Do Medicare or Medicaid Cover Senior Day Care Services?

Many seniors do not necessarily need the constant care of a nursing home but could benefit from participating in a senior day care program one or more days per week. Senior day care usually refers to the daytime supervision of individuals in a group setting in a senior center or similar location.

Types of Senior Day Care Services

Three main types of programs are available.

• The first provides nonmedical supervision of recreational and social activities and meals.
• The second type provides a higher level of care, staffed by trained medical professionals, and may include additional services such as rehabilitative therapies and medication administration.
• The third includes specialized programs geared toward individuals who have Alzheimer’s disease or dementia.

Coverage Varies by State

Medicare does not typically cover senior day care services. Medicaid, on the other hand, does. These programs are less expensive than long-term care facilities and reduce the number of nursing home admissions, often paid for by Medicaid. The result is cost savings for Medicaid programs.

The type of coverage varies from state to state. Every state’s Medicaid program varies and has individual policies for senior day care coverage. Medicaid covers day care through the state program’s primary benefits or waiver programs.

Approximately 15 states plus the District of Columbia cover day care services as part of their Medicaid State Plan. A person must qualify for Medicaid and meet state-specific eligibility requirements but does not necessarily have to be in need of a nursing home level of care.

If a person does not qualify for this, they may be eligible for a Medicaid waiver program. Waivers allow states to offer long-term care services outside of a traditional nursing home setting to people who need some of this care but live at home. The income-limit eligibility criteria are more flexible for the waiver programs. However, individuals must meet specific functional ability criteria to qualify.

In some limited instances, Medicare may pay for services offered at senior day care. For example, it may cover medication administration, recovery from a medical issue when a doctor prescribes it, or outpatient mental health services at a facility that also runs a day care. Some Medicare Advantage plans may also have some senior day care coverage.

For more information on how your loved one may be able to access senior day care benefits, reach out to an elder law attorney in your area.