Adult Day Care Regulations in Texas

Who regulates adult day care in Texas

Texas licenses adult day centers as Day Activity and Health Services (DAHS) facilities. The Texas Health and Human Services Commission (HHSC) issues licenses, inspects facilities and investigates complaints. HHSC notes that DAHS facilities were previously called adult day care centers.

The license requirement is in Texas Human Resources Code Chapter 103, and the standards are in 26 Texas Administrative Code (TAC) Chapter 559. To serve Medicaid or Title XX clients, a facility also needs a contract with HHSC or with STAR+PLUS managed care organizations (MCOs).

Types of adult day programs in Texas

• DAHS facility: A facility that provides DAHS program services on a daily or regular basis, but not overnight, to four or more elderly people or people with disabilities who are not related to the owner. The program provides health, social and related support services through an individual plan of care.
• Individualized Skills and Socialization (ISS): An entity that wants to offer ISS must apply for a DAHS license. ISS rules are in Subchapter H of 26 TAC Chapter 559, amended effective February 9, 2026.

The sources reviewed do not say whether a purely social program with no health services needs a DAHS license, so confirm with HHSC before opening one.

How to get licensed in Texas

1. Apply online through TULIP, HHSC's licensing portal, 45 days before the building is expected to meet Life Safety Code and architectural requirements.
2. Pass a background check for all responsible individuals and corporations, and pay the licensure fee.
3. Pass a Life Safety Code inspection and a health survey. Once HHSC finds the building meets requirements, you may admit one to three people, and HHSC then makes an unannounced inspection to decide whether you meet all license requirements.
4. To serve Medicaid or Title XX clients, get licensed first, then apply for an HHS contract or STAR+PLUS MCO contracts.

A license is valid for three years under 26 TAC 559.11. Operating without one is a Class A misdemeanor under Human Resources Code 103.0041.

Key requirements

• Staffing ratio: At least one direct service staff member for every eight clients, except during facility-provided transportation (26 TAC 559.61).
• Nursing: At least one RN or LVN works at the facility at least eight hours per day, with enough nurses to meet clients' needs at all times (26 TAC 559.61).
• Leadership: You must employ a director, a nurse and an activities director who meet the qualifications in 26 TAC 559.59. The director and activities director each routinely work at least 40 hours a week.
• Inspections: Visits are generally unannounced. The rule requires an inspection at least every two years after the initial one, while HHSC's licensing page says it inspects yearly (26 TAC 559.81).
• Contracted facilities: Title XIX and Title XX contractors must provide or arrange transportation, serve a hot noon meal between 11:00 a.m. and 1:00 p.m., and offer mid-morning and mid-afternoon snacks (26 TAC 211.206).

Chapter 559, including the staffing and inspection rules, was amended effective July 10, 2024. The DAHS contract rules moved to 26 TAC Chapter 211 effective July 31, 2024.

Medicaid funding for adult day in Texas

DAHS is a Medicaid state plan service. STAR+PLUS, the Medicaid managed care program for adults who have disabilities or are 65 or older, offers DAHS to members who need it.

The STAR+PLUS Handbook says a facility must hold a current license and an MCO contract, and the MCO credentials and monitors it. The MCO authorizes DAHS based on a physician's assessment and a functional assessment, with reauthorization at least every 12 months. Failing to obtain authorization may result in nonpayment or recoupment.

For STAR+PLUS members, DAHS is limited to 10 hours per day and 230 hours per month unless the MCO authorizes more. HHSC also contracts directly with licensed facilities for Title XIX (Medicaid) and Title XX DAHS.

Billing basics

For HHSC-contracted DAHS, 26 TAC 211.211 counts three hours but less than six hours of service as one unit and six or more hours as two units. A contracted facility is not entitled to payment if it did not maintain the staff-to-client ratio, exceeded licensed capacity, or submitted monthly claims that do not match its authorizations or attendance records.

HHSC documents list HCPCS code S5101 for STAR+PLUS DAHS, with the same unit definitions. MCOs and providers must use the current LTSS Codes and Modifiers billing matrix for services on or after September 1, 2025.

For HHSC-contracted DAHS, HHSC's DAHS Provider Manual (last revised in 2014) says facilities submit units from the Daily Attendance Record (Form 3683) through the Texas Medicaid & Healthcare Partnership (TMHP); confirm the current claim process with HHSC or TMHP. HHSC's EVV page covers personal care and home health care services, and no source reviewed applies EVV to DAHS.

Other ways centers are paid

Title XX (Social Services Block Grant) DAHS serves people who are not on Medicaid but are categorically eligible or within HHSC's income and resource limits. Only providers with Title XX contracts may accept them, and each HHSC region decides based on available funding.

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

• HHSC: DAHS Licensing
• HHSC: DAHS Providers
• HHSC: Individualized Skills and Socialization
• Human Resources Code Chapter 103
• 26 TAC Chapter 559
• 26 TAC Chapter 211
• STAR+PLUS Handbook: State Plan LTSS
• DAHS Provider Manual
• VA Adult Day Health Care

Frequently asked questions

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

Yes, if you provide day activity and health services to four or more unrelated elderly people or people with disabilities. You apply to HHSC online through TULIP.

Does Texas Medicaid pay for adult day care?

Yes. DAHS is a Medicaid state plan service. STAR+PLUS members receive it through their MCO, and HHSC also contracts directly with facilities for Title XIX and Title XX DAHS.

Who inspects adult day centers in Texas?

HHSC inspection and survey staff. Visits are generally unannounced, and HHSC also investigates complaints and incidents.