Adult Day Care Regulations in Minnesota

Who regulates adult day care in Minnesota

The Minnesota Department of Human Services (DHS) Licensing Division licenses adult day care centers under Minnesota Statutes, chapter 245A and Minnesota Rules, parts 9555.9600 to 9555.9730. For Medicaid, lead agencies (counties, Tribal Nations and managed care organizations) authorize services, and centers must enroll with Minnesota Health Care Programs (MHCP) to bill.

Types of adult day programs in Minnesota

State law defines adult day care as a program running less than 24 hours a day that gives functionally impaired adults coordinated health, social and nutritional services (Minn. Stat. 245A.02, subd. 2a).

• Adult day care center: a center-based program licensed under the 9555 rules (also called an adult day services center).
• Family adult day services (FADS): a program in the license holder's primary residence serving no more than eight adults at a time (Minn. Stat. 245A.143).
• Remote adult day services: services a licensed center delivers through live two-way communication, with DHS Licensing approval (Minn. Stat. 245A.70).
• Health facility units: a nursing home, hospital or boarding care home needs an adult day license if it regularly serves six or more functionally impaired adults who are not its residents or patients (Minn. R. 9555.9610).

How to get licensed in Minnesota

A licensing moratorium is in effect. DHS stopped accepting new adult day care license applications on February 1, 2026 and canceled pending ones. The pause is expected to last until January 31, 2028 (DHS bulletin, December 2025).

Until then, new licenses require an exception (DHS exception FAQs):

1. A county, managed care organization or Tribal Nation identifies a person with a service need, or a local capacity gap, and a provider able to meet it.
2. That agency's moratorium liaison submits the request. DHS expects a decision within 60 days, and it cannot be appealed.
3. If DHS finds a need, you submit a full license application meeting chapter 245A and the 9555 rules, including background studies. DHS expects review within 45 days, depending on your responsiveness.
4. To bill Medicaid programs, enroll with MHCP as a home and community-based services (HCBS) provider, including Provider Training 101 for the owner or managing employee.

Existing centers can request capacity changes without a needs determination.

Key requirements

• Staff ratios: one staff member per eight participants who can take action for self-preservation in an emergency, and one per five who cannot, with a formula for mixed groups (Minn. R. 9555.9690).
• Coverage and training: someone trained in first aid and certified in CPR must be present in the center, in center vehicles and on outings. Staff get 20 hours of orientation within their first 40 hours of work and at least eight hours of in-service training a year.
• Director: must meet education and experience minimums in Minn. R. 9555.9680.
• Health and exercise: a registered nurse helps develop health services and reviews them at least monthly. A registered physical therapist helps develop a daily exercise program and reviews it at least quarterly (Minn. R. 9555.9710).
• Meals and trips: participants present more than four and a half hours get a meal from menus a registered dietitian approves. One-way trips on center vehicles may not exceed 90 minutes.
• Space: at least 40 square feet of usable indoor space per participant and staff member present, excluding hallways, offices, restrooms and storage (Minn. R. 9555.9730).

Medicaid funding for adult day in Minnesota

The DHS Community-Based Services Manual lists adult day services under:

• Elderly Waiver (EW): a 1915(c) waiver for people 65 and older who need nursing home level of care. Members may be in Minnesota Senior Care Plus (MSC+) or Minnesota Senior Health Options (MSHO), where the health plan manages waiver services.
• CADI, BI and DD waivers: 1915(c) disability waivers.
• Alternative Care (AC): for people 65 and older who need nursing facility level of care but are not yet eligible for Medical Assistance. It runs under a federally approved 1115 demonstration plus a state appropriation.

Under AC and EW, DHS's Community-Based Services Manual requires at least two hours of services a day, one or more days a week, on a regular schedule. EW allows up to 48 units (12 hours) a day (Minn. Stat. 256S.12).

Billing basics

For fee-for-service members, the case manager enters a service authorization (SA) in MMIS. Centers bill on the 837P professional claim through MN-ITS or X12 batch software and enter the SA number (MHCP billing for waiver and AC).

• Code: DHS identifies S5100 as the adult day HCPCS code. Remote services use S5100 with modifier U4 for dates on or after July 1, 2023.
• Units: AC, ECS and EW use a state-established 15-minute rate. BI, CADI and DD may use a daily or 15-minute rate.
• Records: keep attendance records with pickup and drop-off times. DHS recovers payments for any date a center exceeds licensed capacity.
• Managed care: for MSC+ and MSHO members, follow the health plan's authorization and billing instructions.

The DHS electronic visit verification (EVV) page covers personal care and home health care 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

• DHS Licensing: Adult day care
• Adult Day Care Moratorium Exceptions FAQs
• Minnesota Rules, chapter 9555
• Adult Day Care Self-Monitoring Checklist
• CBSM: Adult day services
• MHCP: Elderly Waiver and Alternative Care
• National Adult Day Services Association

Frequently asked questions

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

Yes. A center that regularly serves functionally impaired adults must hold a DHS license under chapter 245A and the 9555 rules.

Can I apply for a new adult day license in Minnesota right now?

Only through an exception requested by a county, managed care organization or Tribal Nation, until the moratorium's anticipated end on January 31, 2028.

Does Minnesota Medicaid pay for adult day care?

Yes. The Elderly Waiver and the CADI, BI and DD waivers cover adult day services, and Alternative Care covers older adults not yet on Medical Assistance.

Is social adult day care regulated in Minnesota?

The licensing definition excludes programs where adults gather mainly for socialization, education, supervision, caregiver respite, religious expression, exercise or meals.