After looking at all the available care options for an aging loved one, you may have decided that adult day care is the best route to go. The next steps are finding the right adult day care for your loved one, which we will cover in the next blog, and determining how you are going to pay for it. Does it have to be out of pocket? Or will Medicare or Medicaid cover it? We put together this blog to help answer your questions.
A lot of elderly Americans have Medicare, so whether Medicare will pay for adult day care is very common question. Unfortunately, Medicare does not pay for any form of adult day care. There is some confusion regarding this question partly because Medicare is often mixed up with Medicaid and partly because there are certain Medicare/Medicaid combination programs that cover adult day care. To be clear, a person with only Medicare insurance coverage will not receive adult day care as a benefit.
In all states, Medicaid pays for adult day care and/or adult day health care. This is especially true if an individual would otherwise require full-time nursing home care. Each state has several Home and Community Based Services (HCBS) Medicaid Waivers or 1915 Waivers that are offered as an alternative to nursing home care. These waivers help people remain living in their homes by providing the necessary support services. Very often, this includes adult day care and transportation assistance to and from the community. Unfortunately, waivers are not entitlements and wait lists may exist.
Adult day care is also covered under many Medicaid State Plans (regular Medicaid programs). State Plan Medicaid is an entitlement; so eligible families may use this as a funding source while wait listed for a HCBS Waiver. Typically, regular Medicaid program have more restrictive financial criteria than Medicaid Waivers.
VHA Medical Benefits
The VA will pay for adult day health care but not adult day care. Adult day health care is included in VHA Medical Benefits Package. However, one cannot simply enroll in a program, they first must be assessed and found to have a clinical need for the level of care and supervision provided in adult day health care centers. While the VA will provide assistance, they may not necessarily pay for 100% of the cost. Depending on the individual’s financial resources and level of need, a co-payment may be required.
Specific pensions, such as Aid & Attendance, are intended to be used to provide care for ailing or disabled veterans. Both adult day care and adult day health care fall within that definition and could be used.
Veterans Directed Care
These VA Medical Center based programs give the veterans various options on how they can spend the funds allocated towards their care. Putting funds towards adult day care is within the regulations.
If you’d like to learn more about our Adult Day Program, contact us today.