Texas Medicaid Adult Day Care for Seniors under Day Activity and Health Services (DAHS)

Last updated: March 04, 2024

 

Overview of Texas’ Day Activity and Health Services

Texas’ Day Activity and Health Services (DAHS) provides weekday daytime care in adult day care centers. Intended as an alternative to unnecessary nursing home admissions, DAHS is for persons 18+ years old with chronic medical conditions. Examples of such conditions may include arthritis, Alzheimer’s disease, diabetes, hypertension, vascular disease, and back problems. Statewide, adult day care centers provide eligible persons with supervision, meals, physical rehabilitation, nursing services, and personal care assistance (i.e., assistance with mobility, toileting, eating). While Day Activity and Health Services are available to Medicaid-eligible adults and seniors, the state also makes this service available to persons who are not eligible for Medicaid.

Many home and community based services (HCBS) Medicaid programs allow program participants to self-direct their own care, specifically allowing them to hire their own caregiver. This is not an option through Day Activity and Health Services. Program participants, however, are able to select which adult day care center to attend from the facilities that serve their area.

DAHS is an entitlement. This means if an applicant meets all of the state’s eligibility criteria, they are guaranteed to receive assistance. Unfortunately, there could potentially be a wait list if an adult day care center is operating at full capacity. If there is a waitlist at one’s desired facility, the applicant could select another facility in their area that has space for new participants.

Program participants must reside in their own home, the home of a friend or relative, or an adult foster care home. Program rules do not specify if one can live in an assisted living facility and receive DAHS.

Day Activity and Health Services is available through Texas’ State Plan Medicaid Program. Persons who are not Medicaid-eligible can access DAHS through Community Care Services Eligibility (CCSE).

 Seniors do not have to be eligible for Texas Medicaid to receive Day Activity and Health Services.

 

Benefits of Texas’ Day Activity and Health Services

Day Activity and Health Services facilities must be open Monday – Friday for a minimum of 10 hours each day (with the exception of holidays). Benefits, which are based on an individual’s service plan, may include the following services and supports.

– Activities – recreational, social, educational
– Meal / Snacks / Special Diets
– Nursing Services – i.e., administering medications, evaluating health status
– Personal Care Assistance
– Physical Rehabilitation
– Transportation – to / from the facility

 

Eligibility Requirements for Texas’ Day Activity and Health Services

Day Activity and Health Services are available to Texas residents 18+ years old who have a chronic medical condition. They must have a doctor’s order identifying the condition and verifying that DAHS is needed. To access DAHS via Texas’ Regular State Plan Medicaid, an applicant must be eligible for SSI (Supplemental Security Income). Texans who are eligible for SSI are automatically enrolled in Medicaid. While the focus of this page is Medicaid-funded DAHS, financial eligibility criteria for persons not eligible for Medicaid are included below. Additional eligibility criteria for DAHS follows and is accurate for 2024.

 

Financial Criteria: Income, Assets & Home Ownership

Income
To be eligible for SSI, and hence Texas’ Regular State Plan Medicaid, an individual must have income under $943 / month. Married couples, regardless of if one or both spouses are applicants, must have income under $1,415 / month.

To access DAHS through Community Care Services Eligibility (CCSE), which is the non-Medicaid pathway, an individual must have income under $2,829 / month. A couple (regardless of if one or both spouses are applicants) is $5,658 / month.

 There are other avenues through which Texas seniors might be financially eligible for Day Activity and Health Services (DAHS). Persons enrolled in the STAR+PLUS HCBS Waiver have access to DAHS. Persons who qualify via the waiver program are allowed a higher monthly income than those who qualify via the Regular State Medicaid plan. Furthermore, a non-applicant spouse may be entitled to a Monthly Maintenance Needs Allowance and a Community Spouse Resource Allowance.

Assets
The asset limit for SSI (and Regular State Plan Medicaid in Texas) is $2,000 for a single applicant. For couples, the asset limit is $3,000 (regardless of whether one spouse or both are applicants).

An applicant who is not eligible for TX Medicaid and is applying through CCSE, is limited to $5,000 in assets. A couple is limited to $6,000 in assets (regardless of if one or both spouses are applicants).

Some assets are not counted towards the 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 Texas’ Regular Medicaid program.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Applicants for Texas’ Regular State Plan Medicaid need not worry. For eligibility for this program, the home is exempt (non-countable) given the applicant (or their spouse) lives in it. Note that there are other Texas Medicaid programs, such as the STAR+PLUS HCBS Waiver and Nursing Home Medicaid, that have more rules when it comes to home exemption. Learn more here.

 

Medical Criteria: Functional Need

While many long-term care Medicaid programs require an applicant need a Nursing Facility Level of Care (NFLOC), Day Activity and Health Services does not. Instead, an applicant must have one or more functional limitations. To make this determination, a health assessment of one’s medical needs is completed. One area of consideration is one’s ability / inability to independently complete their Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, eating, toileting, bathing). Relevant to some persons with Alzheimer’s disease or a related dementia, problematic behaviors, such as wandering and socially inappropriate or disruptive behavior, are also considered. To be clear, a diagnosis of dementia in and of itself does not mean one will meet the level of care need.

 Learn more about long-term care Medicaid in Texas.

 

Qualifying When Over the Limits

In Texas, for a senior to be eligible for Regular State Plan Medicaid, they must be eligible for SSI. Medicaid eligibility is automatically established when one is approved for SSI. While many Medicaid programs have alternative pathways to Medicaid eligibility, seniors applying for Regular State Plan Medicaid do not have another option. Therefore, if over the income and / or asset limit(s) for SSI, Medicaid planning strategies to help persons who would otherwise be ineligible for Medicaid to become eligible is not feasible. However, TX has another Medicaid program, STAR+PLUS HCBS that provides long-term care for persons who require a Nursing Home Level of Care and it does not limit eligibility to persons enrolled in SSI.

 

How to Apply for Texas’ Day Activity and Health Services

Before You Apply

To receive Medicaid-funded Day Activity and Health Services, one must be eligible for Texas’ Regular State Plan Medicaid. To be eligible, seniors must be eligible for SSI. Approval for SSI benefits is automatic approval for Medicaid. This means one is automatically sent a Medicaid benefit card when approved for SSI. To be clear, seniors do not apply for State Plan Medicaid via Texas Health and Human Services Commission (HHSC). Persons apply for SSI benefits (and hence, Medicaid benefits) via the Social Security Administration. Learn how to apply for SSI here. Once enrolled in SSI (and hence, Medicaid), persons can inquire about DAHS. Persons already receiving SSI (and hence, Medicaid), should contact the Medicaid agency to inquire about DAHS.

Seniors not eligible for Texas’ Regular State Plan Medicaid can apply for DAHS via Community Care Services. This can be done at Your Texas Benefits, or by calling 2-1-1 or 877-541-7905 (select your language and then option #2). Alternatively, they can apply in person at their local office.

Learn more about Day Activity and Health Services here. People can see a directory of Day Activity and Health Services facilities here and scroll down to “Texas DAHS Directory”.

The Texas Health and Human Services Commission (HHSC), an agency within Texas Health and Human Services (HHS), administers the Day Activity and Health Services Program. HHSC licenses and certifies DAHS facilities as adult day care centers.

 

Approval Process & Timing

The SSI / Medicaid application process takes approximately 3 to 5 months. This includes the several weeks it generally takes one to complete the SSI application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process can be delayed even further.

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