Adult day health care programs (ADHC) provide essential services for seniors and individuals with disabilities. ADHC programs offer medical supervision, therapy, and personal care. These programs allow participants to remain in their homes and receive necessary support. Many families worry about these services’ costs and whether Medicaid can help. This post explains how Medicaid contributes to Louisville’s adult day health care (ADHC) funding.
How Medicaid Helps Cover Cost for Adult Day Health Care Programs in Louisville
Kentucky Medicaid does not pay for ADHC outright. Instead, coverage is available through Home and Community-Based Services (HCBS) Waivers. These waivers help seniors who meet Nursing Facility Level of Care requirements stay at home rather than move into a nursing home.
The Home and Community-Based (HCB) Waiver is Kentucky’s primary Medicaid program that funds ADHC services. It works like a voucher, covering specific long-term care services for eligible individuals. However, it does not cover rent, utilities, or food. Because enrollment is limited, applicants may find themselves on a waitlist.
What Medicaid May Cover
If approved for the HCB Waiver, Medicaid may help pay for:
- Medical monitoring and supervision
- Physical, occupational, and speech therapy
- Personal care assistance with daily activities
- Case management to coordinate services
These services usually require a doctor’s recommendation.
What Medicaid Typically Does Not Cover
Medicaid generally does not pay for:
- Social and recreational activities
- Transportation to and from the facility
- Meals, unless they are medically necessary
Who Qualifies for the HCB Waiver?
Applicants must meet financial and functional requirements to qualify for Medicaid-funded ADHC in Kentucky.
Financial Requirements
As of 2025:
- A single applicant must have countable assets of $2,000 or less and a monthly income no higher than $2,901.
- Married couples have different limits depending on whether one or both spouses apply.
For married applicants:
- If both spouses apply, they can have a combined $4,000 in assets. Their combined income must be below $5,802 per month.
- The applicant can have $2,000 in assets if only one spouse applies. The non-applicant spouse can keep up to $157,920 under the Community Spouse Resource Allowance. The non-applicant’s income is not counted.
Functional Requirements
Medicaid also requires applicants to need a Nursing Facility Level of Care. They must require substantial assistance with daily activities or have a cognitive impairment such as Alzheimer’s disease. The state evaluates eligibility based on these needs.
How to Apply for Medicaid ADHC Coverage
Applying for the HCB Waiver takes time, and enrollment spots are limited. It’s best to apply as early as possible. Medicaid also enforces a 60-month look-back period, which means applicants cannot give away assets to qualify.
Here’s a detailed guide on how to apply for HCB Waiver.
What Can You Do Now?
Contact Kentucky Medicaid to check eligibility for the HCB Waiver, as spots are limited. If Medicaid isn’t an option, explore long-term care insurance, veterans’ benefits, or private pay. Connecting with local providers can also help you compare services and costs.
SpringHouse Senior Living offers adult day care and respite care for those who need extra support. Contact us to learn more about how we can help.
Spring House Senior Living
At Spring House, we understand that finding the right senior living community can be challenging. That’s why we offer a variety of amenities and services to cater to different needs and preferences. Schedule a tour of one of our communities in Cartersville, Lithia Springs, or Louisville today. You’ll see why Spring House is the ideal choice for senior living.
