How to start an adult day care center in Alabama

Alabama does not require a state license for an adult day care center, according to Alabama Medicaid Agency, with the Alabama Department of Senior Services as operating agency for the Elderly and Disabled waiver. Adult day health — no state license; Medicaid waiver provider approval.

License required

No

License

No state license or certification. Adult day health providers serving Medicaid waiver clients must meet the waiver's adult day health standards and contract with Medicaid or its operating agency.

Issuing agency

Alabama Medicaid Agency, with the Alabama Department of Senior Services as operating agency for the Elderly and Disabled waiver

Survey and inspection

The state agencies that contract for adult day health must confirm that each facility meets the waiver's minimum standards.

Medicaid waiver coverage

Adult day health is a covered service in the Elderly and Disabled (E&D) and Alabama Community Transition (ACT) 1915(c) waivers. The provider manual describes it as at least 4 hours a day of social and health care in an approved community facility.

Regulation

Alabama Medicaid Provider Manual ch. 107 (Waiver Services); Elderly and Disabled and ACT 1915(c) waiver documents

Program

Alabama Medicaid

Enrollment portal

Alabama Medicaid Electronic Provider Enrollment Application Portal (AMMIS)

Fiscal agent

Gainwell Technologies (runs the Provider Enrollment Unit for the Alabama Medicaid Agency)

Application fee

Alabama collects the fee from new and re-enrolling institutional provider types on its fee list (e.g., ASCs, community mental health centers, DMEPOS suppliers, ESRD clinics, FQHCs), paid by certified or cashier's check to the Alabama Medicaid Agency; the agency's participation requirements document carries the current amount. Hardship exceptions can be requested through the fiscal agent. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Alabama says skilled nursing facilities were moved to the high/moderate risk tier at CMS's direction, and high-risk enrollment triggers a fingerprint-based criminal background check. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Alabama states SNFs get a site visit at initial enrollment and at each 5-year revalidation. Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Alabama notifies providers when they are due and posts monthly lists of providers due for revalidation; a file closed for missing revalidation requires a brand-new application. Revalidations can be uploaded through the secure web portal. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Alabama Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Alabama State Health Planning and Development Agency (SHPDA); applications decided by the Certificate of Need Review Board

Services covered

• hospitals (general, specialized, psychiatric, long-term care)
• skilled nursing facilities
• intermediate care facilities
• rehabilitation centers
• ambulatory surgery facilities
• kidney disease treatment / freestanding dialysis
• community mental health centers
• alcohol and drug abuse facilities
• facilities for the developmentally disabled
• hospice
• home health agencies
• health maintenance organizations

Alabama certificate of need details →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Adult day care clinics/centers — active organization NPIs (NPPES)

58 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

930,919 (as of Jun 1, 2026)

All Alabama Home care Medicaid rates, ranked →

• Community Transition (ACT) Waiver (1915(c))
• Community Waiver Program (1915(c))
• Home and Community-Based Waiver for the Elderly and Disabled (1915(c))
• Home and Community-Based Waiver for Persons with Intellectual Disabilities (1915(c))
• HCBS Living at Home Waiver for Persons with Intellectual Disabilities (LAH) Waiver (1915(c))
• SAIL Waiver (1915(c))
• Technology Assisted (TA) Waiver (1915(c))

Alabama waivers and waiting lists →