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 elderly and disabled persons (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 from which program participants can choose.
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, which means meeting eligibility requirements does not equate to immediate receipt of program benefits. The waiver has a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms.
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).
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. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.
Benefits of the Medical Day Care Services Waiver
Medical day care facilities operate 5-7 days per week for 4-12 hours each day. The following services and supports are generally provided.
– 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 (65+) or younger (16-64) if disabled, at risk of nursing home placement, and not enrolled in another HCBS Medicaid Waiver Program. Disabled persons who enroll prior to turning 64 can continue to receive waiver services upon turning 65. Additional eligibility criteria for persons 65+ can be found below.
Financial Criteria: Income, Assets & Home Ownership
In 2021, 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.
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 from his/her applicant spouse and a community spouse resource allowance.
In 2021, 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 in 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. In other words, the look back period is not applicable.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, 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 to the home and his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse lives in the home.
– The applicant has a minor child living in the home.
– The applicant has a disabled relative living in the home.
To learn more about the potential of Medicaid taking the home, click here.
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.
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 relative to their income. 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, trusts are an option. Irrevocable Funeral Trusts 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 on 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 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 free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, prior bank statements, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.
The Medical Day Care Services Waiver is not an entitlement program, which means there may be a waitlist for program participation. This waiver is approved for a maximum of approximately 6,000 beneficiaries per year. If there is a waitlist, access to the program is based on one’s date of application.
To apply for the Medical Day Services Waiver, persons should contact their local Maryland Access Point (MAP). Contact information by county can be found here or persons can call 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. Contact information for health departments by county can be found here.
For additional information about the MDC Services Waiver, click here. Persons can also call 410-767-1444 to reach the Maryland Department of Health.
A list of licensed adult day care centers participating in the program can be found here.
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 even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, 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.