Adult Day Care Regulations in South Carolina

Who regulates adult day care in South Carolina

The South Carolina Department of Public Health (DPH) licenses day care facilities for adults. Its Bureau of Healthcare Quality licenses health care facilities, enforces the state rules and investigates complaints and serious incidents.

The licensing law is S.C. Code Title 44, Chapter 7, and the facility standards are in Regulation 61-75, Standards for Licensing Day Care Facilities for Adults. The statute still names the Department of Health and Environmental Control (DHEC), but the state's 2026 Medicaid waiver requires providers to hold a current Adult Day Care license from DPH.

Types of adult day programs in South Carolina

State law defines a "daycare facility for adults" as a facility for adults 18 or older that offers a group program of individual and group activities and therapies, provides community-based care to people who need a supportive setting for less than 24 hours a day, and operates a minimum of four and a maximum of fourteen hours a day (section 44-7-130). There is no separate social or medical license category.

Medicaid uses the name Adult Day Health Care (ADHC) for the service it buys from licensed facilities. SCDHHS also pays for a separate Adult Day Health Care Nursing service.

How to get licensed in South Carolina

A day care facility for adults that cares for two or more unrelated persons needs a license (section 44-7-260). Under Regulation 61-75.100.102, you must have the license before you operate or advertise, and you may not enroll participants before its effective date.

1. Confirm that your program fits the statutory definition, including the four to fourteen hour daily operating window.
2. Submit the Adult Day Care Facility application from DPH's Applications for Licensure page, with owner and facility details, a signed oath, proof of ownership or a lease, verification of the administrator's qualifications and the number of participants.
3. Show substantial compliance with DPH licensing standards, which is required for an initial license.
4. To serve Medicaid participants, enroll as an Adult Day Health provider with the South Carolina Department of Health and Human Services (SCDHHS).

The license covers one facility at one location and states the maximum number of participants. You need an amended license before changing location, name or capacity, and a new license for a change in controlling interest, because licenses are not transferable. A facility that misses the renewal and late fees within 30 days after expiration becomes unlicensed.

Key requirements

• Staffing ratio: at least one direct care staff member or volunteer for every eight participants, with records that show compliance (Regulation 61-75.500.503).
• Administrator: a full-time administrator, plus a staff member designated in writing to act in the administrator's absence (Regulation 61-75.500.502).
• Physical exams: a physician or other authorized healthcare provider examines each participant within 60 days before enrollment and at least every two years (Regulation 61-75.1100).
• Medicaid ADHC: generally five or more hours per day on a regular schedule, in a setting integrated into the community that is not on the grounds of or next to a public institution (42 CFR 441.301(c)(4)).
• Participant rights and systems: Medicaid providers must tell participants their rights, including how to file a complaint, and must use the automated systems SCDHHS requires to document and bill.

Medicaid funding for adult day in South Carolina

SCDHHS covers ADHC in the Community Choices waiver (SC.0405), which serves people eligible for nursing home care who prefer to live in the community. SCDHHS's Community Long Term Care (CLTC) division runs it, and the renewal (SC.0405.R05.00) took effect July 1, 2026 (Community Choices waiver renewal). The state's HCBS fee schedule also lists ADHC under the Intellectual Disability and Related Disabilities (ID/RD) and Community Supports waivers.

ADHC provides health and social services in a licensed, non-institutional setting, including community outings. Since July 1, 2022, ADHC transportation is no longer a separate waiver service, and participants get rides through the non-emergency medical transportation (NEMT) broker. DPH and SCDHHS verify provider qualifications at enrollment, within the first year and then for a sample of providers every 18 months.

Billing basics

• The HCBS Waivers Fee Schedule (effective November 1, 2025) lists S5102 for Adult Day Health Care and S5105 for Adult Day Health Care Nursing, each billed per day.
• Further ADHC standards are in the ADHC Scope of Service in the SCDHHS HCBS Manual.
• We could not confirm the claim format or authorization steps from an official source.

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

• DPH Day Care Facilities for Adults
• DPH Applications for Licensure
• S.C. Code Title 44, Chapter 7
• Regulation 61-75 (Justia copy)
• SCDHHS Home and Community-Based Waivers
• SCDHHS HCBS Waivers Fee Schedule
• VA Adult Day Health Care

Frequently asked questions

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

Yes, if your day care facility for adults cares for two or more unrelated persons. You must hold a DPH license before you operate, advertise or enroll participants.

Does South Carolina Medicaid pay for adult day care?

Yes. SCDHHS covers Adult Day Health Care in the Community Choices waiver, and its fee schedule also lists the service under the ID/RD and Community Supports waivers.

Is social adult day care regulated in South Carolina?

Yes, if it meets the definition. The law covers any daycare facility for adults, with no separate social or medical category.

Who inspects adult day centers in South Carolina?

DPH's Bureau of Healthcare Quality licenses these facilities and investigates complaints. For Medicaid providers, DPH and SCDHHS also verify qualifications on a set schedule.