Will Medicare or Medicaid Cover Adult Day Care Expenses?

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Q: I am the full-time caregiver for my mom, and I also work full-time. She cannot be left home alone all day, so I am looking into adult day care. Will Medicare or Medicaid pay for it?

A: Medicare does not pay for any type of adult day care (ADC). Some Medicare Advantage Plans (Part C) may provide partial coverage for these services, but they are not required to do so. However, Medicaid will typically provide some type of coverage, but acceptance into these programs can be challenging.

Medicaid will provide for social adult day care, care in the home or in an assisted living facility, under the Home and Community Based Services (HCBS) program available in many communities. This method of managing services helps seniors to remain living in their community for as long as possible and avoid placement in a nursing home. There may be a waiting list for services, depending on whether the state includes them in their basic Medicaid State Plan or uses a waiver program.

Medicaid will also pay most or all of the costs for services provided by licensed adult day health care settings for participants with very low income, few assets, and a demonstrated need for skilled nursing care. This medical model of daily care usually requires a health assessment and a physician's order before someone can be admitted into the program. These centers often provide rehabilitative physical, occupational, and speech therapies, and staff include a registered nurse (RN), therapists, and other health professionals.

A third type of day care provides social and health services specifically for seniors with Alzheimer's and other types of dementia. The staff is specifically trained in dementia care and will help participants with activities of daily living (ADLs), coordinate activities for their unique physical and cognitive skill levels, and provide careful supervision and security measure to prevent wandering. Medicaid typically covers this specialized type of care.

Private medical insurance policies sometimes cover a portion of adult day care center costs when licensed medical professionals are involved in the care. Long-term care insurance may also pay for adult day services, depending on the policy.

There are also many local programs that might be able to help you offset the costs. Check with your local Area Agency on Aging for a list of resources. PACE is one example that helps with community care services, but it is only available in some states.

K. Gabriel Heiser is an attorney with over 25 years of experience in elder law and estate planning. He is the author of "How to Protect Your Family's Assets from Devastating Nursing Home Costs: Medicaid Secrets," an annually updated practical guide for the layperson.

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27 Comments

I'VE CHECKED INTO THIS MYSELF HERE IN NEVADA. I AM OVER QUALIFIED FOR ANY COUNTY OR STATE ASSISTANCE BECAUSE I GET BOTH PENSION AND SSA. YOU'RE DAMNED IF YOU DO AND DAMNED IF YOU DON'T. THE ONLY HELP I'VE BEEN ABLE TO GET FOR FOOD, ETC. IS THRU PROJECT MANA AND SENIOR SERVICES AT OUR LOCAL REC CTR.
BUT HAVEN'T BEEN ABLE TO GET ANYONE IN TO HELP ME CLEAN MY APT. AND ORGANIZE THINGS FOR ME. IT LOOKS LIKE I'M A HOARDER THIS PLACE IS SUCH A PIT. CLEANERS WHERE I LIVE COST AT LEAST $30 PER HOUR AND I CAN'T AFFORD THAT. I HAVE SEVERAL PHYSICAL DISABILITIES ALONG WITH MY EXTREME CASE OF MYALGIC ENCEPHALOMYELITIS/CHRONIC FATIGUE SYNDROME (ME/CFS) AND AM PRETTY MUCH BEDRIDDEN THESE DAYS.
There are three types of adult day care:
1. Adult day social care provides social activities, meals, recreation, and some health-related services.
2. Adult day health care offers more intensive health, therapeutic, and social services for individuals with severe medical problems and for those at risk of nursing home care.
3. Alzheimer’s specific adult day care provides social and health services only to persons with Alzheimer’s or related dementia.
It depends on the state.