Medicaid Benefits in Adult Day Care: Programs, Locations & How Coverage Works

Adult Day Care facilities provide daytime supervision, meals and socialization for seniors, and some offer medical care and specialized services. Medicaid Long Term Care will help cover the cost of adult day care in every state through one of these programs — Home and Community Based Services (HCBS) Waivers or Aged, Blind and Disabled (ABD) Medicaid. To qualify for these programs and adult day care benefits, seniors must meet certain financial and medical requirements.



Understanding the Three Types of Adult Day Care

Adult Day Care (ADC) facilities are places where seniors (who often have health problems related to chronic illness or old age) can receive supervision, personal care and medical services during the daytime for up to eight hours at a time. Not all ADCs offer the same level of service, however. There are three levels of adult day care service, although you may find ADC facilities that offer one, two, or all three levels of care in different areas of the same facility.

  1. Social Adult Day Care (SADC) or Adult Day Services, is for seniors who need supervision, activities and meals, but not medical care. If someone has a chronic illness, Social Adult Day Care would not be appropriate, but for seniors looking for supervision and socialization it might be exactly what they need.
  2. Adult Day Health Care (ADHC) or Adult Day Medical Care, offers services similar to Social Adult Day Care (like activities and socialization), but Adult Day Health Care staff includes trained nurses or other healthcare professionals who can provide medical care. Adult Day Health Care facilities are equipped with  medical equipment and offer benefits like physical and occupational therapy and help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).
  3. Specialized Adult Day Care is usually for people with Alzheimer’s disease or other dementias who require help from specially trained staff. These facilities offer comprehensive medical care and personal assistance with the Activities of Daily Living, and they may have distinct features, like brighter lighting and special locks on doors to prevent wandering.

All Adult Day Care facilities are licensed and/or regulated by states. Administrators and staff must be qualified, and there is often an enforced staff-to-resident ratio to ensure adequate care. A good ratio is 1 staff member for every 6 residents, though the number could be between 1-to-4 and 1-to-10.


Services Provided in Adult Day Care

The services offered in Adult Day Care (ADC) will vary with each facility, but in general they include:

  • Supervision
  • Meals
  • Recreation
  • Social activities
  • Exercise
  • Medication Management
  • Counseling
  • Education
  • Respite care
  • Transportation

The type and number of services available in an ADC facility depend on the level of adult day care being offered, which we discussed above. Specialized Adult Day Care will have a highly trained medical staff and specially designed facility to care for seniors with Alzheimer’s disease and other dementias. Adult Day Health Care facilities will have nurses on staff who can ide medical checkups and help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Social Adult Day Care offers the lowest level of care, but it still provides supervision, meals and activities, which are provided at all three levels of adult day care.

In most cases, the cost of these services is included in the daily fee for the Adult Day Care facility, which averages around $70. Medicaid Long Term Care is likely to cover that entire cost, or at least some of it, because paying for adult day care that will help keep seniors out of nursing homes is much more affordable than paying for the nursing home itself. Medicaid will pay for adult day care costs through one of two programs, which we will discuss next.

 Attention: Medicare does NOT cover adult day care. However, Medicare Advantage (Medicare Part C) offers additional benefits from private insurers and might include ADCs.


Medicaid Programs that Cover Adult Day Care and their Eligibility Requirements

There are three Medicaid Long Term Care programs relevant to seniors — Nursing Home Medicaid, Home and Community Benefit Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid. The latter two will cover adult day care: HCBS Waivers and ABD Medicaid. These two programs have different financial requirements and medical requirements that can change depending on where the applicant lives and their marital status.

 Toolbox: To figure out the eligibility criteria for your specific situation, use our Medicaid Eligibility Requirements Finder by clicking here.


Aged, Blind and Disabled Medicaid

Aged, Blind, and Disabled (ABD) Medicaid will cover adult day care in some (about 15) states. There is no medical requirement to get basic healthcare coverage through ABD Medicaid, applicants only need to be aged (65 or over), or blind, or disabled. However, to get long term care benefits like adult day care, applicants and recipients have to demonstrate a need for that care. So, an ABD Medicaid applicant would have to show they require daytime supervision and care to be eligible for adult day care benefits via ABD Medicaid.

ABD Medicaid applicants do have to meet financial requirements – an asset limit and an income limit. In most states in 2024, the asset limits for ABD Medicaid are $2,000 for an individual and $3,000 combined for a married couple, and the income limits are between $943 and $1,751/month for an individual, and between $1,415 and $2,593/month combined for a married couple.

ABD Medicaid is an entitlement, which means all qualified applicants are guaranteed by law to receive benefits. However, receiving long-term care services and supports through ABD Medicaid, including adult day care coverage, depends on the programs, funds and caregivers available in the beneficiary’s area. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular state Medicaid available to financially needy people of all ages.

Home and Community Based Services Waivers

The most common way for Medicaid to cover adult day care is through a Home and Community Based Services (HCBS) Waiver. Every state has at least one HCBS Waiver and some have several. Unlike ABD Medicaid, HCBS Waivers are not an entitlement. Instead, HCBS Waivers have a limited number of enrollment spots, and once those spots are full, additional applicants may be placed on a waitlist that can list months or even years.

Also unlike ABD Medicaid, HCBS Waivers have a medical requirement. In most cases, HCBS Waiver applicants must need a Nursing Facility Level of Care (NFLOC), which means they need they kind of 24/7 care and supervision usually associated with nursing homes. Some HCBS Waivers have less strict medical criteria, like being at risk of needing a NFLOC, but all of them have a significant level of care requirement.

The financial criteria for HCBS Waivers are more lenient than the criteria for ABD Medicaid. In most states in 2024, the asset limits for HCBS Waivers are $2,000 for an individual and either $3,000 or $4,000 combined for a married couple with both spouses applying, and the income limits in most states in 2024 are $2,829/month for an individual and a combined $5,658/month for a married couple with both spouses applying. For a married couple with just one spouse applying for HCBS Waivers in 2024, the asset limits in most states are $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, and the income limit is $2,829/month for the applicant spouse, while the income of the non-applicant spouse is not counted.

To find a list of the HCBS Waivers available in every state, click here.  Or you can go to our 50-State Guide to see what HCBS Waivers are available in your state and what benefits they offer.


Understanding Consumer Direction & How It Helps Finding Adult Day Care

Even if there is no Adult Day Care (ADC) facility in your area that accepts Medicaid, or the HCBS Waiver or ABD Medicaid program doesn’t specifically cover adult day care, it may still be possible to use Medicaid benefits to pay for the ADC. Some HCBS Waivers and ABD Medicaid programs offer Consumer Directed Care, which gives recipients more control over their Medicaid coverage.

In some cases, Consumer Directed Care beneficiaries will receive a monthly budget they can spend on healthcare of their choice. This could include paying for an ADC facility that may not accept direct Medicaid payments. Medicaid beneficiaries who can not make choices on their own can have a representative make decisions for them regarding Consumer Directed Care in many cases. To lean more about Consumer Directed Care, click here.


How to Find Medicaid Adult Day Care Providers in Your Area

Unfortunately, most states do not offer publicly accessible databases of Medicaid-certified Adult Day Care (ADC) facilities. Before you start looking for an ADC, it’s a good idea to write down a detailed list of your loved one’s care requirements. You should also have a schedule in mind for how often and on which days you’ll use adult day care. Having this information handy when you begin your search will save time and effort later.

Next, make a list of ADCs in your area. Contacting your local Area Agency on Aging is a good place to start if you’re not sure how to begin. Then call the ADCs and find out if they meet your care and schedule requirements. After that, visit the ADCs that will fit your needs.

It’s usually best to visit a prospective ADC at least twice. First, visit alone to get a sense of the home and make sure you’re comfortable. If you think it would provide a nurturing and stimulating environment, visit a second time with your loved one.

Instead of enrolling for a full year, you could try a one-week trial. That way you can use the ADC for a week and see how well your loved one is taken care of, and whether they like it there.

Finally, enter into a contractual agreement with the ADC to receive services there. You’ll probably set a schedule, and services and costs will be finalized.