Adult day care regulations by state

Adult Day Care Regulations in Maryland

Maryland's Office of Health Care Quality licenses adult medical day care centers under COMAR 10.12.04, while social model programs fall outside that rule. Medicaid pays centers a per diem for medical day care when participants are enrolled in a home and community-based services waiver and need nursing facility care.

Last reviewed

October 17, 2026

Who regulates adult day care in Maryland

The Maryland Department of Health's Office of Health Care Quality (OHCQ) licenses adult medical day care centers under COMAR 10.12.04, Day Care for the Elderly and Adults with a Medical Disability. OHCQ reviews applications, surveys centers and investigates complaints.

Maryland Medicaid, also part of the Department of Health, pays for medical day care under its Medical Day Care Services program. OHCQ refers centers that use only a social, non-medical model to the Maryland Department of Aging and its Senior Center Plus Program.

Types of adult day programs in Maryland

Maryland licenses adult medical day care centers. Participants are health-impaired adults whose illness or disability does not require 24-hour inpatient care, but whose needs cannot be met in an episodic outpatient setting and require at least one day of care per week (COMAR 10.12.04.02).

COMAR 10.12.04 does not apply to nutrition sites, senior centers under the Department of Aging, or social model programs that people attend for meals or diversion activities (COMAR 10.12.04.01).

How to get licensed in Maryland

  1. Submit a Letter of Interest through OHCQ's online form. Include policies and procedures (medical records, medications, nutrition, social work, background checks, transportation and activities), ownership information, job descriptions, projected hours and census, a staffing plan, and proof that structural plans went to the Department's Plans Review and Approval Unit.
  2. Wait for OHCQ to approve the Letter of Interest. It will not accept a license application before then.
  3. Complete the Application for an Adult Medical Day Care License (current form dated March 2026).
  4. A Department representative interviews you and inspects the proposed center. The license is issued once the application is complete and the center complies with the rules (COMAR 10.12.04.04).

A license lasts two years and cannot be transferred to another location or owner. Each separate premises needs its own license.

Key requirements

  • Director: a bachelor's degree, preferably in a health and human services field, or a registered nurse. Centers licensed for 35 or more participants need a full-time director (COMAR 10.12.04.14).
  • Nursing: a registered nurse with at least three years of health care experience must be on site or readily available by phone. An LPN works in a team with the RN on site, and a certified nursing assistant must be on site whenever no RN or LPN is.
  • Staffing levels: the rule set a 1:7 staff-to-participant minimum for two years after adoption. After that, staffing follows each participant's needs as determined in the ADCAPS assessment and must always be sufficient.
  • Training: two hours on cognitive impairment and mental illness within 90 days for staff who give individual care, plus at least eight in-service sessions a year.
  • Services: nursing under RN direction, health observation documented at least monthly, meals and snacks, an emergency plan, a daily activities program and help with daily living activities (COMAR 10.12.04.15).
  • Space: 100 square feet of activity space per participant for the first five participants, then 60 square feet for each additional participant, plus a rest area with visual privacy (COMAR 10.12.04.28).
  • Inspections: centers must be open at all reasonable times to announced or unannounced inspections (COMAR 10.12.04.07).

Medicaid funding for adult day in Maryland

Maryland Medicaid's medical day care rules are in COMAR 10.09.07. Medicaid pays only when the participant is enrolled in a home and community-based services waiver and medical day care is in the participant's waiver service plan (COMAR 10.09.07.07). The Department's quality assurance manual notes that CMS approved the Adult Medical Day Care Services Waiver effective July 1, 2008. Confirm the current Medical Day Care Services Waiver approval period with Maryland Medicaid.

Participants must be certified each year as needing nursing facility care and be present at least four hours for a day of care (COMAR 10.09.07.05). Medicaid does not cover people under 16, more than one day of care per person per day, attendance above licensed capacity, or a day of care on a day when the Department is billed for services such as day habilitation, PACE or Senior Center Plus (COMAR 10.09.07.06).

To take part, a center must hold its license, be open at least six hours a day, five days a week, and show the Medicaid program that a need exists for medical day care in its service area (COMAR 10.09.07.03). Medicaid providers also need a licensed social worker, a medical director and, if the center director is not an RN, an RN health director (COMAR 10.09.07.04).

Billing basics

Medicaid pays a per diem rate for each day a participant attends, limited to the days authorized in the waiver service plan. Requests for payment follow the general Medicaid billing rules in COMAR 10.09.36 (COMAR 10.09.07.08).

The Department's quality assurance manual says medical day care providers must use the LTSSMaryland platform, and the plan of care must be completed within 30 days of admission. Check Medicaid's provider transmittals, which can be filtered to medical day care, for current procedure codes and billing instructions. Electronic visit verification (EVV) is not mentioned in COMAR 10.09.07 or the manual.

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

Frequently asked questions

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

Yes, to run an adult medical day care center. COMAR 10.12.04.03 says no one may establish or operate a center without a license, and OHCQ handles licensing. Each separate premises needs its own license.

Does Maryland Medicaid pay for adult day care?

Yes, for participants enrolled in a home and community-based services waiver whose service plan includes medical day care. Medicaid pays a per diem for each day attended.

Who inspects adult day centers in Maryland?

OHCQ conducts prelicensure, licensure, biannual, change of ownership and follow-up surveys and investigates complaints. Inspections can be announced or unannounced.

Is social adult day care regulated in Maryland?

OHCQ does not license social model programs that people attend for meals or diversion activities. It refers centers that use only a social, non-medical model to the Maryland Department of Aging's Senior Center Plus Program.

Sources

This guide summarizes publicly available rules and program information as of the review date shown above. It is not legal advice. Rules, program names and billing requirements change, so confirm current requirements with the state agencies linked on this page before you apply, enroll or bill.

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