Page Reviewed / Updated - Apr. 2018
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. Finally, the target group of the Medicaid program also impacts eligibility. As an example, seniors must meet one set of eligibility criteria, adults aged 18-64, a second, differing set of eligibility criteria and the developmentally disabled, a third set.
The state Medicaid programs most likely to cover adult day care are called 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 most states. Furthermore, those states that do not cover adult day care through a Medicaid waiver, offer alternative public funding for adult day care. A major advantage of Medicaid waivers is they almost always have higher monthly income limits than regular Medicaid programs. A downside is waivers have enrollment caps and very often there are waiting lists.
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 Medicaid 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.
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. In most states, waivers require the participant to be in need of nursing home level care. In 2018, most waivers limit the participant’s monthly income to less than $2,250. 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.
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 $750 / month in 2018 for a single applicant or $1,125 for a married couple. Again, as with waivers, there is some flexibility when calculating what qualifies as monthly income.
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.
1. 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.
2. 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. In addition, assistance with the activities of daily living, with medical equipment and medication administration is provided.
3. 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.
Regardless of the Medicaid program or waiver from which one receives the adult day care benefit; all programs will put limits on the amount of adult day care the beneficiary can receive. Limits are typically dependent on the individual. However, one can expect a maximum of 8 hours per day / 5 days per week.
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. Therefore, paying for adult day care is, in fact, a cost saving measure for most Medicaid programs because the cost of adult day care is minor when compared to the cost of full-time nursing home care.
The following information is current as of April 2018. 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).
2018 Medicaid Adult Day Care Benefits - State by State
Medicaid Policies & Programs that Cover Adult Day Care
Other ADC and Assistance Options
The Alaskans Living Independently Waiver pays for Adult Day Care. It has replaced the Older Alaskans Program. Another option is the Adults with Physical & Developmental Disabilities Waiver.
|Arizona||Arizona, through its managed care system called Arizona Long Term Care System (ALTCS), covers adult day care.|
|Arkansas||The DAAS ElderChoices Waiver has expired, but it did cover adult day care. ARChoicesis a new program which covers the same benefit. |
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|Colorado||Colorado pays for adult day care and adult day health care through the Elderly, Blind and Disabled Waiver.|
|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. ||Search for Other Assistance Programs|
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|
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The District of Columbia has a single, inclusive waiver called the Elderly and Person with Disabilities (EPD) Waiver, which offers adult day care as a benefit. It is also covered under the District's regular Medicaid program.
Florida no longer has Medicaid waivers through which to provide for adult day care. However, the state's Medicaid managed care program does offer this benefit. Read about the Statewide Managed Long Term Care program.
|Georgia||Both Georgia's Community Care Services Program and the SOURCE Waiver include adult day health care as a benefit.|
Hawaii has a managed Medicaid program called Med Quest. Under Med Quest, there are benefits for both adult day social and medical care.
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The Illinois HCBS Waiver for the Elderly covers adult day care as the Community Care Program. Two managed Medicaid programs are also relevant: HealthChoice Illinois and Medicaid-Medicare Alignment Initiative.
|Indiana||Indiana's Aged and Disabled Waiver (A&D) pays for adult day care. |
Kansas' HCBS Frail and Elderly Medicaid Waiver pays for adult day care.
|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. The Supports for Community Living Waiver has the benefit, but not for most seniors. |
|Maine||MaineCare offers the Older Adults and Adults with Disabilities Waiver which covers adult day health care as does the state regular Medicaid program.|
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 Increased Community Services Program.
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.
Through the Michigan Choice Waiver Program, the state will pay for adult day care. Under the self-directed Home Help Program, it is likely participants can use funds the adult day care as well. Finally, the newer Health Link Program helps but is not available in all counties.
|Minnesota||Minnesota pays for adult day care through the Medicaid Waiver called the Elderly Waiver. As with most waivers, participation is limited. Another option is the Community Access for Disability Inclusion Waiver.|
In Mississippi, the Elderly and Disabled (E&D) Waiver includes adult day care as a benefit to its beneficiaries.
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. Lastly, the Medicaid Care Options (MCO) has specific benefits for individual participants, ADC is likely an approved benefit.
Montana's Home and Community Based Services Medicaid Waiver will cover the cost of adult day care for its participants.
Nebraska offers residents the Aged and Disabled Medicaid Waiver. Under this waiver, adult day care is an included benefit. The PAS program provides for a person attendant, which can be an employee of an adult day care center.
Nevada Medicaid pays for adult day care through the HCBW for the Frail Elderly as well as through their State Plan.
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.
New Jersey has a statewide managed Medicaid program. The adult day care benefit was preserved under this new program. Read more. Regular NJ Medicaid also offers this benefit.
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.
|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.|
|North Dakota||North Dakota's Medicaid Waiver for Aged and Disabled pays for adult day care.|
Through Oklahoma Medicaid's ADvantage Program Waiver, services in adult day health care communities are covered.
Oregon has a Medicaid Waiver called Aged & Physically Disabled Waiver that used to offer the benefit, but now does not. However, the K Plan offers the benefit and does not limit enrollment like the waiver did.
The PA Department of Aging Waiver pays for "adult daily living services" as does the self-directed care program called Services My Way. In 2018, a new Medicaid program called HealthChoices is available.
Rhode Island Global Consumer Choice Compact 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.
South Dakota Medicaid's Home & Community Based Waiver Services for the Elderly's benefits include adult day care.
The TennCare CHOICES in Long-Term Care Program covers adult day care. The Elderly and Disabled HCBS Waiver is no longer available.
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.
|Utah||The Alternatives Program |
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The new Vermont Global Commitment to Health Waiver has this benefit as does CFC Moderate Needs Group Services Program. The state also a specific program called Adult Day Services and finally ADC is available under the regular Medicaid program.
|Washington||The COPES Program (Community Options Program Entry System Waiver) covers both adult day and adult care health care as does New Freedom. The newer Medicaid Alternative Care Program also covers it.|
|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. |
Wisconsin residents can receive adult day care through the IRIS Program. Worth noting is that COP-W and CIP-II have both expired. However, the benefit will continue to be available under Family Care and Partnership.
|Wyoming||Wyoming HCBS Waiver paid for adult day care until it was absorbed by the Community Choices Waiver. The new waiver continues to offer the same benefits.|