Adult Day Care Wisconsin

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Wisconsin adult day services at a glance

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

How is adult day care regulated in Wisconsin?

Wisconsin does not license adult day care centers. Instead, the Wisconsin Department of Health Services (DHS), Division of Quality Assurance (DQA), certifies them under Wis. Admin. Code DHS 105.14, a Medical Assistance (Medicaid) certification rule in effect since December 1, 2021. Certification is required only if a center serves one or more participants whose care is paid by Medicaid. For any other center it is voluntary.

Wisconsin uses one program type, the adult day care center (ADCC). The rule defines it as a program that serves adults for part of a day in a group setting when they need an enriched health, supportive or social experience and may need help with daily living activities, supervision or protection (DHS 105.14(1)(b)5.). There is no separate adult day health care license or medical model category, and we did not find a separate dementia program certification. DQA says centers may operate in family homes, free standing buildings, or shared spaces such as churches, schools and senior centers.

Three layers of rules can apply to a Wisconsin center, and each comes from a different part of state or federal government:

• Certification (DHS DQA). DHS 105.14, adopted under Wis. Stat. 49.45(47), sets the application, staffing, space, services, records and incident reporting rules for certified centers.
• Medicaid (DHS Division of Medicaid Services). Medicaid pays for adult day care through Family Care and Family Care Partnership, run by managed care organizations (MCOs) under the Family Care 1915(c) waiver, through the IRIS self-directed program, and through PACE. These programs require DHS 105.14 certification and compliance with federal home and community based settings rules, but add no staffing ratio of their own.
• Other funding (DHS aging programs). The Alzheimer's Family and Caregiver Support Program can pay for adult day care for people with dementia, delivered through local aging units and Aging and Disability Resource Centers (ADRCs). We did not find center standards from this layer beyond its program definitions.

Because the Medicaid programs adopt DHS 105.14 as their provider standard, the certification rule is the one that sets how a center operates. Medicaid adds limits on what it will pay for, such as the 8-hour daily limit in IRIS.

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

No. Wisconsin has no adult day license. But if you plan to serve anyone whose care is paid by Medicaid, the center must be certified by DQA under DHS 105.14 before Medicaid will pay, and each location is certified separately. A private-pay-only center may operate without certification.

How to apply. DQA describes the process on its Opening a Medicaid Certified Adult Day Care Center page. You apply through the DHS DQA Provider Portal and include:

• The $127 application fee.
• A program description and a dimensioned floor plan showing exits and how each room is used.
• A fire inspection report.
• Background checks for owners and operators.
• A balance sheet (Model Balance Sheet F-62674A) and a financial reference showing at least 60 days of projected operating funds in reserve.
• Transportation liability insurance if you will transport participants, well water test results if the site uses a well, and a program evaluation plan.

These items are set out in DHS 105.14(2). A center may not be located on land zoned industrial or manufacturing. DHS must approve or deny a complete application within 70 days, and the applicant must be found fit and qualified, which covers background, compliance history, criminal record and financial viability.

Medicaid enrollment. Separately from certification, a facility that provides adult day care under the adult long-term care waivers must enroll with Wisconsin Medicaid through ForwardHealth and get its own Medicaid ID for each physical location.

Certificate of need and local permits. We did not find a certificate of need requirement or a moratorium for adult day centers. Beyond the fire inspection report, and a building code inspection report if your municipality requires one, we did not find other required local permits. Check zoning and occupancy rules with your city or county.

One certification per site. A certification covers only the premises and operator named in the application. Moving to a new location requires a new application and a new survey.

Buying a center. Certification does not transfer. The buyer must submit a complete certification application at least 30 days before the change of ownership, and the seller must notify DHS within the 30 days before the change. The seller stays responsible until DHS certifies the buyer, and cited violations must be corrected first (DHS 105.14(2)(i)). DQA says the prior owner's Medicaid contract ends at the change of ownership.

Renewal and inspections. A certification stays valid until it is suspended or revoked. The rule requires a report and certification continuation fees every 24 months, but the DQA Opening page describes a report sent through the portal around February 1 and due April 1, with an annual fee. We did not find the continuation fee amount, so ask DQA which cycle applies and what it costs. After an announced initial survey, DQA conducts a second, unannounced survey within 2 years of certification, and it may inspect at any time (DQA Survey Guide P-03495). No fixed recertification interval is stated.

Closing. A center that closes must give DHS, each participant and any case manager 30 days' written notice and surrender its certification. A center that serves no participants for 24 months must also surrender it.

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

A certified Wisconsin center needs at least 1 caregiver for every 8 participants, and 1 caregiver for every 4 participants who are severely impaired. Severely impaired means a person cannot perform 3 or more activities of daily living at the program without help, supervision or prompting. At least one qualified caregiver must be on site whenever any participant is present.

These rules are in DHS 105.14(7)(c). Staffing must also be enough to carry out each participant's service plan.

• Certification (DHS DQA): 1:8 for participants who are not severely impaired, 1:4 for severely impaired participants.
• Medicaid (Family Care, IRIS): no ratio specified. These programs rely on DHS 105.14 certification.
• Other funding (Alzheimer's Family and Caregiver Support Program, Older Americans Act Title III-E): no ratio specified.

Dementia. We did not find a ratio set by dementia diagnosis. A participant with dementia falls under the 1:4 ratio only if they meet the severely impaired definition based on daily living activities.

Who counts toward the ratio. A volunteer counts if they meet caregiver standards and training and have signed a written job description. In a multi-use building, adult day caregivers must be distinct and cannot be assigned to another program at the same time. The rule does not say whether the program director counts.

Qualifications. Under DHS 105.14(3):

• The operator must be at least 21.
• The program director must be at least 21 and have an associate degree or higher in a health care related field, or at least 2 years of experience in a health care related field serving a similar population.
• A qualified caregiver at least 18 years old must be in charge when the director is away.
• Caregivers must be at least 16, and caregivers who give medications must be 18 or older.

Nurses. We did not find a requirement to employ a nurse on site, or any nurse or social worker staffing that scales with census. Some medications (injectable, nebulizer, stomal, enteral, vaginal or rectal) must be given by an RN or LPN, or delegated by a nurse to a caregiver under Wisconsin nursing rules.

Training. All employees get an orientation before starting duties. Within 90 days, caregivers must be trained on participant needs, recognizing changes in condition (including first aid) and fire extinguisher use. Training in personal care, standard precautions and medication administration is required before doing those tasks, and untrained caregivers must be directly supervised. The director and caregivers need at least 10 hours of continuing education each calendar year (DHS 105.14(4)).

Background checks and health screening. Employees and contractors with regular direct contact with participants need a caregiver background check under Wis. Stat. 50.065 and ch. DHS 12. DQA says checks are done at hire and every four years. Employees must also be screened for communicable diseases, including tuberculosis, within 90 days before they start work, with re-screening based on exposure risk. We did not find required vaccinations for staff.

Schedules. Centers must keep a current written schedule for every caregiver showing name, assignment and time worked.

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

A certified Wisconsin center must provide or arrange leisure activities, personal care, supervision, communication services, health monitoring and behavior management, based on its program description. Anyone present 5 hours or more gets a meal, and each participant needs at least 50 square feet of usable floor space. Transportation is optional, but a center that offers it must carry liability insurance.

Services. Under DHS 105.14(7)(e), each center provides or arranges:

• Leisure activities, including community outings.
• Personal care for each participant's assessed needs.
• Supervision and communication services.
• Health monitoring, with a note at least every quarter.
• Behavior management.

Meals. A meal providing at least one-third of daily nutritional needs must be provided or arranged for each participant present 5 or more hours. Snacks must be available, and menus are kept for 6 months. Family Care adult day care may include light meals but not a full nutritional regimen of 3 meals a day, and IRIS allows up to 2 meals a day.

Transportation. A center that transports participants must carry liability insurance and keep vehicles safe. In Family Care and IRIS, transportation from home to the center can be part of the adult day service and its rate.

Space and capacity. Under DHS 105.14(8):

• At least 50 square feet of usable floor space per participant, not counting passageways, bathrooms, lockers, offices, storage, staff rooms, furnace rooms or space taken by fixed equipment.
• Capacity is stated on the certification and may not be exceeded. A change in capacity needs written DQA approval before it takes effect, and participants and payers get 30 days' written notice.
• A center inside a nursing home, community-based residential facility (CBRF), residential care apartment complex (RCAC) or pre-vocational setting needs its own entrance and separate program space.
• Delayed egress door locks are allowed only with DQA approval, in a building with supervised sprinkler and fire detection systems, and only when needed for participants at risk of wandering away, such as people with dementia.

We did not find a set number of restrooms per participant (fixtures must work and be sanitary), a required rest area, or a required separate dementia space.

Hours. We did not find a minimum number of days or hours a center must be open. The program description must state the center's days and hours. IRIS pays for no more than 8 hours of adult day care a day, and Family Care and IRIS require the hours to be set in the member's plan.

Written policies. Each certified center needs a program description that names the operator, director and person in charge, capacity, goals and services, days and hours, limits on care, the fee schedule and how fee changes are announced, how families are told of changes, how incidents are documented, the participant groups served, and voluntary and involuntary discharge criteria. It must be given to each prospective participant or representative before an agreement is finalized. Centers also need:

• A standard precautions procedure.
• Policies to investigate abuse, neglect, misappropriation and injuries of unknown source.
• An involuntary discharge appeal procedure and a grievance procedure.
• A written medication management policy naming which caregivers may handle medications.
• A written emergency plan covering fires, tornadoes, missing participants, injuries and staff absences.
• An annual program review with a participant satisfaction survey, corrective action plans and follow-up (DHS 105.14(11)).

Participant groups. Each center must name the groups it serves (for example people of advanced age, people with dementia or people with a traumatic brain injury) and explain how they fit together if it serves more than one. Changing the groups served needs 30 days' advance written notice and DQA approval.

Safety and postings. Centers hold documented fire drills every quarter and tornado drills every year, test smoke detectors monthly and have fire extinguishers inspected yearly. The certification, any statement of deficiency (for 90 days), any enforcement notice and the evacuation plan must be posted.

What rules protect participants in Wisconsin adult day centers?

In a certified Wisconsin center, each participant is assessed before enrollment, signs an enrollment agreement, is screened for tuberculosis and other communicable diseases, and has a service plan within 30 days that is reviewed every 6 months. Involuntary discharge is allowed only for listed reasons, usually with 30 days' written notice. Serious incidents must be reported to DHS within 3 days or 3 working days.

Enrollment. Under DHS 105.14(5) and (7):

• Participants must be 18 or older unless DHS approves a minor.
• Qualified staff assess each person before enrollment, or within 5 days for an emergency enrollment. The assessment covers health, mental health, nursing needs, medications, nutrition and choking risk, ability to evacuate, and preferences.
• A signed enrollment agreement describes the services and their cost and confirms the person received a statement of participant rights.
• A physician, physician assistant, nurse practitioner or RN screens for communicable diseases, including tuberculosis, within 90 days before or 7 days after enrollment. We did not find a required physical exam or physician order beyond this screening.

Service plan. A service plan must be in place within 30 days of enrollment and reviewed every 6 months or when needs change. Health monitoring is documented at least quarterly.

Discharge. A center may discharge a participant against their wishes only for nonpayment after a chance to pay, for care needs beyond its certification or program description, for medical care it cannot provide, for imminent risk of serious harm, or as otherwise allowed by law. It must give 30 days' written notice unless the person's presence puts someone in danger, and it must have an appeal procedure.

Attendance and records. DHS 105.14 does not spell out a daily attendance record, but at survey DQA asks for an active participant roster with start dates and days in attendance. Participant records are kept 7 years after final discharge, employee records 3 years after an employee leaves, and other required records 2 years (DHS 105.14(2)(p)).

Incidents. Under DHS 105.14(2)(k) to (n):

• A death related to restraint, psychotropic medication, suicide, accident or injury is reported to DHS within 3 days.
• A written report is due to DHS within 3 working days for a missing participant (police are called immediately), a police call about an incident, a serious injury needing hospital or emergency room care, structural damage that changes services, a fire, or an evacuation other than a drill.
• Allegations of abuse, neglect and misappropriation must be investigated, and substantiated incidents reported to DHS within 7 days.
• A participant's legal representative must be told immediately of incidents, injuries, significant changes and abuse or neglect allegations, and within 72 hours of a misappropriation allegation.

For Family Care members, the renewed waiver also added the Adult Incident Reporting System (AIRS), with an updated list of incidents the managed care organizations must report. This is a separate, plan-level duty.

Rights and fees. Participants in a certified center have the right to be told about all services and charges and to use a grievance process. Centers give a fee schedule with daily charges and extra fees, and 30 days' written notice before changing services or charges.

How does Medicaid pay for adult day in Wisconsin?

Wisconsin Medicaid pays for adult day care through four programs: Family Care, Family Care Partnership, IRIS and PACE. Every center paid by these programs must hold DHS 105.14 certification. There is no state fee schedule for adult day care, so Family Care rates are negotiated with each managed care organization, and IRIS bills under codes S5100 (15 minutes) and S5102 (per day).

Family Care and Family Care Partnership. DHS runs these managed long-term care programs through contracted MCOs under 1915(b) and 1915(c) waivers (WI.0367.R05.00) renewed for January 1, 2025 through December 31, 2029. Partnership combines health care and long-term care.

• Service: Adult Day Care Services may include personal care and supervision, light meals, medical care and transportation to and from the center. The hours must be in the member-centered plan.
• Rates and codes: adult day care is not on the HCBS minimum fee schedule, so each MCO sets its rate, unit and codes in its provider contract. The waiver's cost estimates project an average of $13.97 per hour for adult day care. That is a planning estimate, not a rate an MCO must pay. We did not find the codes MCOs use, so ask each MCO.
• Transportation: transportation from home is included in the adult day rate, not billed separately.

IRIS (Include, Respect, I Self-Direct). IRIS is Wisconsin's 1915(c) self-directed program. Under the IRIS Service Definition Manual P-00708B (March 2026):

• Codes and units: S5100 (per 15 minutes), S5102 (per day), and S5105 for specialized services (per day, or per 15 minutes with modifier U8).
• Limits: no more than 8 hours a day, not provided remotely, not provided by relatives or guardians, and up to 2 meals a day.
• Provider: must be DHS 105.14 certified, meet home and community based settings rules and be enrolled with ForwardHealth.
• Rate: we did not find a published IRIS rate.

PACE. The Program of All-Inclusive Care for the Elderly serves people 55 and older who are eligible for nursing home care in Kenosha, Milwaukee, Racine and Waukesha counties. Members receive many services at a PACE center. PACE is paid a set amount per member, so adult day is not billed by the unit.

Attendance documentation. Family Care and IRIS require the number of adult day hours to be in the member's plan. We did not find a state rule requiring electronic attendance tracking or a sign-in and sign-out method for adult day billing. MCO provider contracts were not reviewed and may set their own documentation rules, so ask each MCO or IRIS fiscal agent what records it needs to pay a claim.

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

Yes. Because Wisconsin has no adult day license and certification is required only to serve Medicaid-funded participants, a center that serves only private-pay participants may operate without DQA certification. Once a center is certified, the DHS 105.14 rules cover all of its participants, whoever pays.

What an uncertified center may not do. We did not find state limits on the services, such as personal care, nursing or medications, that an uncertified center may offer. The main limit we found is that it cannot be paid by Medicaid. Ask DQA if you are unsure whether a service you plan to offer needs another kind of license.

Protections for private-pay participants. In a certified center, every participant gets a fee schedule with daily charges and extra fees, 30 days' written notice of changes in services or charges, a statement of rights and a grievance process. We did not find a rule that bars treating participants differently by payment source.

Other funding.

• Alzheimer's Family and Caregiver Support Program. Under Wis. Stat. 46.87, this DHS program can pay for adult day care for people with Alzheimer's disease or another dementia who live in the community. Ch. DHS 68 defines respite to include services provided by an adult day center. Contact your local aging unit or ADRC.
• National Family Caregiver Support Program (Older Americans Act Title III-E). This program offers temporary respite to caregivers of adults 60 and older. The DHS caregiver page does not list adult day care by name for this program, so ask your aging unit whether it can be used for adult day.
• Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to veterans who need help with daily living activities, at VA medical centers, State Veterans Homes or community organizations. We did not find Wisconsin-specific VA sites or contracts.

The market. The DQA adult day care center directory lists 115 certified centers. The file carries no date; the count is as of October 21, 2026, when it was retrieved. No count of uncertified private-pay centers is published. The state association is the Wisconsin Adult Day Services Association (WADSA).

What is changing next for adult day in Wisconsin?

As of our last check on October 21, 2026, we did not find an upcoming change to Wisconsin's adult day rules or Medicaid adult day payment, and no pending change to DHS 105.14. Several recent changes matter for operators.

• Family Care waivers renewed, January 1, 2025. CMS renewed the Family Care and Family Care Partnership 1915(b) and 1915(c) waivers in November 2024, effective January 1, 2025 through December 31, 2029 (DHS waiver renewal page). The renewal added the Adult Incident Reporting System for MCOs.
• ForwardHealth enrollment for each location. Facilities that provide adult day care under the adult long-term care waivers must enroll with Wisconsin Medicaid through ForwardHealth and get a separate Medicaid ID for each location. We could not confirm the deadlines for this change, so ask your MCO or ForwardHealth whether your enrollment is complete.
• Updated guidance documents. DQA updated the Adult Day Care Center Survey Guide (P-03495) in August 2026, and DHS updated the IRIS Service Definition Manual (P-00708B) in March 2026. Operators should work from these current versions.

Wisconsin adult day sources

• DHS Division of Quality Assurance: Adult Day Care Center Rules and Regulations
• DQA: Opening a Medicaid Certified Adult Day Care Center
• Wis. Admin. Code DHS 105.14: adult day care centers
• Wis. Admin. Code DHS 105.14(7): services and staffing
• DQA Adult Day Care Center Survey Guide P-03495 (August 2026)
• DHS: Family Care and Family Care Partnership 1915(c) waiver WI.0367.R05.00
• DHS: IRIS Service Definition Manual P-00708B (March 2026)
• ForwardHealth: enrollment criteria for multiple locations and services
• DHS: Caregiver support programs
• DQA: Adult day care center directory (Excel)

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 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, West Virginia. 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.