Medicaid's Adult Day Care and Adult Day Health Care Benefits and Eligibility

Page Reviewed / Updated - Jan. 2014

Medicaid's Benefits for Adult Day Care

As of 2013, all 50 states offer assistance for adult day care in one form or another through their Medicaid programs.

Does Medicaid Pay for Adult Day Care?  In a word, Yes.  However, a better question might be under what circumstances will Medicaid pay for adult day care and is my loved one eligible?  To answer this question requires some background information about Medicaid.  

First it is important to think of Medicaid not as a single program but rather a collection of many different programs.  Not only does each state have their own rules with regards to Medicaid's benefits, but each state typically has several different Medicaid programs, all of which have their own policies for adult day care coverage.  

The state Medicaid programs most relevant to readers of this website are the Medicaid Waiver programs.  Historically, long term care Medicaid was provided only in nursing homes.  Medicaid waivers allow states to offer Medicaid paid-for services outside of nursing homes to individuals who live at home.  It is under these programs that most individuals receive assistance from Medicaid for adult day care.  

Unfortunately, most waivers have enrollment caps and waiting lists sometimes exist.  Therefore, while Medicaid may pay for adult day care and your loved one may be eligible, they may still have to wait to receive services.  Fortunately, there are many good affordable adult day care options and there are other assistance options that help pay for adult day care

Did You Know?
There are more than 4,600 adult day centers in the United States.  An increase of 35% in the last 10 years.


Qualifying for Medicaid Adult Day Care

Every Medicaid program in every state has its own eligibility considerations. Generally speaking most adult day care is provided under Medicaid waivers.  Eligibility for waivers considers the applicant's income and financial resources as well as their functional ability.  For 2013, in most states, single applicants are limited to $2,130 / month in income and countable assets valued at less than $2,000.  However, applicants with resources or income in excess may be able to qualify for Medicaid by working with a Medicaid planning professional.  Learn more about Medicaid eligibility here and learn more about Medicaid planning here.

Types of Adult Day Care

Prior to a discussion of the state by state benefits, it is helpful to have additional background information on what defines adult day care and what different types of adult day care exist as Medicaid in your state may cover some types of adult day care and not others.  

Generally speaking adult day care involves the day-time supervision of needy individuals in a group environment in a center or location.  There are three types of adult day care., although each type may be referred to by several different names.

Social Adult Day Care - sometimes called Adult Day Services or abbreviated ADC or ADS, provides non-medical supervision.  The focus is on maintaining health through recreational and social activities and nutritious meals.  

Adult Day Health Care - also called Adult Day Medical Care or ADHC provides a higher level of care services with trained nurses on staff.  In addition to activities and meals, physical, occupational, and speech therapies may be provided as well as assistance with the activities of daily living and with medical equipment and medication administration.  

Specialized Adult Day Care - typically for Alzheimer's patients, this may even be referred to as Alzheimer's Day Care or Day Treatment, though usually it is open to individuals with most forms of dementia.  In Alzheimer's Day Care, there is an additional focus to prevent wandering, injury and behavioral challenges.

While these distinctions exists, in practice and in different states, the lines between these types of adult day care may not be so clear.  Often times, one center will provide all 3 types of care.

Did You Know?
Many adult day care centers have dogs and cats and some even let participants bring their own pets.

Coverage Reasoning

Why Does Medicaid Cover the Cost of Adult Day Care?  Since Medicaid is usually thought of as the primary payer for nursing home care for low income, elderly individuals, why then do these programs cover the cost of adult day care?  Medicaid, like most government programs, is under pressure to contain its costs.  By paying for adult day care, Medicaid helps many families care for loved ones at home.  In doing so, this reduces the number of nursing home admissions which are paid for (or will eventually be paid for) by Medicaid.  So paying for adult day care is, in fact, a cost saving measure for most Medicaid programs as the cost of adult day care is very minor when compared to the cost of full-time nursing home care.

State by State Guide to Medicaid's Adult Day Care Benefits

The following information is current as of 2013.  It should be emphasized that even though Medicaid will pay for adult day care in every state, it is not always the best source of funding.  Medicaid's reimbursement rates for adult day care are not high and not all adult day care centers will accept Medicaid enrollees.  Readers are encourage to consider both Medicaid and the alternative options available to them in each state (listed in the column on the right side of the table).


2013 Medicaid Adult Day Care Benefits

State

Medicaid Policy on Adult Day Care

Other ADC and Assistance Options

Alabama In Alabama, the Elderly and Disabled Medicaid Waiver pays for Adult Day Health Care.

Find Local Adult Day Care in AL
Search for Other Assistance Programs

 

Alaska The Older Alaskans Program pays for Adult Day Care.


AK Adult Day Services Program
Find Local Adult Day Care in AK
Search for Other Assistance Programs

Arizona Arizona, through its managed care system called Arizona Long Term Care System (ALTCS), covers adult day care.

Arizona Non-Medical HCBS
Find Local Adult Day Care in AZ
Search for Other Assistance Programs

 

Arkansas The DAAS ElderChoices Waiver pays for both adult day social and health care.

Find Local Adult Day Care in AR
Search for Other Assistance Programs
California

In 2012, California allowed its Medi-Cal Adult Day Health Care (ADHC) program to expire and replaced it with the Community-Based Adult Services (CBAS) program.  Under this new program adult day care is still a benefit, though now it is under managed care and the eligibility requirements have been made more restrictive.   The state continues to cover adult day care through the Multipurpose Senior Services Program Waiver (MSSP).  

Alzheimer's Day Resource Centers
Find Local Adult Day Care in CA
Search for Other Assistance Programs




Colorado Colorado pays for adult day care and adult day health care through the Elderly, Blind and Disabled Waiver

Home Care Allowance
Old Age Pension
Find Local Adult Day Care in CO
Search for Other Assistance Programs

 

Connecticut Connecticut Personal Care Assistance (PCA) Program covers adult day care as does the Home Care Program for Elders, which is both a Medicaid and non-Medicaid program.

Find Local Adult Day Care in CT
Search for Other Assistance Programs
Delaware

Delaware's Amended Elderly and Disabled (E&D) Waiver pays for adult day services, both social and medical day care.

Alzheimer's Day Treatment
Find Local Adult Day Care in DE
Search for Other Assistance Programs
D.C. The DC Medicaid Waiver does not cover adult day care at present.

Find Local Adult Day Care in DC
Search for Other Assistance Programs

Florida

Florida Alzheimer’s Disease Waiver covers Alzheimer's day are but only in 4 counties.  The Nursing Home Diversion Waiver and Aged and Disabled Adult Waiver both cover day care and are available statewide.

Alzheimer's Disease Respite
Community Care for the Elderly
Find Local Adult Day Care in FL
Search for Other Assistance Programs

Georgia Both Georgia's Community Care Services Program and the SOURCE Waiver include adult day health care as a benefit.

Find Local Adult Day Care in GA
Search for Other Assistance Programs
Hawaii Hawaii offers the QUEST Expanded Access Medicaid program (QExA) which is managed care and does include benefits for both adult day social and medical care.

Kupuna Care
Find Local Adult Day Care in HI
Search for Other Assistance Programs
Idaho

Idaho Medicaid has the HCBS Aged & Disabled Waiver which covers adult day care.

Idaho Homemaker Services
Find Local Adult Day Care in ID
Search for Other Assistance Programs
Illinois The Illinois HCBS Waiver for the Elderly covers adult day care.


Illinois Community Care
Find Local Adult Day Care in IL
Search for Other Assistance Programs
Indiana Indiana's Aged and Disabled Waiver (A&D) pays for adult day care.


Indiana Choice
Find Local Adult Day Care in IN
Search for Other Assistance Programs
Iowa

Iowa HCBS Elderly Waiver covers adult day care.

 

Case Management for Frail Elders
Find Local Adult Day Care in IA
Search for Other Assistance Programs

Kansas

Kansas' HCBS Frail and Elderly Medicaid Waiver pays for adult day care.

 

Kansas Senior Care Act
Find Local Adult Day Care in KS
Search for Other Assistance Programs
Kentucky Kentucky’s Home and Community Based (HCB) Waiver Program for Aged and Disabled pays for adult day health care, but not adult day social.

Hart-Supported Living
ADC and Alzheimer's Respite
Find Local Adult Day Care in KY
Search for Other Assistance Programs

Louisiana All 3 of the following Louisiana waivers pay for adult day care: Adult Day Health Care (ADHC) Waiver, Elderly and Disabled Adult (EDA) Waiver and the Community Choices Waiver.

Find Local Adult Day Care in LA
Search for Other Assistance Programs
Maine MaineCare offers the Older Adults and Adults with Disabilities Waiver pays for adult day health care.

Maine Home-Based Care
Find Local Adult Day Care in ME
Search for Other Assistance Programs

Maryland Maryland's Waiver for Older Adults covers adult medical day care.


Senior Care Program
Find Local Adult Day Care in MD
Search for Other Assistance Programs
Massachusetts The Mass-Health Frail Elder Home and Community-Based Services Waiver (HCBS) covers adult day care. 

HCP and ECOP Programs
Find Local Adult Day Care in MA
Search for Other Assistance Programs
Michigan Through the Michigan Choice Waiver Program, the state will pay for adult day care.

Find Local Adult Day Care in MI
Search for Other Assistance Programs
Minnesota Minnesota pays for adult day care through the Medicaid Waiver called the Elderly Waiver.  As with most waivers, participation is limited.

Minnesota Alternative Care Program
Find Local Adult Day Care in MN
Search for Other Assistance Programs
Mississippi

In Mississippi, the Elderly and Disabled (E&D) Waiver includes adult day care as a benefit to its beneficiaries.

Mississippi In-Home Services
Find Local Adult Day Care in MS
Search for Other Assistance Programs
Missouri Missouri Medicaid's Aged and Disabled Waiver pays for adult day care.  The HCBS Waiver also covers respite care services in adult day care centers.

Find Local Adult Day Care in MO
Search for Other Assistance Programs
Montana Montana's Home and Community Based Services Medicaid Waiver will cover the cost of adult day care for its participants.  

Find Local Adult Day Care in MT
Search for Other Assistance Programs

Nebraska

Nebraska offers residents the Aged and Disabled Medicaid Waiver.  Under this waiver, adult day care is an included benefit.

Nebraska Social Services for Aged
Find Local Adult Day Care in NE
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Nevada

Nevada Medicaid pays for adult day care through the HCBW for the Frail Elderly.

Nevada COPE
Find Local Adult Day Care in NV
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New Hampshire The Choices For Independence Medicaid program pays for adult day care, though the program does not refer to this service using that phase, instead they use phrase
Adult Medical Day Services.  The distinction is important as the program does not cover adult day social care.

Transitions in Caregiving
Find Local Adult Day Care in NH
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New Jersey

New Jersey's Global Options Waiver pays for adult day health service.

 

NJ Alzheimer's Adult Day Care
NJ Assistance for Community Caregiving
Find Local Adult Day Care in NJ
Search for Other Assistance Programs

 

New Mexico New Mexico offers the CoLTS C Waiver which is a Medicaid program that includes adult day health services.

Find Local Adult Day Care in NM
Search for Other Assistance Programs
New York New York's Managed Long Term Care Program Waiver covers both adult day social care and health care.

Expanded In Home Services for the Elderly
Find Local Adult Day Care in NY
Search for Other Assistance Programs
North Carolina

North Carolina, through the CAP/ DA Medicaid Waiver, pays for adult day care.  

North Carolina Project C.A.R.E.
Find Local Adult Day Care in NC
Search for Other Assistance Programs

 

North Dakota North Dakota's Medicaid Waiver for Aged and Disabled pays for adult day care.

ND Older Americans Act Services
Find Local Adult Day Care in ND
Search for Other Assistance Programs

 

Ohio Choices Home Care Waiver covers adult day care as does the PASSPORT Waiver.

Find Local Adult Day Care in OH
Search for Other Assistance Programs
Oklahoma

Through Oklahoma Medicaid's ADvantage Program Waiver, services in adult day health care communities are covered.

Oklahoma Adult Day Services
Find Local Adult Day Care in OK
Search for Other Assistance Programs
Oregon  Oregon has a Medicaid Waiver called Aged & Physically Disabled Waiver that pays for adult day care.  There are a limited number of slots available.  

Project Independence
Find Local Adult Day Care in OR
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Pennsylvania    The PA Department of Aging Waiver pays for "adult daily living services" as does the Services My Way Program.

Find Local Adult Day Care in PA
Search for Other Assistance Programs
Rhode Island

Rhode Island Home and Community Care Waiver pays for adult day health care.  There is a non-Medicaid version of this program called the Home and Community Care Co-Payment which does as well.

 

Home and Community Care Co-Pay
Find Local Adult Day Care in RI
Search for Other Assistance Programs
South Carolina The Community Choices Waiver covers adult day health care and transportation.

Find Local Adult Day Care in SC
Search for Other Assistance Programs
South Dakota

South Dakota Medicaid's Home & Community Based Waiver Services for the Elderly's benefits include adult day care.

Homemaker, Chore and Respite
Find Local Adult Day Care in SD
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Tennessee Elderly and Disabled HCBS pays for adult day care as does the TennCare CHOICES in Long-Term Care Program.

OPTIONS for Community Living
Find Local Adult Day Care in TN
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Texas

The Day Activity and Health Services Program covers adult day care as does the managed care Star Plus Waiver.


Community Care for Aged/Disabled
Services to Assist Independent Living
Find Local Adult Day Care in TX
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Utah Utah Medicaid pays for adult day health services under the Aging Waiver for Individuals Age 65 or Older.   

The Alternatives Program
Find Local Adult Day Care in UT
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Vermont

Vermont's Choices for Care Medicaid Waiver pays for adult day care.

 

Dementia Care Respite Grants
Find Local Adult Day Care in VT
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Virginia Virginia pays for adult day care through the primary EDCD Waiver.


Virginia Adult Services
Find Local Adult Day Care in VA
Search for Other Assistance Programs
Washington The COPES Program (Community Options Program Entry System Waiver) covers both adult day and adult care health care.

Find Local Adult Day Care in WA
Search for Other Assistance Programs

 

West Virginia West Virginia Medicaid does not include direct assistance for adult day care.  However, through the Personal Options portion of the Aged and Disabled Waiver, participants have the flexibility to choose certain services they require which are outside the standard services.  Under this option, beneficiaries can choose adult day care.

Family Alzheimer’s In-Home Respite
Find Local Adult Day Care in WV
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Wisconsin Wisconsin residents can receive adult day care through the CIP-II and COP-W Waivers as well as through the IRIS Program.

Alzheimer's Caregiver Support
Family Care and Partnership
Find Local Adult Day Care in WI
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Wyoming Wyoming HCBS Waiver pays for adult day care.


Wyoming CBIHS
Find Local Adult Day Care in WY
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