Adult Day Care Regulations in Illinois

Who regulates adult day care in Illinois

In Illinois, adult day service (ADS) standards come mainly from the Illinois Department on Aging (IDoA) Community Care Program (CCP). The CCP rules in 89 Ill. Adm. Code 240, adopted under the Illinois Act on the Aging, set certification, staffing, facility and service requirements for CCP adult day providers.

The Illinois Department of Healthcare and Family Services (HFS) is the state Medicaid agency and oversees the Persons who are Elderly waiver, which IDoA operates day to day. The Department of Human Services, Division of Rehabilitation Services (DHS-DRS) operates the Persons with Disabilities waiver, which also covers adult day care.

Types of adult day programs in Illinois

Under Section 240.230, ADS provides direct care and supervision of adults 60 and older in a community-based setting. Required components include a person-centered ADS Addendum to the plan of care (established by the fourth week of service and reassessed at least annually), purposeful activities and rest, help with daily living activities, health-related services including medication support, a daily meal and snacks, transportation, emergency care and reporting of critical events within seven days.

Therapies, skilled nursing, shopping assistance and escorts are ancillary services. They are not included in the unit rate, and the Department does not pay for them.

How to get certified in Illinois

Section 240.1505 sets the requirements for CCP provider certification. An adult day applicant must:

1. Submit a certification request on the Department's form, with documentation of legal structure, ownership, directors and officers.
2. Show at least two years of direct social services programming experience (the Department may grant provisional certification for up to two years).
3. Disclose past enforcement actions, sanctions, decertifications and abuse or neglect citations.
4. Document written policies, proof of required insurance, audited financial reports (or start-up documentation for new entities) and assets covering 90 days of operating expenses.
5. Provide at least five independent references and agree to meet service, staffing and training requirements.

Key requirements

• Staffing ratio: two staff for 1 to 12 participants, three for 13 to 20, four for 21 to 28, five for 29 to 35, six for 36 to 45, plus one for each additional seven participants (Section 240.1555).
• Nurse: an RN or LPN on duty at least half of a full-time work period each day participants attend, as staff or under contract. An LPN must be supervised by an RN who meets with the LPN at least monthly (Section 240.1560).
• Leadership: a Program Coordinator or Director on duty full time when participants are present, or a qualified substitute.
• Training: 26 hours of pre-service training in the first week, including two hours of dementia training, and 14 hours of in-service training each year. At least two staff must be CPR and first aid trained, with one on site whenever participants are present.
• Space and facility: at least 40 square feet of activity area per participant, one accessible bathroom for up to 12 participants and two bathrooms for 13 or more, a quiet rest area, quarterly fire drills and compliance with state fire, plumbing, accessibility, food sanitation and Life Safety Code rules (Section 240.1550).
• Setting: the site must be an integrated home and community-based setting that protects privacy, dignity, autonomy and choice.
• Meals: a midday meal providing at least one-third of daily nutrition needs, with menus approved by a registered dietitian.

These sections were most recently amended effective July 16, 2024.

Medicaid funding for adult day in Illinois

• Persons who are Elderly waiver. This 1915(c) waiver (IL.0143) serves people 60 and older who are at risk of nursing facility placement, based on the Determination of Need assessment. It covers adult day service and is part of CCP. It operates concurrently with a 1915(b) managed long-term services and supports waiver and the HealthChoice Illinois managed care program.
• Persons with Disabilities waiver. Operated by DHS-DRS for people under 60 at application, it covers adult day care.

CCP costs for participants enrolled in Medicaid are claimed under a Title XIX waiver, and costs for other eligible participants are paid from state appropriations. Participants who get waiver services through a Medicaid managed care organization work with that plan's care coordinator.

Billing basics

Under Section 240.230, one ADS unit is one direct participant contact hour (60 consecutive minutes of active programming), not counting transportation. Transportation is billed per one-way trip, with no more than two units per participant in 24 hours, and trips to doctors or shopping are excluded. IDoA publishes current CCP rates on its Community Care Program pages.

Illinois requires electronic visit verification (EVV) through HHAeXchange for personal care and home health services, including personal care under the Elderly waiver. HFS's EVV page does not list adult day.

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

• Illinois Department on Aging: Community Care Program
• Illinois Department on Aging: Adult Day Service
• 89 Ill. Adm. Code 240: Community Care Program
• HFS: Persons who are Elderly Waiver
• HFS: Persons with Disabilities Waiver
• HFS: Illinois Electronic Visit Verification

Frequently asked questions

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

The Illinois rules in this guide cover certification of Community Care Program providers by the Department on Aging. To serve CCP participants, you must meet the certification, staffing and facility standards in 89 Ill. Adm. Code 240. If you plan to serve only private-pay participants, confirm with IDoA and local building, fire and health officials which requirements apply.

Does Illinois Medicaid pay for adult day care?

Yes. The Persons who are Elderly waiver covers adult day service through CCP, and the Persons with Disabilities waiver covers adult day care for people under 60.

What staffing ratio applies to adult day in Illinois?

CCP adult day sites need two staff for up to 12 participants, rising in steps to six staff for 36 to 45 participants and one more for each additional seven.

Is electronic visit verification required for adult day in Illinois?

HFS's EVV page lists personal care and home health services and does not mention adult day. Check with HFS or your managed care plan before assuming any exemption.