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

Page Reviewed / Updated - Apr. 2016

Medicaid's Benefits for Adult Day Care

 As of April 2016, all 50 states offer assistance for adult day care in one form or another through their Medicaid programs.  However, Washington D.C. does not. 

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. 

Medicaid Waivers

The state Medicaid programs most likely to cover adult day care are Medicaid Waivers. There are several versions of waivers and one may find these referred to as HCBS Waivers, 1915 Waivers, 1115 Waiver or Home and Community Based Waivers. Historically, long term care Medicaid was provided only in nursing homes. Medicaid waivers allow states to offer Medicaid services outside of nursing homes to individuals who live at home. It is under these waivers that most individuals receive assistance from Medicaid for adult day care. There are waivers which cover adult day care in forty-seven states. However, with the exception of the District of Columbia, those states that do not cover adult day care through a Waiver, offer alternative public funding. The major advantage to Waivers is they almost always have higher monthly income limits than regular Medicaid programs. The downside is Waivers have enrollment caps and very often there are waiting lists.

Regular / State Plan Medicaid

To a lesser extent “regular Medicaid” or Medicaid State Plans offers adult day care as a benefit. Presently, eleven states cover adult day care services with their Medicaid State Plan. State Plan Medicaid, is an entitlement. Those persons who meet the eligibility requirements are entitled to receive the benefits. This is not the case with Waivers, which have a limited number of slots and persons can meet the eligibility requirements and still be “wait-listed” to receive benefits. The downside to State Plan Medicaid (when compared to Waivers) is that very often the monthly income limit for eligibility is considerably lower than the limit for Medicaid Waivers.

 Fortunately, for those who do not qualify for Medicaid, free help is available to find quality, affordable day care. Other good news is that there are non-Medicaid assistance options that help pay for adult day care as well.

 

Medicaid Adult Day Care Eligibility

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. Most waivers require the participant to be in need of nursing home level care. In 2016, most waivers limit the participant’s monthly income to less than $2,199. Excluding the value of their home, their countable assets are limited to between $1,000 - $15,000 (depending on their state). However, applicants with resources or income in excess may be able to qualify for Medicaid by working with a Medicaid planning professional.

Gain eligibility for Medicaid-funded, adult day care under a Medicaid state plan is both less and more restrictive than with a waiver. Applicants do not necessarily need to require nursing home level care. This is good news for persons with Alzheimer’s or dementia who require supervision but 24 / 7 care. Financially, the asset limit is the same as with Medicaid waivers, but the monthly income limit is likely more restrictive. Typically, it is pegged to the Supplemental Security Income benefit rate, or $733 / month in 2016.

 

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.  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 exist, 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?  Medicaid is usually thought of as the major payer of 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 April 2015.  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 encouraged 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).


2016 Medicaid Adult Day Care Benefits - State by State

State

Medicaid Policies & Programs that Cover 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 Alaskans Living Independently Waiver pays for Adult Day Care.  It has replaced the Older Alaskans Program.


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

Under the Community-Based Adult Services program, adult day care is a benefit.   Medi-Cal also continues to cover adult day care through the Multipurpose Senior Services Program Waiver.

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.

Statewide Respite Care Program 

Find Local Adult Day Care in CT

Search for Other Assistance Programs
Delaware

Delaware has switched from Medicaid waivers to a managed Medicaid program.  As such the Amended Elderly and Disabled (E&D) Waiver is no longer valid.  However, adult day care is a benefit under the new Diamond State Health Plan Plus.

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 no longer has Medicaid waivers through which to provide for adult day care.  However the state's new Medicaid managed care program does offer this benefit.  Read about the Statewide Managed Long Term Care program.

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.

Non-Medicaid HCBS

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 as does the Health and Disability Waiver for persons under 65 years of age.

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

The following Louisiana waivers pay for adult day care: Adult Day Health Care (ADHC) Waiver and the Community Choices Waiver.

The Elderly and Disabled Adult (EDA) Waiver is no longer an option.

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

 

Maine MaineCare offers the Older Adults and Adults with Disabilities Waiver which covers adult day health care as does the state regular Medicaid program.

Maine Home-Based Care

Caregiver Respite

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

 

Maryland

Maryland has several programs which cover adult day care or adult day medical care.  These are the Waiver for Older Adults,  Community Pathways, the Medical Day Care program and the Medicaid State Plan.

Senior Care Program
Find Local Adult Day Care in MD
Search for Other Assistance Programs

 

Massachusetts

Mass-Health covers adult day care under the Frail Elder Home and Community-Based Services Waiver (HCBS).  Under regular Medicaid there is also an Adult Day Health benefit.

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.

Alternative Care Program

Essential Community Supports

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
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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

Lifespan Respite Subsidy Program

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

 

Nevada

Nevada Medicaid pays for adult day care through the HCBW for the Frail Elderly as well as through their State Plan.

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. The Medicaid State Plan also has this benefit.

Transitions in Caregiving
Find Local Adult Day Care in NH
Search for Other Assistance Programs

 

New Jersey

In 2014, New Jersey switched from the Global Options Waiver to a statewide managed Medicaid program.  Fortunately, the adult day care benefit was preserved under this new program.  Read more. Regular NJ Medicaid also offers this benefit.

NJ Alzheimer's Adult Day Care
NJ Assistance for Community Caregiving
Find Local Adult Day Care in NJ
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New Mexico New Mexico has re-designed their Medicaid program.  It is now called Centennial Care and there is a program with Centennial Care called Community Benefit.  Under Community Benefit, adult day care is offered.  The CoLTS C Waiver is no longer a valid option.

Older Americans Act

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 as does the State Plan.

Expanded In Home Services for the Elderly

Community 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.  Special Assistance In-Home Program for Adults provides a cash benefit which can be used for adult day care.

 

North Carolina Project C.A.R.E.
Find Local Adult Day Care in NC
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North Dakota North Dakota's Medicaid Waiver for Aged and Disabled pays for adult day care.

ND Older Americans Act Services

SPED and EX-SPED

Find Local Adult Day Care in ND
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Ohio

The PASSPORT Waiver covers adult day care.  However, the Choices Home Care Waiver is no longer valid.

Older American Act Services

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
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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.  However, the State Plan offers the benefit as well and does not limit enrollment.

 

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.

Options 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.  The State Plan also has this benefit.

 

Home and Community Care Co-Pay
Find Local Adult Day Care in RI
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South Carolina

The Community Choices Waiver covers adult day health care and transportation as does the Community Supports Waiver.

Find Local Adult Day Care in SC
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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

The TennCare CHOICES in Long-Term Care Program covers adult day care.  The Elderly and Disabled HCBS Waiver is no longer available.

 

Homemaker & Adult Day Care

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

Texas has now moved to a statewide Medicaid managed care program called the Star Plus Waiver.  Adult day care is an included benefit of this program and the State Plan. Day Activity and Health Services has this benefit, but is limiting enrollment.

 

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 as well as the New Choices Waiver.

The Alternatives Program
Find Local Adult Day Care in UT
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Vermont

The new Vermont Global Commitment to Health Waiver has replaced the Choices for Care Waiver.  The new program continues to offer adult day care as a benefit as does the states regular Medicaid program.

 

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
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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 and as can participants in Family Care and Partnership.

Alzheimer's Caregiver Support
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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