Adult Day Services by State

Where are adult day rules changing next?

These are the changes states have announced or scheduled that affect adult day services: licensing pauses, rule rewrites, Medicaid rates and benefit changes. Dates come from the state. Where no date has been published, we say so.

With a date

• California, December 31, 2026: The federal approval behind CBAS, Medi-Cal's adult day health benefit, ends December 31, 2026. A renewal has been submitted to CMS and is not yet confirmed.
• Illinois, January 1, 2027: The waiver adult day rate is proposed to rise from $16.84 to $17.84 an hour, and transportation from $12.44 to $13.44 a trip, on January 1, 2027 or on CMS approval.
• Minnesota, January 31, 2028: DHS has paused new adult day care licenses through January 31, 2028, with exceptions only at the request of a county, health plan or Tribal Nation.

Announced, no date yet

• Arizona: AHCCCS plans a new procurement for the ALTCS health plans that pay for adult day health, with proposals expected in fall 2026. No contract start date is published.
• Connecticut: The state proposes renewing the Home Care Program for Elders state plan benefit that pays for adult day health for five years from February 1, 2027, pending CMS approval.
• Florida: AHCA opened rulemaking in June 2026 to update the adult day care rules and add an adult day health care services rule. New Medicaid adult day enrollment in Miami-Dade County has been paused since May 1, 2026.
• Idaho: Idaho plans to move Medicaid to comprehensive managed care, now targeted for January 1, 2030. Whether adult day health is part of the move has not been published.
• Iowa: Iowa plans to replace several disability waivers that pay for adult day with two new waivers. The planned October 1, 2026 start passed and no new date is published.
• Louisiana: Louisiana has proposed an amendment to the Adult Day Health Care Waiver and a revised reimbursement section of its manual. CMS approval and an effective date have not been published.
• Maryland: The licensing agency lists a targeted revision of the adult medical day care rules as pending. No draft or date has been published.
• Nevada: State law directs the Nevada Health Authority to set up a PACE program. No launch date has been published.
• New Hampshire: The adult day licensing rule must be readopted or extended by about June 2027, and the Choices for Independence waiver that pays for adult day expires June 30, 2027.
• New Jersey: Bills in the legislature would add Medicaid coverage of social adult day care for people 60 and older and ease eligibility for medical day care. Neither has passed.
• New York: New social adult day care providers are under a moratorium until at least January 2027, and the Governor has asked for options up to phasing out the Medicaid social adult day benefit.
• Utah: Proposed waiver amendments would raise Adult Day Health rates by 65.2 percent in both the Aging and New Choices waivers once CMS approves them.
• 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.
• West Virginia: The state is funding development of PACE, starting with daytime health centers. No start date has been published.

How do adult day rules compare across states?

One row for each state and Washington DC. ADC is adult day care (the social model) and ADHC is adult day health care (the medical model). Filter the table to find the states that share a setup, and click a state for its licensing, staffing, Medicaid and sources.

Swipe sideways to see every column.

How do states regulate adult day services?

Adult day services give older adults and adults with disabilities supervision, activities, meals and, in many centers, health care during the day, while they keep living at home. States regulate them through up to three layers: a licensing or certification agency, the Medicaid provider rules for centers that bill Medicaid, and the contract standards of funding programs such as the state unit on aging. A center can be subject to one, two or all three, and the strictest layer usually decides what it has to do.

What is the difference between adult day care and adult day health care?

Adult day care, often called the social model, focuses on supervision, activities, meals and help with daily tasks. Adult day health care, the medical model, adds nursing, health monitoring and often therapy. Some states license the two separately, some have one license with optional health services, and some draw the line only through Medicaid, which may pay for adult day health care but not social adult day care.

Does every adult day center need a license?

No. In some states every center serving a few adults or more needs a state license, whoever pays. In others there is no state license at all, and only centers that bill Medicaid or take state funds must be certified. In a third group it depends on the center's size, the services it offers or whether it is run for profit. The map shows which applies in each state.

How does Medicaid pay for adult day?

Most states pay for adult day through home and community-based services waivers, managed long-term care plans or a state plan benefit, and PACE programs often deliver care through their own day centers. The billing unit differs: some states pay per day or half day, others in 15-minute units or by the hour, and a few use different units in different programs. Rates are set by the state in many places and negotiated with health plans in others.

How current is this information?

Each state summary is checked against primary sources such as the state's administrative code, its licensing agency, its Medicaid agency and provider manuals, and approved waiver documents on medicaid.gov, and each state page shows the date it was last verified. This page is a reference, not legal advice, so confirm details with your state before you act on them.

Frequently asked questions about adult day services by state

Related reading

• Adult Day Care Services and Reference Guide
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• Effective Transportation Tracking for Elder Day Centers
• How Adult Day Services Let You Serve 50 Clients with Just 8 Staff (podcast)
• Medicaid Home Care by State: EVV requirements map

Ankota provides software for adult day centers, including attendance, care plans, transportation and Medicaid billing. If you want to talk through how your state's rules apply to your center, contact Ankota.