease, and verification that you have complied with certificate of need review.
• A recommendation from the state fire marshal is required.
• Plans for new construction, additions or renovations must be submitted and approved, and the construction is inspected before new participants are admitted (sections 5.2 and 5.4).
• OHFLAC sets your licensed capacity, meaning the number of participants you may serve at one time, and issues the initial license after a satisfactory inspection.

Certificate of need. The rule says no initial license is issued for a project that is reviewable under the certificate of need law (W. Va. Code 16-2D) without a finding that it conforms to the certificate of need decision. We did not find whether a new medical adult day care center is reviewable today, so ask OHFLAC or the West Virginia Health Care Authority before you sign a lease. We did not find a moratorium on new centers.

One license per site. A license covers only the named licensee and center. Each center owned by the same licensee needs its own license.

Buying a center. Licenses are not transferable. A new owner files the same OHFLAC initial or change of ownership (CHOW) application, with the same $100 fee and 90-day lead time. A change of licensee or center name must be reported within 15 days. We did not find a separate advance notice period for a sale.

Renewal and inspections. Licenses last up to one year and expire June 30 unless renewed. The renewal application and $100 fee are due at least 90 days before expiration. Increasing capacity needs prior written approval. OHFLAC makes unannounced inspections at least once every 12 months, and a plan of correction is due within 15 working days of a statement of deficiencies (sections 4.5 and 4.9).

Medicaid enrollment. To bill Medicaid, a licensed center must also enroll as an Aged and Disabled Waiver provider and meet the federal home and community based settings rules. BMS verifies the center's license every year.

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

West Virginia's licensing rule requires at least one full-time staff member involved in direct services for every 6 participants, with more staff added as participant needs require. A nurse must be on duty during all primary hours, and a registered nurse must be in the center at least 8 hours a week. Medicaid sets no separate ratio, and we did not find a separate ratio for participants with dementia.

• Licensing (OHFLAC): 1 full-time direct services staff per 6 participants (64CSR2 section 6.4.k). OHFLAC may require more staff after a poor outcome tied to supervision or unmet needs.
• Medicaid (Aged and Disabled Waiver): no ratio specified. The waiver relies on the licensing rule and adds background check rules.
• Other funding: we did not find a Bureau of Senior Services staffing standard.

Minimum staff on site. The director, or a responsible employee designated in writing, must be present and in charge at all times. The center may not operate more than 30 days without a qualified director or supervising RN, and changes in either must be reported within 10 days.

Who counts toward the ratio. Full-time direct services staff count. Volunteers count only if they are professionally trained or certified in a health occupation and are oriented and trained like staff.

Nurses. A nurse is on duty during all primary hours and on call at other times, with backup coverage arranged. The center employs or contracts with a West Virginia licensed RN who is in the center at least 8 hours per week and oversees care plans, medications and monthly nursing notes. The RN needs two years of experience in direct care of elderly or disabled people, or specialized training plus one year. LPNs need one year of experience or training and work under RN supervision.

Director. The director must be at least 21 and have two years of post-secondary education, or a high school diploma plus five years of experience in social services or health care with elderly or disabled people, two of them in a supervisory role. The director completes 8 hours of training each year.

Activity director. The activity director must be certified by the National Certification Council for Activity Professionals (NCCAP), be a qualified therapeutic recreation specialist or a licensed occupational therapist or assistant, or have a high school diploma plus the NCCAP 90-hour course and 90-hour practicum, with 10 hours of continuing education a year.

Direct care staff. Direct care staff need at least a tenth grade education, one year of paid or volunteer experience with adults in health care or social services, and the ability to read and write. Medicaid adds that staff must be over 18.

Training. New staff are trained before working unsupervised and within 14 days, then every year, on topics listed in the rule. Training includes at least 2 hours on Alzheimer's disease and dementia, and new employees get five days of supervised on-the-job training. All employees need current first aid and CPR (section 6.6).

Background checks. Before hire, the licensing rule requires checks of the State Police central abuse registry, the nurse aide abuse registry, the applicable licensing boards and the Bureau for Children and Families, and listed people may not be hired. For Medicaid providers, staff must also meet the WV CARES fingerprint-based check requirements, rechecked every 5 years, and pass monthly federal exclusion (OIG) checks.

Health screening. Staff need a TB skin test or chest x-ray before working with participants, then a TB screening every year.

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

A licensed medical adult day care center provides nursing services, medication administration and supervision, help with personal care, a daily activity program and meals. It must be open at least 4 and no more than 14 hours a day, at least five days a week, and meet detailed space and restroom rules. Transportation is optional.

Services. Nursing, medication administration and supervision, and help with activities of daily living are part of the model, and restorative therapies are optional. A center may not admit people who need ongoing or extensive nursing care (64CSR2 section 8).

Hours. Centers operate at least 4 and no more than 14 hours a day, at least five days a week, during hours that cover a normal work week for caregivers (section 6.1.a). For Medicaid, a half day needs at least 4 hours of service and a full day at least 7 hours.

Activities. The activity program offers at least 20 hours a week, and 4 hours a day, of scheduled activities, with alternatives for people who do not join group activities. A large print weekly calendar, including activities suited to people with dementia, is posted a week ahead (sections 9.3 and 9.4).

Meals. Under section 10, participants who attend 4 hours or less get one meal, 5 to 8 hours one hot meal and two snacks, and more than 8 hours two hot meals and two snacks. A registered dietitian prepares or approves menus two weeks ahead, and therapeutic diets are served as ordered. Medicaid adds that meals may not make up a full regimen of three meals a day.

Transportation. If a center transports participants, vehicles must be maintained, enough staff must ride along for safety, and drivers need a valid license, current first aid and CPR, and emergency training (section 11).

Space and capacity. Under section 5:

• At least 500 square feet for dining, leisure and activities for the first five participants, then 35 square feet for each additional participant, not counting toilets, bathing rooms, offices and storage. Dining needs at least 15 and leisure and activity space at least 20 square feet per participant.
• More space for specialty services: 40 square feet per participant for Alzheimer's and dementia, 50 for physical rehabilitation therapy and 70 for developmental disability.
• At least two participant toilet rooms, then one toilet and sink for every 10 participants, plus a toilet that staff and visitors can use and one fully accessible bathing facility.
• A private rest area of at least 120 square feet near a toilet, with at least one bed and one recliner, and a private treatment or examination room.
• Parking with one space for every five participants, plus staff parking. Alarm systems may be required for participants who wander.

Written policies. Each center needs written policies on participant care and safety, a participant bill of rights, rules of participation, and an admission packet covering admission and discharge criteria, complaints, medication handling, oxygen, hours and closures, personal belongings, confidentiality, monitoring devices and the fact that the center does not handle personal funds. It also needs a written emergency operations plan (missing participants, severe weather, floods, bomb threats, utility failure) with an alternate shelter agreement and an emergency transportation policy, a written activity plan, abuse reporting and investigation procedures, and a preventive maintenance program for equipment. Policies are reviewed at least every year, signed and dated, and available to staff, participants and the public.

Postings and drills. The license, participant rights and responsibilities, the abuse hotline and licensing office numbers, and the latest survey deficiencies with the plan of correction must be posted (section 7.1). The emergency plan is reviewed and rehearsed with all staff every year, new participants are shown how to evacuate on their first day, and emergency numbers are posted by each phone (section 12.2).

What rules protect participants in West Virginia adult day centers?

West Virginia's licensing rule requires a pre-admission interview, a health assessment with a TB test, a written admission contract with full cost disclosure, and a service plan within 14 attendance days. Participants get 30 days written notice before a discharge or a rate increase. Major incidents go to OHFLAC by the next business day.

Who can enroll. A center may refuse or not keep people who need more care than it provides or who pose a serious risk of harm (64CSR2 section 8.1). Medicaid members must meet Aged and Disabled Waiver eligibility, including nursing facility level of care, and their adult day hours are set in their person-centered service plan.

Admission contract. The written contract states the population served, the services (including CPR), an hourly, daily, weekly or monthly price with full disclosure of costs and the refund policy, and whether transportation is offered and what it costs (section 6.7.c).

Assessment and care plan timelines.

• The director or RN holds a pre-admission interview.
• A written health assessment by a physician or other authorized licensed professional is done within 60 days before or 5 working days after admission, including a TB skin test or chest x-ray, then every year.
• The RN writes an initial service plan on the first day.
• A functional needs assessment is due within 7 attendance days.
• The multi-disciplinary team completes the full service plan within 14 attendance days and reviews it every quarter.

Discharge. Participants get 30 days written notice before a discharge and before any rate increase (sections 6.7.e and 6.7.f).

Attendance and records. Each participant's record includes a daily attendance record, a daily record of medications, treatments and services, assessments, the service plan, orders, progress notes and a current photo. The center also keeps a register of all participants by admission date. Participant records are kept at least 5 years after discharge, personnel records 3 years after employment ends, and records of food served 30 days. For Medicaid claims, records that document the audit trail are kept at least 3 years, so the 5-year licensing rule is the longer one.

Incidents. Major incidents, such as a serious injury, an unnatural death, a missing participant who is at risk, or an assault with injury, are reported to OHFLAC as soon as possible and no later than the next business day. Suspected abuse or neglect is reported right away to Adult Protective Services, with the written APS form within 48 hours, and OHFLAC is told the investigation results within 72 hours (section 7.2).

How does Medicaid pay for adult day in West Virginia?

West Virginia Medicaid pays for Adult Medical Day Care through the Aged and Disabled Waiver, run by the Bureau for Medical Services. Only OHFLAC-licensed medical adult day centers enrolled as waiver providers can bill. Service is paid as a half day (at least 4 hours) or a full day (at least 7 hours), and approved providers can bill non-emergency transportation between home and the center.

The Aged and Disabled Waiver. This 1915(c) waiver (WV.0134.R08.00) was renewed by CMS effective July 1, 2025, through June 30, 2030 (BMS renewal notice). It serves people who meet nursing facility level of care, and Adult Medical Day Care is provided according to each member's person-centered service plan.

• Billing unit: one half day event (at least 4 hours) or one full day event (at least 7 hours).
• Rates: the approved waiver uses $45 per half day and $85 per full day in its cost estimates. These are planning figures in the waiver, not a published rate schedule. We could not open the BMS rate chart, so confirm current rates with BMS.
• Billing codes: we did not confirm the procedure codes for Adult Medical Day Care. Ask BMS or check the current Aged and Disabled Waiver rate chart.
• Transportation: the waiver's service definition allows approved providers to bill non-emergency medical transportation between the member's home and the center.
• Provider rules: the center must be an enrolled waiver provider, follow the home and community based settings rules, and have its license verified every year.

Attendance documentation. The licensing rule requires a daily attendance record in each participant's file and staffing records that show who was on duty and their hours. The waiver says Personal Attendant service is the only Aged and Disabled Waiver service subject to electronic visit verification. For other services, including adult day, BMS uses claim edits that cap units per month or year and post-payment reviews that check services were provided. We did not find a rule on arrival and departure times specific to adult day claims, because the waiver policy manual chapter could not be opened. Ask BMS what attendance records it expects to see in a review.

Other Medicaid programs. We did not find another Medicaid program in West Virginia that pays for adult day today. See the changes section below for the state's plan to develop PACE.

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

Yes. A medical adult day care center can be fully private pay, but it still needs an OHFLAC license, because the rule applies whatever the payer. A program that is primarily social and recreational falls outside the rule and needs no state adult day license.

Where the line is. Operating or advertising a medical adult day care center without a license is not allowed, and OHFLAC may inspect centers it suspects are operating without one (64CSR2 sections 4.1.a and 4.5.d). We did not find a rule that lists exactly which services, such as nursing, medication administration or hands-on personal care, turn a social program into a medical center that needs a license. If you plan to offer any health services, ask OHFLAC before you open.

Protections for private-pay participants. Licensed centers must give a written contract with full disclosure of costs and the refund policy, give 30 days notice of rate changes, and may not charge for costs that were not disclosed. They may not discriminate by race, national origin, religion, age, gender, sexual orientation or disability (section 6.7). We did not find a rule against turning people away based on how they pay.

Other funding. Under the Older West Virginians Act, federal aging funds may pay for adult day care as a supportive service. We did not find which local programs, if any, use those funds for adult day, or what standards apply, so ask the Bureau of Senior Services or your local aging provider. We did not find VA adult day health care at West Virginia VA medical centers; veterans should ask their VA medical center what is available.

The market. We did not find a state-published count of licensed medical adult day care centers, and OHFLAC's facility lookup could not be read. Ask OHFLAC for a current list. We did not find a West Virginia adult day services association.

What is changing next for adult day in West Virginia?

West Virginia is funding the development of PACE (the Program of All-Inclusive Care for the Elderly), starting with daytime health centers. No start date has been published. As of our last check on October 21, 2026, we did not find an adopted change to the adult day licensing rule or to Medicaid adult day payment.

• PACE development funding (announced). On August 21, 2026 the Governor announced a $1.25 million Rural Health Transformation Program funding opportunity to develop PACE in West Virginia, beginning with daytime health and activity centers that offer nursing, medication help and social activities. This is a funding opportunity, not a launched program, and no opening dates have been set.
• Fayette County pilot bill (introduced only). House Bill 5343, introduced February 9, 2026, would create a three-year medical adult day care pilot in Fayette County. It was referred to committee, and we did not confirm any later action.
• Aged and Disabled Waiver renewal (in effect). CMS renewed the waiver that covers Adult Medical Day Care effective July 1, 2025, through June 30, 2030.

West Virginia adult day sources

• W. Va. Code R. 64CSR2: Licensure of Medical Adult Day Care Centers
• West Virginia Secretary of State: 64CSR2 rule record
• 64CSR2 section 4: licensing procedures
• 64CSR2 section 6: administration, staffing and participant rights
• OHFLAC Initial or CHOW License Application for Medical Adult Day Care
• Bureau for Medical Services: Aged and Disabled Waiver application WV.0134.R08.00
• Bureau for Medical Services: Aged and Disabled Waiver renewal, July 1, 2025
• W. Va. Code 16-5S-8: Older West Virginians Act supportive services
• West Virginia Department of Health: PACE funding announcement, August 21, 2026
• West Virginia Legislature: HB 5343 (2026)

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
• Adult Day Care Activity Ideas to Keep Clients Engaged
• 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 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, Oregon, South Dakota, Vermont, Washington, 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.