Adult Day Care Regulations in North Carolina

Who regulates adult day care in North Carolina

North Carolina certifies adult day programs rather than licensing them. The NCDHHS Division of Aging (called the Division of Aging and Adult Services in the rules) is the certifying agency, and county departments of social services share responsibility for certification and monitoring. Under G.S. 131D-6, the department must inspect and certify adult day care programs every year.

The standards are in 10A NCAC 06R for adult day care and 10A NCAC 06S for adult day health. NC Medicaid runs the waiver that pays for adult day health.

Types of adult day programs in North Carolina

• Adult day care: a supervised daytime group program for adults with cognitive or physical impairments.
• Adult day health: adds health services for people who need health monitoring, medication administration, special feeding or other treatment. Certification under 10A NCAC 06S is required for Medicaid payment.
• Combination programs: offer both, with their own staffing and space standards.
• Special care services: programs that advertise special care for dementia, mental health disabilities or other special needs must give written disclosures to DHHS and prospective participants.

A center operates in a building other than a single family dwelling. An adult day care home serves up to 16 people in a single family dwelling where the owner lives.

How to get certified in North Carolina

The Division states that certification is required regardless of funding. State law exempts only narrow cases, such as programs serving three or fewer people. These steps come from 10A NCAC 06R .0601 and the Division's information request packet (September 2019).

1. Contact the county department of social services where the program will be located. The county provides technical assistance and studies your program.
2. Prepare the package: policies, an organizational diagram, job descriptions, a 12-month budget, a floor plan, and fire, building and sanitation approvals dated within 30 days.
3. Add ownership documents, staff medical statements, first aid and CPR proof, and five-year statewide criminal history searches for the owner and direct-care staff.
4. The county submits the package to the Division, which may make a pre-certification visit and must give its decision in writing within 14 business days.

The certificate must be posted and lasts 12 months unless revoked, terminated or made provisional. The county submits renewal materials before it expires.

Key requirements

• Staffing: adult day care centers need one full-time equivalent direct-care staff person per eight participants (10A NCAC 06R .0305). Adult day health needs one per five, and combination programs one per six.
• Program director: at least 18, with two years of post-secondary education or a high school diploma plus five years of related experience, and two years of supervisory experience. The director or a qualified substitute must be on site during operating hours.
• Nursing: adult day health needs an RN or LPN health care coordinator, licensed in North Carolina, on site at least four hours a day. An LPN must be supervised by an RN (10A NCAC 06S .0204).
• Space: 40 square feet of indoor program space per participant for adult day care, excluding hallways, offices and restrooms (10A NCAC 06R .0401). Adult day health requires 60 and combination programs 50.
• Restrooms: one toilet per 12 adults, counting staff, and one hand lavatory per two toilets.
• Hours: at least six hours a day and five days a week, with closures allowed for holidays, weather, emergencies and vacations (10A NCAC 06R .0506).

Medicaid funding for adult day in North Carolina

NC Medicaid pays for adult day health through the Community Alternatives Program for Disabled Adults (CAP/DA), a 1915(c) waiver renewed effective November 1, 2024. CAP/DA serves adults 18 and older who meet an institutional level of care, are enrolled in fee-for-service Medicaid (Medicaid Direct) and hold a waiver slot.

Clinical Coverage Policy 3K-2, amended September 1, 2025, covers attendance at a certified adult day health facility for participants who need a structured day program with nursing supervision. Service must be provided at least four hours a day on a regular schedule.

Billing basics

CAP/DA is fee-for-service, and the 3K-2 policy refers to claims adjudicated by NCTracks. Providers need NC Medicaid enrollment, a signed DHHS Provider Administrative Participation Agreement, approval for the CAP taxonomies and annual CAP/DA orientation training.

The case management entity authorizes providers based on the approved service plan. NC Medicaid's archived CAP/DA fee schedule (July 2022) lists adult day health as code S5102, per diem. Confirm codes against the current fee schedule.

The 3K-2 policy ties electronic visit verification (EVV) to in-home aide, personal assistance and respite services. It does not list adult day health.

Other ways centers are paid

The Division publishes Home and Community Care Block Grant service standards for adult day care and adult day health, which require compliance with the certification standards. Its information packet stresses that private-pay participants are essential.

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

• NCDHHS Division of Aging: Adult Day Services
• G.S. 131D-6
• 10A NCAC 06R: Adult Day Care Standards for Certification
• 10A NCAC 06S: Adult Day Health Standards
• Adult Day Care Information Request Packet
• NC Medicaid CAP/DA
• Clinical Coverage Policy 3K-2
• NC Medicaid CAP Fee Schedules

Frequently asked questions

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

North Carolina certifies adult day programs instead of licensing them. Certification by NCDHHS is required, with narrow exemptions such as programs serving three or fewer people. The process starts with your county department of social services.

Does North Carolina Medicaid pay for adult day care?

Yes, for adult day health. NC Medicaid covers it at certified facilities for CAP/DA waiver participants, who must be enrolled in Medicaid Direct and meet an institutional level of care.

Who inspects adult day centers in North Carolina?

County departments of social services study and monitor programs. The Division of Aging reviews certification packages, may make pre-certification visits and issues certificates that run for 12 months.

Is social adult day care regulated in North Carolina?

Yes. Social adult day care must meet 10A NCAC 06R, including a one to eight staff ratio in centers and 40 square feet per participant. Adult day health programs meet added standards in 10A NCAC 06S.