Adult day care regulations by state

Adult Day Care Regulations in California

In California, CDPH licenses Adult Day Health Care centers, CDSS licenses nonmedical Adult Day Programs, and the California Department of Aging certifies ADHC centers for Medi-Cal as CBAS providers. Medi-Cal pays for CBAS mainly through managed care plans under the CalAIM 1115 demonstration, which DHCS proposes moving to 1915(i) state plan authority.

Last reviewed

October 17, 2026

Who regulates adult day care in California

The California Department of Public Health (CDPH) Licensing and Certification Division licenses Adult Day Health Care (ADHC) centers. The California Department of Social Services (CDSS) Community Care Licensing Division licenses nonmedical Adult Day Programs through its Adult and Senior Care Program.

For Medi-Cal, the California Department of Aging (CDA) certifies licensed ADHC centers as Community-Based Adult Services (CBAS) providers. CBAS is administered under an interagency agreement among the Department of Health Care Services (DHCS), CDPH and CDA.

Types of adult day programs in California

  • Adult Day Health Care (ADHC) center: a licensed facility that provides adult day health care. CDPH licenses these centers under the California Adult Day Health Care Act (Health and Safety Code sections 1570 through 1596.5).
  • Community-Based Adult Services (CBAS): the Medi-Cal benefit delivered at licensed ADHC centers that CDA has certified, including nursing, therapies, social services, personal care, a meal and transportation.
  • Adult Day Program (ADP): a community-based facility or program that provides care to people 18 or older who need personal services, supervision or help with activities of daily living, on less than a 24-hour basis (Health and Safety Code section 1502(a)(2)).

Social adult day is regulated in California. An ADP needs a CDSS license unless it qualifies for an exemption in 22 CCR section 82007, such as health facilities and clinics.

How to get licensed in California

Adult Day Health Care centers

Send the initial application packet to CDPH's Centralized Applications Branch, not to a district office. The CDPH provider checklist includes ownership and property documents, a floor plan, criminal record clearances, transfer agreements with a hospital, physician and ambulance service, financial statements and fire safety forms.

CBAS certification for Medi-Cal

  1. Complete CDA's online pre-screening: an acceptable program plan, two online training modules and contact with local Medi-Cal managed care plans about the need for your center.
  2. Submit the Initial Certification Application within one year of pre-screening approval.
  3. CDA finalizes certification only after you hold the ADHC license. Approval may take 18 to 24 months, and CDA is accepting applications in all counties.

Adult Day Programs

Complete the CDSS Adult Care online orientation, then send the application (LIC 281) and the Adult Day Program infection control plan (LIC 9283) to the Centralized Applications Bureau. Named applicants need criminal record clearances, and CDSS orders a fire clearance and conducts a pre-licensing inspection. CDSS expects the process to take 90 to 120 days.

Key requirements

ADHC centers follow Title 22, Division 5, Chapter 10. Medi-Cal program standards are in Title 22, Division 3, Chapter 5.

  • An initial ADHC license expires one year after issue, and the licensing department inspects each center at least annually (sections 78229 and 78215).
  • Each center needs a full-time program director on site who is a professional in nursing, social work, psychology, recreation, occupational, physical or speech therapy, dietetics or gerontology (section 78417).
  • Medi-Cal standards require the program director, a registered nurse with public health background, a medical social worker, a program aide and the activity coordinator on duty, with therapy and dietitian hours that scale with attendance (section 54423).
  • A day of attendance requires at least four hours of covered services at the center, not counting transportation time (section 54113).

Adult Day Programs follow Title 22, Division 6, Chapter 3. Programs need at least one direct care staff member for every eight clients present, and one for every four clients who rely on others for all activities of daily living (section 82065.5). Administrators must be at least 21 and meet education and experience standards (section 82064).

Medicaid funding for adult day in California

Medi-Cal pays for CBAS under the CalAIM Section 1115 demonstration, effective through December 31, 2026. CBAS is a Medi-Cal managed care benefit, and the member's plan determines eligibility. Members exempt from managed care can receive CBAS through fee-for-service Medi-Cal.

Participants must be 18 or older, eligible for Medi-Cal and meet at least one medical criterion, such as Nursing Facility Level of Care A. In its renewal request submitted May 11, 2026, DHCS proposes moving CBAS to 1915(i) state plan authority. DHCS's public notice does not give an effective date.

The Multipurpose Senior Services Program (MSSP), a 1915(c) waiver, also lists adult day care among the services it can purchase for its participants.

Billing basics

For managed care members, centers bill the Medi-Cal plans they contract with, so CDA encourages applicants to confirm that local plans are contracting with new CBAS providers.

A DHCS EVV codes document (updated March 2024) says CBAS Emergency Remote Services codes S5136 and Q5001, with modifier CR (public emergency) or SC (personal emergency), are billed with HCPCS S5102 and revenue code 3103 (adult day care, medical and social, daily).

EVV does not apply to center-based CBAS. CDA's CalEVV page says EVV applies only to provider types and codes on the DHCS list, and the only CBAS entry is Emergency Remote Services delivered in the home.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

Frequently asked questions

Do I need a license to open an adult day center in California?

Yes, in most cases. A medical-model center needs an Adult Day Health Care license from CDPH. A nonmedical Adult Day Program needs a CDSS license unless an exemption in 22 CCR section 82007 applies.

Does California Medi-Cal pay for adult day care?

Yes, through Community-Based Adult Services at licensed ADHC centers that CDA has certified. Centers mostly bill Medi-Cal managed care plans.

Who inspects adult day centers in California?

CDPH inspects each licensed ADHC center at least annually. CDSS inspects Adult Day Programs, and CDA handles CBAS certification.

Is social adult day care regulated in California?

Yes. Nonmedical programs are licensed by CDSS as Adult Day Programs under Title 22, Division 6, Chapter 3.

Sources

This guide summarizes publicly available rules and program information as of the review date shown above. It is not legal advice. Rules, program names and billing requirements change, so confirm current requirements with the state agencies linked on this page before you apply, enroll or bill.

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