adult day care, medicaid, coverage

How to Get Coverage for Adult Day Care

Adult day care is a good option for caregivers who need to take a break, take care of their own wellbeing, or go to work. It is a good alternative to home health care, which can be much more costly.

An elderly person typically goes to an adult day care center for 4 to 12 hours per day, up to 5 days a week, where they receive transportation, do recreational activities, receive medical care, and have nutritious meals.

Costs vary by state, but the national average for annual costs (without government subsidies) is $25,200.

Types of adult day care

There are different kinds of adult day care, all of which may be offered at the same day care center.

The basic types of adult day care are:

  • Social adult day care – also called Adult Day Services, this kind of care is focused on fun activities and healthy meals.
  • Adult day health care – also called Adult Day Medical Care, this type of care might also include physical and occupational therapy, assistance in completing tasks, and administering medication.
  • Specialized adult day care – this type of care is for those with Alzheimer’s and dementia who need more focused attention.

Medicare does not cover adult day care, but Medicaid and other assistance programs may provide coverage. Programs differ by state, so check with your local Area Agency on Aging or the National Adult Day Services Association to see what the best options are for you.

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Ways to get help with costs

There are options for getting help paying for adult day care. 

  • Medicaid Waivers. These waivers let states provide Medicaid services outside of a nursing home to those who live at home.
  • State Medicaid Plan. Programs vary by state, so check with your state to see what they offer.
  • Veterans Health Benefits. VHA will cover part of adult day health care after an assessment. Check with your plan.
  • The Program of All-Inclusive Care for the Elderly (PACE) is available to frail elderly individuals who qualify for both Medicare and Medicaid.
  • Non-Medicaid State assistance. If you qualify, these programs may be able to help.

Most Medicaid programs will pay for a maximum of 8 hours per day / 5 days per week of adult day care. There are income limits and other health qualifications you must meet before you can get coverage.

Other benefits

Some adult day care centers also offer options for caregivers, such as support groups, education, counseling, and help finding local resources.

Adult day care is also tax deductible. Check with a financial advisor to see the best way to claim adult day care on your taxes.

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