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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 in 2005 was $70. 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.

  • Private Pay
    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.
  • Long-Term Care Insurance
    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.
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.
 

As with many services covered by long-term care insurance, there are two payment methods:

  1. You pay the billed amount directly to the day center and request reimbursement from the insurance company.
  2. 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.

  • Maryland Medical Assistance (Medicaid)
    The Maryland Medical Assistance program pays for a variety of services for individuals with low income. Most adult medical day centers in Maryland accept Medical Assistance reimbursement. To be eligible for any service funded by the Medical Assistance Program, an individual must meet financial eligibility requirements and medical eligibility requirements.

    Statewide, the local Department of Social Services processes all applications for the Maryland Medical Assistance Program. Baltimore County has five offices to serve you. You may call or visit any office to obtain an application. If you need assistance in completing the form, ask the adult day center social worker for help.

    • Medical Eligibility for Medical Assistance
      A person is medically eligible for adult medical day services, as defined in the regulations, if he or she:
      • Is chronically ill or disabled
      • Has an illness or disability that does not require 24-hour inpatient care
      • Has a physical or mental illness that prevents the person from accomplishing daily activities outside of a sheltered environment

      Medical eligibility for payment under the Medical Assistance Program is not determined by the adult day center. An independent third party determines medical eligibility. In Maryland, this task is performed by KePRO.
      • Steps in Determining Medical Eligibility for Medical Assistance
        1. Day center nurse and/or social worker interview and assess potential participant to determine that the day center can accommodate the needs of the individual
        2. The applicant's private physician performs a physical examination, completes the required Medical History and Physical Form and returns it to the day center staff
        3. The day center staff sends documentation to KePRO for a determination as to whether the applicant is medically eligible for adult day services paid for by the Medical Assistance Program
        4. KePRO's decision is forwarded to the adult day center

KePRO is an independent agency responsible for determining if applicants are in need of care offered at an adult day center as evidenced by the following:

  • Medical diagnoses
  • Need for assistance with activities of daily living
  • Need for supervision
  • How likely the person is to enter a nursing home if adult medical day service is not available
 
    • Provider Responsibilities
      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 6-month or 1-year periods. At the end of each authorization period, which is usually 6 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.

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. In Baltimore County, call
410-887-2594.
  • Veterans Benefits
    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.
 

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.

Baltimore 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, the Senior Information and Assistance Office at (410) 887-2594 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.

Baltimore City
In Baltimore City, the Commission on Aging and Retirement Education administers this grant; contact the Senior Information and Assistance 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.