Adult Day Care Regulations in Washington

Who regulates adult day care in Washington

Washington does not license adult day centers. Instead, the Department of Social and Health Services (DSHS) sets standards for adult day care and adult day health in WAC 388-71-0702 through 388-71-0776, and centers that serve Medicaid clients hold a state contract. Since May 2025, these long-term services sit in the DSHS Home and Community Living Administration (HCLA), which took over functions of the former Aging and Long-Term Support Administration.

Local area agencies on aging (AAAs) act as DSHS designees. They review contract applications, inspect prospective centers and monitor contracted centers at least once a year. Adult day health centers also need a core provider agreement with the Washington State Health Care Authority (HCA) to bill.

Types of adult day programs in Washington

• Adult day care: core services for adults with medical or disabling conditions, such as personal care, routine nurse health monitoring and meals.
• Adult day health: skilled nursing and/or rehabilitative therapy in addition to the adult day care core services, with transportation included in the daily rate.

The rules define an adult day center as a structured, nonresidential program that meets the needs of adults with impairments through individualized care plans. According to WAC 388-71-0702, the requirements apply to centers that contract with DSHS or an AAA and to adult day centers that operate on a private pay basis.

Opening an adult day center in Washington

There is no license application. To serve Medicaid clients, you apply for a state contract under WAC 388-71-0724:

1. Request an application form from DSHS or your local AAA. A person convicted of abuse or neglect of a vulnerable adult cannot provide adult day services.
2. Submit evidence of compliance and the required documents, including your business license, business plan and budget, financial statements, policies, floor plan, local building, fire and health reports, staff TB results, a sample client file, an activity calendar, a menu and insurance certificates.
3. The AAA inspects the site and notifies you in writing of any deficiencies within 30 days. It verifies corrections and sends DSHS a written recommendation.
4. Adult day health centers also sign a core provider agreement with HCA.

Contracting follows each AAA's procurement procedure, and the rules state that DSHS and AAAs are not required to contract with any center.

Key requirements

• Staffing ratio: at least one direct care staff member to six clients, increased as nursing, therapy and functional needs rise. Centers document daily how they met the ratio (WAC 388-71-0754).
• Minimum coverage: when only one participant is present, at least two staff must be on site and at least one must be currently certified in CPR and first aid.
• Adult day care staff: an administrator or program director, an activity coordinator, a consulting registered nurse and a consulting social worker (WAC 388-71-0756).
• Adult day health staff: an administrator, a program director (who may be the same person), a registered nurse, an activity coordinator, a physical, occupational or speech therapist, and a social worker (WAC 388-71-0758).
• Facility: at least 60 square feet of multipurpose program space per participant, a designated rest area with at least one bed, couch or recliner for every ten participants, and accessible design under Section 504 and the ADA (WAC 388-71-0766).

Medicaid funding for adult day in Washington

The main funding source is the Community Options Program Entry System (COPES), a 1915(c) Medicaid waiver that covers both adult day care and adult day health. The Residential Support Waiver also lists adult day health, and the rules name Roads to Community Living and other agency-approved funding.

Clients need a current CARE assessment and enrollment in an approved funding program. Adult day health also requires an unmet need for skilled nursing, skilled therapy or counseling. Waiver providers must be contracted through the local AAA before services are authorized.

Billing basics

Adult day care is reimbursed hourly for up to four hours per day, and at a daily rate for four or more hours. The DSHS long-term care manual (revised May 2026) defines an in-person adult day care unit as 15 minutes. Transportation is not paid under the adult day care rate.

Adult day health is paid at a daily rate that includes transportation, plus a one-time intake evaluation that includes the negotiated care plan. Rates are adopted by rule and adjusted by the legislature.

A 2024 DSHS rulemaking notice on electronic visit verification (EVV) covers Medicaid in-home personal care and respite care and does not mention adult day services.

Other ways centers are paid

Under WAC 388-71-0730, an AAA may fund adult day services with Senior Citizens Services Act or state respite care funds for people who are not eligible for Medicaid adult day care or adult day health. This funding is not an entitlement. Centers may also serve private pay clients. 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

• DSHS Home and Community Living Administration
• Chapter 388-71 WAC: Home and Community Services and Programs
• WAC 388-71-0724: Adult Day Program State Contract
• DSHS Adult Day Services publication (22-1731)
• DSHS Long-Term Care Manual: COPES

Frequently asked questions

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

No state license exists for adult day centers. To serve Medicaid clients, you need a state contract through DSHS or your local area agency on aging, and adult day health centers also need an HCA core provider agreement.

Does Washington Medicaid pay for adult day care?

Yes. The COPES waiver covers adult day care and adult day health for eligible clients, and the Residential Support Waiver covers adult day health.

Who inspects adult day centers in Washington?

The local area agency on aging inspects a center before contracting and monitors contracted centers at least annually for DSHS.

Is social adult day care regulated in Washington?

Adult day care follows the standards in WAC 388-71, which apply to contracted centers and to centers operating on a private pay basis, but there is no license.