Adult Day Care Regulations in Michigan

Who regulates adult day care in Michigan

The official sources reviewed for this guide did not identify a Michigan license or certification specific to adult day centers. The standards a center must meet depend on how its participants are funded.

• The Michigan Department of Health and Human Services (MDHHS) Aging, Community Living, and Supports Bureau (ACLS Bureau) publishes Operating Standards for Service Programs (copy posted by AgeWays, an area agency on aging) for programs funded with state or federal funds through contracts with area agencies on aging. Its Adult Day Services standard (C-1, Transmittal Letter 2025-505) was updated in October 2024 (also an AgeWays copy).
• MDHHS operates the MI Choice Waiver, and the MI Choice chapter of the Michigan Medicaid Provider Manual (version dated January 1, 2023, read from a copy posted by AgeWays) sets standards for Adult Day Health providers. Check the current quarterly manual on the MDHHS site.

For context, the state's adult foster care license covers "foster care," which MCL 400.704(8) defines as supervision, personal care and protection plus room and board for 24 hours a day, 5 or more days a week, for 2 or more consecutive weeks.

Types of adult day programs in Michigan

Adult Day Services is the ACLS term for programs funded through area agencies on aging: daytime care for any part of a day, but less than 24 hours, for adults with functional or cognitive impairment.

Adult Day Health is the MI Choice service. It is furnished four or more hours per day on a regularly scheduled basis, one or more days per week or as specified in the participant's person-centered service plan (PCSP), in a community-based setting that combines health and social services. MI Coordinated Health also covers an Adult Day Program.

Opening an adult day center in Michigan

The sources reviewed describe these routes for centers that want public funding:

1. Contract with your area agency on aging under its area plan and meet the ACLS Adult Day Services standard.
2. Join a MI Choice waiver agency's provider network. Waiver agencies operate as prepaid ambulatory health plans, and participants may choose any willing and qualified provider in the network.
3. Document compliance with Michigan and local barrier-free design and building codes, fire safety standards and public health codes (MI Choice), and with fire safety standards and the Michigan Food Code (ACLS).

Before opening, confirm with MDHHS and local building, fire and health officials whether any license applies to your model.

Key requirements

The ACLS Adult Day Services standard requires:

• At least two staff present whenever two or more participants attend, and support staff of at least one person for every five participants. Volunteers trained to the same level as paid staff count toward the minimums.
• A program director or manager with at least a bachelor's degree or applicable knowledge and experience.
• A medication policy approved by a registered nurse, physician or pharmacist, with licensed nurses overseeing medication administration.
• A face-to-face assessment before or at admission, a service plan, and reassessment every six months.
• One hot meal per eight-hour day providing one-third of recommended daily allowances.

The MI Choice Adult Day Health standard (January 2023 manual) requires:

• A full-time program director with at least a bachelor's degree in a health or human services field.
• At least one staff person for every 10 participants, and a staff member knowledgeable in first aid, including CPR, on site whenever participants are present.
• Transportation, personal care, nutrition and recreation, provided directly or arranged.
• Emergency practice drills every six months and compliance with the federal Home and Community Based Settings Final Rule.

Medicaid funding for adult day in Michigan

The main Medicaid route is the MI Choice Waiver, approved by CMS under sections 1915(b) and 1915(c). It serves older adults and people with physical disabilities who meet Michigan's nursing facility level of care criteria. MDHHS contracts with waiver agencies, and Adult Day Health centers serve participants as part of a waiver agency's provider network.

MI Coordinated Health replaced MI Health Link on January 1, 2026, according to Adult Services Manual item 126. It enrolls people 21 and older with full Medicare and Medicaid in four regions through Highly Integrated Dual Eligible Special Needs Plans (HIDE SNPs). Its waiver services, including the Adult Day Program, are for enrollees who meet nursing facility level of care.

The Program of All-Inclusive Care for the Elderly (PACE) is a separate managed care program for people 55 and older. PACE and MI Choice enrollees must leave those programs to join MI Coordinated Health.

Billing basics

The MI Choice chapter of the Medicaid Provider Manual (January 2023 version) limits HCPCS codes S5101 and S5102 to one unit per day for Adult Day Health. Services must be in the PCSP before they are authorized, and participants cannot receive Community Living Supports at the center at the same time. If a center does not include transportation, MI Choice pays for it separately. The sources reviewed did not confirm how centers submit claims to waiver agencies or HIDE SNPs.

For area agency on aging contracts, the ACLS unit of service is one hour, changed from 15 minutes in October 2024.

MDHHS bulletin MMP 26-10, effective April 1, 2026, requires electronic visit verification (EVV) for personal care and home health care services, including in MI Choice. It does not mention 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

• MDHHS ACLS Bureau
• MI Choice Waiver Program
• MI Coordinated Health Program (ASM 126)

Frequently asked questions

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

The official sources reviewed did not identify a Michigan license specific to adult day centers. Area agency on aging programs must meet the ACLS standards, and MI Choice providers must meet the Adult Day Health standards. Confirm with MDHHS and local officials before opening.

Does Michigan Medicaid pay for adult day care?

Yes. The MI Choice Waiver covers Adult Day Health, and MI Coordinated Health covers an Adult Day Program for eligible enrollees.

What staffing ratio applies to adult day in Michigan?

The ACLS standard requires at least one support staff person for every five participants. The MI Choice standard (January 2023 manual) requires at least one staff person for every 10 participants.