Medicaid-Funded Adult Day Care: Maryland Medical Day Care Services Waiver (MDCSW)

Last updated: February 18, 2025

 

Overview of MD Medical Day Care Services Waiver

The Maryland Medical Day Care Services Waiver (MDCSW) provides daytime care and supervision in a community based facility for seniors and persons who are disabled (aged 16+ years old) who are at risk of nursing home admission. Medical day care, sometimes called adult day health care, provides program participants assistance with their Activities of Daily Living (mobility, transitioning, eating, toileting, etc.), nursing services, medication management, activities, meals, and opportunities to socialize in a group setting. For persons who have an informal (unpaid) family caregiver, medical day care can serve as respite care, allowing the primary caregiver a break from caregiving duties.

Program participants can choose from which medical day care center they would like to receive services. The program maintains a list of licensed medical day care centers.

Given the program’s eligibility criteria are met, program beneficiaries can live in a variety of settings and receive medical day care. This includes one’s home, the home of a loved one, an adult foster care home, or an assisted living residence.

The Medical Day Care Services Waiver is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. There are a limited number of participant enrollment slots, and when they are full, a waitlist for program participation forms.

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Wait List Alternatives: Are you interested in connecting with a Medicaid Planning Professional to discuss alternatives to Maryland’s Medical Day Care Services Waiver? Wait-lists can last from months to years, but there are other Medicaid programs that offer immediate care outside of nursing homes.
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Maryland’s Medical Day Care Services Waiver (MDCSW), also called the MDC Services Waiver, is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. Medicaid in Maryland is called Medical Assistance (MA).

 Maryland seniors might also be interested in Maryland’s Community First Choice Program or the Community Personal Assistance Services Program.

 

Benefits of the Medical Day Care Services Waiver

Medical day care facilities operate 5-7 days per week for 4-12 hours each day. In addition to case management, the following services and supports are generally provided.

– Activities
– Daily Living Skills Training and Enhancement
– Health Care Services
– Meals / Snacks
– Medication Management
– Nutrition Services
– Personal Care Assistance
– Skilled Nursing Services / Nursing Assessments
– Social Work Services
– Therapies – i.e., physical, occupational
– Transportation – to / from the medical day care facility

 

Eligibility Requirements for Medical Day Care Services

MDCSW is for Maryland residents who are elderly (aged 65+) or younger (aged 16-64) if disabled, at risk of nursing home placement, and not enrolled in another HCBS Medicaid Waiver Program. Persons who are disabled who enroll prior to turning 64 years old can continue to receive waiver services upon turning 65 years old. Additional eligibility criteria for persons aged 65+ follows.

 The American Council on Aging provides a quick and easy MD Medicaid Eligibility Test for seniors

 

Financial Criteria: Income, Assets & Home Ownership

Income
In 2025, the individual applicant income limit is $350 / month. Married couples, regardless of if one or both spouses are applicants, can have a monthly income up to $392.

 Maryland state residents eligible for SSI (Supplemental Security Income) automatically qualify for Medicaid / Medical Assistance.

While many Home and Community Based Services Medicaid programs allow a non-applicant spouse to retain a larger portion of a couple’s income and assets, the Medical Day Care Services Waiver does not. In contrast, Maryland’s Community Options Waiver, which also offers medical day care as a benefit, does allow a non-applicant spouse a Monthly Maintenance Needs Allowance and a Community Spouse Resource Allowance.

Assets
In 2025, the asset limit is $2,500 for a single applicant. For married couples, the asset limit is slightly higher at $3,000. This hold true whether one or both spouses are applicants. Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

While there is a 60-month Look-Back Rule, during which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or Home and Community Based Services via a Medicaid Waiver, it is not relevant for the Medical Day Care Services Waiver.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Spend Down Calculator.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Medicaid in MD considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has “Intent” to Return home, and in 2025, their home equity interest is no greater than $730,000. Home equity is the current value of the home minus any outstanding debt against it. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse who lives in the home.
– The applicant has a child under 21 years old who lives in the home.
– The applicant has a disabled or blind child of any age who lives in the home.

While the home is likely exempt while one is receiving Medicaid benefits, it may not be safe from Medicaid’s Estate Recovery Program. Learn more about the potential of Medicaid taking the home.

 

Medical Criteria: Functional Need

An applicant must require a Nursing Facility Level of Care (NFLOC). For the Medical Day Care Services Waiver, the assessment tool used to make this level of care determination is the interRAI Home Care (HC). This assessment contains twelve categories relative to daily living. Points are assigned based on the amount and level of assistance required. The higher the score, the greater the level of care need. Several categories are Activities of Daily Living (ADLs), which are essential for day-to-day functioning, and include mobility, eating, toileting, bathing, and dressing / grooming. Relevant to many persons with Alzheimer’s disease or a related dementia, cognition, such as decision making ability, memory, and comprehension, are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.

 Learn more about long-term care Medicaid in Maryland. 

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for MD Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

Maryland has a Medically Needy Spend-Down Program for applicants who have high medical expenses. Via this program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s income limit.

When persons have assets over the limits, Irrevocable Funeral Trusts are an option. These are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. There are additional ways to “spend down” excess assets in a way that Medicaid does not count them as assets. This includes adding on to one’s home, purchasing home appliances, and even taking a vacation. For married couples with a significant amount of “excess” assets, Medicaid Divorce is an option. There are many other strategies available when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of MD Medicaid / Medical Assistance benefits. Professional Medicaid Planners are educated in the planning strategies available in Maryland to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, while Medicaid’s 60-month Look-Back Rule does not apply to the Medical Day Care Services Waiver Program, it does apply to Nursing Home Medicaid and other long-term care Medicaid programs. If one might apply for one of these program in the future, it is vital that the Look-Back Rule not be violated. Medicaid planning strategies should ideally only be implemented with careful planning and well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Certified Medicaid Planner.

 

How to Apply for MD Medicaid Medical Day Care Services Waiver

Before You Apply

Prior to submitting an application for MDCSW, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.

As part of the application process, applicants need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.

Since the Medical Day Care Services Waiver is not an entitlement program, there may be a waitlist for program participation. This waiver is approved for a maximum of approximately 7,913 beneficiaries per year. If there is a waitlist, access to the program is based on one’s date of application.

 

Application Process

To apply for the Medical Day Services Waiver, persons should contact their local Maryland Access Point (MAP) or call MAP at 1-844-627-5465. Persons can also contact the Adult Evaluation and Review Services (AERS) Program in their area to determine if they meet the functional eligibility criteria. The AERS Program is part of one’s local Health Department. See contact information for health departments by county.

Learn more about the MDC Services Waiver. Persons can also call the Maryland Department of Health at 410-767-1444 for more information. See a list of licensed adult day care centers participating in the program.

The Maryland Department of Health’s (MDH) Office of Long Term Services and Support (OLTSS) administers the Medical Day Care Services Waiver .

 

Approval Process & Timing

The Maryland Medicaid / Medical Assistance application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as wait-lists may exist, approved applicants may spend many months waiting to receive benefits.

 What are 1915(c) HCBS Medicaid Waivers?
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. Meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.

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