Adult Day Care Regulations in Delaware

Who regulates adult day care in Delaware

The Delaware Department of Health and Social Services (DHSS) Division of Health Care Quality (DHCQ) licenses adult day care facilities under 16 Del. Admin. Code 3360, Regulations for Adult Day Care Facilities (text as last amended February 1, 2022; check regulations.delaware.gov for later changes). DHCQ's online list showed 10 licensed adult day care centers in October 2026.

The DHSS Division of Medicaid and Medical Assistance (DMMA) runs Medicaid. It operates the Diamond State Health Plan Plus (DSHP-Plus) long-term care program with the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD).

Types of adult day programs in Delaware

Delaware has one license type. Regulation 3360 applies to any program that provides health, social and related support services to four or more functionally impaired adults who live in the community, for less than 12 hours a day, in a setting other than a participant's home or the operator's residence. There are no separate social and medical licenses.

A functionally impaired adult needs supervision because of a cognitive or physical impairment, or cannot independently perform one or more activities of daily living. All participants must be 18 or older. Programs meant exclusively or primarily to provide activities or training to people with developmental disabilities or mental illness are not covered.

How to get licensed in Delaware

1. Before you build, extensively remodel or convert a building, submit plans and specifications to the Department and get written approval. The site must also be approved in advance, and the Department inspects it before occupancy.
2. Request a licensure application from the Department. Submit ownership details, officers and anyone with a financial interest of 5% or more, disclosure of felony records, the name of the responsible director and your policy and procedure manuals.
3. Receive a provisional license, valid for less than one year, while your on-site survey is pending during the first 90 days of operation.
4. Once you are in substantial compliance, receive a one-year license. Apply to renew at least 30 days before it expires, using DHCQ's renewal application.

Each location needs its own license, and licenses cannot be transferred. The Department inspects licensed facilities at least once every three years.

Key requirements

• Minimum staff: at least two staff on duty whenever participants are present. Volunteers and staff who have not finished orientation do not count (§ 12.1).
• Ratios: above 16 participants, one staff person for every eight participants, with no rounding. Programs serving mainly people with severe cognitive or physical disabilities need 1:4 for those participants (§§ 12.2 and 12.3).
• Nursing: at least one RN or LPN on the premises whenever participants are present, if the facility serves participants who need nursing services. At least one CPR-certified employee must also be on site (§§ 12.4 and 12.5).
• Director: a bachelor's degree in health or social services or a related field plus one year of supervisory experience, comparable training with management experience, or a registered nurse with two years of supervisory experience (§ 13.11).
• Background checks: follow 19 Del.C. § 708 and 11 Del.C. § 8563 and run the adult abuse registry check. No one convicted of a crime against a person may be employed (§§ 13.1 and 13.2).
• Space: 100 square feet for each of the first five participants and 60 square feet for each one after that, not counting offices, bathrooms, storage, exam rooms or dining rooms not used for activities (§ 5.10.2).
• Program: planned activities for at least 65% of open hours, at least one meal a day for participants there four or more hours, a morning snack and quarterly fire drills (§§ 10.4.1, 9.5.3, 9.5.4 and 6.4).

Medicaid funding for adult day in Delaware

Delaware Medicaid covers adult day services through DSHP-Plus, which provides long-term care services and supports for residents who are elderly or physically disabled. DSHP-Plus is a mandatory managed care program that operates under a Section 1115 demonstration waiver.

Delaware contracts with three managed care plans: AmeriHealth Caritas, Delaware First Health and Highmark Health Options. Long-term care services are delivered through these plans, and each plan assigns case managers who develop members' plans of care, so centers serving DSHP-Plus members are paid through the plans.

Billing basics

Confirm procedure codes, authorization steps and claim rules with each DSHP-Plus plan you contract with. No official Delaware fee schedule or billing manual listing adult day codes was confirmed for this guide.

DMMA's electronic visit verification (EVV) FAQ (December 2025) covers personal care and home health services and does not mention adult day services.

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

• DHCQ Licensed Adult Day Care Centers
• 16 Del. Admin. Code 3360: Regulations for Adult Day Care Facilities
• DHCQ Applications and Forms
• Diamond State Health Plan Plus (DSHP-Plus)
• Diamond State Health Plan
• DSAAPD Community-Based Day Programs

Frequently asked questions

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

Yes, if you provide health, social and related support services to four or more functionally impaired adults for less than 12 hours a day. DHCQ issues the license under Regulation 3360, starting with a provisional license for new facilities.

Does Delaware Medicaid pay for adult day care?

Yes. Adult day services are a DSHP-Plus benefit for eligible residents who are elderly or physically disabled, delivered through Delaware's three Medicaid managed care plans.

Who inspects adult day centers in Delaware?

DHCQ. New facilities are surveyed during their first 90 days of operation, and licensed facilities are inspected at least once every three years.

Is social adult day care regulated in Delaware?

Yes. Regulation 3360 covers programs offering health, social and related support services to four or more functionally impaired adults, and Delaware does not have a separate social adult day license.