Most adult medical day centers include the cost of all available services (supervision, medical services, activities, meals, snacks and transportation) in the daily rate. Few centers separate out costs. The average daily cost of adult day services is $72 to $90. It is important that you understand what services are covered in the daily fee of the day center you wish to use and what services are provided at an additional fee. Multiply the daily rate times the number of days the applicant will attend each week and add any additional fees to determine the weekly cost of care.
There are a variety of ways to pay for adult medical day services.
Some individuals pay privately for the services of an adult medical day center. Each center sets its rate for private pay clients. This will vary from center to center; check with each center you are considering.
Private Funding (Scholarships)
A few adult medical day centers may have scholarship funds or other private funding through a parent corporation, religious organization or a private grant. Ask each facility you are considering if they have any scholarships for participants.
Senior Care Program
The Maryland Department of Aging established a fund to enable senior citizens to remain in the community called the Senior Care Program. It can provide funds to help individuals with many expenses, including adult medical day services. Individuals meeting the medical and financial eligibility requirements of the Senior Care Program must work with a case manager from the Departments of Health, Social Services or Aging in their local community. The Senior Information and Assistance specialist in your community will complete an initial screening by telephone and then refer you to the appropriate agency. To reach Baltimore County's Senior Information and Assistance Specialist, call 410-887-2594.
Veterans meeting VA eligibility requirements may receive partial or full funding for adult medical day services. To receive payment, a center must be pre-approved by the Department of Veterans Affairs. If your loved one is a veteran, ask the centers you are considering if they are approved providers. The Department of Veterans Affairs may offer funding through particular centers and you may find your loved one is eligible for other services as well.
Some long-term care insurance pays for adult medical day services. If the applicant has a long-term care insurance policy, review it carefully to see if it will pay for adult medical day services. The amount the policy will pay and the point at which it will begin and end paying are stated in the policy.
As with many services covered by long-term care insurance, there are two payment methods:
- You pay the billed amount directly to the day center and request reimbursement from the insurance company.
- The day center bills the insurance company directly.
Make sure you understand the payment method used by the applicant's long-term care insurance provider and complete any necessary paperwork in a timely fashion.
Qualified individuals can access medical day care services through one of the following home and community-based service waivers: Medical Day Care Services Waiver, Older Adult Waiver, Living at Home Waiver, Traumatic Brain Injury Waiver, Model Waiver, Community Pathways Waiver and New Directions Waiver. Individuals may be enrolled in only one home and community-based waiver at a time.
If you are currently enrolled in one of the above waivers and would like to attend adult day care, contact your service coordinator/case manager.
The newest waiver, Medical Day Services Waiver Program (PDF) is a single service waiver that provides community eligible Medicaid participants who meet nursing home facility level of care criteria with a community based alternative to receiving care in an institutional setting. This single service waiver program serves individuals aged 16 or older with an individualized plan of care that is designed to support their health and safety in the community.
Individuals who are Community Medical Assistance participants and are interested in attending Adult Medical Day Care should call their local Adult Evaluation and Review Service (AERS) to begin the application process.
To receive funding for adult medical day services under the Medical Assistance (MA) Program, the day center must be an approved center that meets the specific regulations established for the MA Program, and abide by defined staffing regulations.
Recipient (Adult Day Center Participant) Responsibilities
Medical Assistance coverage for adult day services is granted for six-month or one-year periods. At the end of each authorization period, which is usually six months, a renewal (sometimes called reconsideration) must be completed. The Department of Social Services mails a packet to the applicant. The forms in the packet must be completed and returned to the worker at the local Department of Social Services office indicated on the cover letter. If all the forms are completed in a timely fashion, Medical Assistance coverage should continue as long as the participant continues to meet financial and medical eligibility requirements.
Office of Health Services Grant
The Maryland Department of Health and Mental Hygiene (DHMH) provides funding to participants of adult medical day centers to help offset the cost of care. The administrative agency for this program varies by county.
In Baltimore County, the Department of Aging administers the grant from DHMH, which is available to participants of nearly all licensed day centers in the County. To apply for this program, your loved one must have a case manager from the Departments of Aging, Social Services or Health; the case manager is authorized to make the application for services. If your loved one does not have a case manager from one of these agencies, call Maryland Access Point (MAP) at 410-887-2594. They will complete a screening by telephone and then refer you to the appropriate agency. There may be a waiting list for funds from this grant.
In Baltimore City, the Commission on Aging and Retirement Education administers this grant. Contact the MAP program in Baltimore City at 410-396-1341 for application information.
Other Maryland Counties
The Department of Health and Mental Hygiene contracts directly with specific adult medical day centers for this program in all Maryland subdivisions except Baltimore City and County. If you are looking for an adult medical day center in one of these areas, ask the director if the center receives funding through the Office of Health Services (OHS) Program and if your loved one can be considered for funding through this program at their center.