Adult Day Care Benefits in Illinois: Who Pays and How to Find Help

Who may pay for adult day care in Illinois

Adult day care is not one single benefit in Illinois. Payment depends on age, Medicaid status, disability status, Veteran status, location, the center, and the care plan.

Original Medicare usually does not pay for long-term care services in the community. Medicare lists adult day health care as a type of long-term care, and says Medicare and most health insurance do not pay for long-term care. A Medicare Advantage plan may offer extra benefits, but you must check the plan’s current rules.

The strongest public routes in Illinois are usually Medicaid waiver services, the Illinois Department on Aging Community Care Program, DHS-DRS services for some people under 60, VA health care for eligible Veterans, and local respite support through the aging network.

Adult day care can help a caregiver keep working because it covers part of the day when the person cannot safely be alone. It may also reduce the need for a full-time home aide. But it does not replace night care, emergency care, or 24-hour supervision.

If you are also trying to find out whether a family caregiver can be paid, see Can I get paid to be a caregiver? and the paid caregiver quiz. Adult day care pays the center. It usually does not pay the family caregiver directly.

Medicaid and waiver coverage

Community Care Program for adults age 60 and older

The Illinois Department on Aging runs the Community Care Program, often called CCP. CCP helps older adults who might otherwise need nursing home care stay in their homes and communities.

CCP services include care coordination, in-home service, adult day service, emergency home response, and automated medication dispenser service. Illinois says Adult Day Service is for older adults who want to stay in the community but cannot be home alone during the day because of a physical, social, or mental impairment.

As of the last check for this article, basic CCP eligibility listed by Illinois includes being age 60 or older, living in Illinois, meeting citizenship or eligible non-citizen rules, meeting the asset rule, having an assessed need for long-term care through the Determination of Need assessment, and applying for Medicaid if eligible.

The local Care Coordination Unit does the screening and care planning. The care plan is important. A center may exist near you, but payment usually depends on whether adult day service is approved in the person’s plan.

Persons who are Elderly waiver

The Persons who are Elderly waiver is an Illinois Medicaid home and community-based services waiver. Illinois HFS says it is a part of the Community Care Program and is run day to day by the Illinois Department on Aging.

This waiver may include Adult Day Service. It is for people age 60 or older who are at risk of nursing facility placement and meet Medicaid and other waiver rules. The state also looks at whether the person can be safely served in the home or community and whether the service cost is less than institutional care.

For a plain-English overview of waiver rules, see Medicaid HCBS waivers explained. If the family is worried about income, assets, or medical bills, also read Medicaid spend-down and Medicaid look-back period.

Managed care and MLTSS

Some Illinois Medicaid members get long-term services through a managed care organization. If your loved one has a HealthChoice Illinois plan, MLTSS, or another Medicaid managed care plan, call the plan and ask for the care coordinator.

Use these words: “My family member needs adult day service because they cannot be left alone during the day. Can you review the care plan and tell me what providers are covered?”

If you call the local Care Coordination Unit directly, tell them the person is in managed care. Have the plan name and member ID ready.

DHS-DRS Home Services Program for some people under 60

If the person is under age 60 and has a severe disability, the Illinois Department of Human Services Division of Rehabilitation Services may be the better first call. The Home Services Program helps some people with severe disabilities stay in their homes.

DHS lists Adult Day Care as one service under the Home Services Program. HFS also lists Adult Day Care under the Persons with Disabilities waiver. The route may depend on age, diagnosis, Medicaid status, disability status, and assessment.

Call DHS-DRS and ask for the Home Services Program. If the person turns 60 or is already over 60, DHS says to contact the Illinois Department on Aging.

VA adult day health care

VA Adult Day Health Care is different from many social adult day programs. VA says it is a daytime program for Veterans that may include social activities, peer support, recreation, and health services from nurses, therapists, social workers, and other staff.

VA says the program is for Veterans who need help with daily activities such as bathing, dressing, or meals, Veterans who are isolated, or Veterans whose caregivers are under strain. It may be offered at VA medical centers, State Veterans Homes, or community organizations.

Eligibility is not automatic. VA says enrolled Veterans may be eligible if they meet clinical criteria, the service is available, and community care rules apply when a community provider is used. A copay may apply based on service-connected disability status and financial information.

Start with the Veteran’s VA primary care team. Ask for the social worker or case manager. Also ask about VA respite care. VA respite may include a Veteran going to an adult day health care program while the family caregiver takes a break.

If the Veteran or surviving spouse may need cash help for care, read VA Aid and Attendance. That benefit is separate from VA Adult Day Health Care.

Dementia day programs

Illinois says some Adult Day Service centers may focus on people with Alzheimer’s disease and related disorders. Others may serve certain language or cultural groups.

Do not assume every center can handle wandering, exit-seeking, sundowning, aggression, or complex medical needs. Ask direct questions before you enroll.

If dementia care is the main issue, ask the Area Agency on Aging about caregiver training, respite, and local memory programs. A day program can help, but it must match the person’s real needs.

Transportation and meals

Illinois says Adult Day Service centers include nutritious lunches and snacks, and special diets are provided. Ask the center how they handle diabetes, swallowing problems, low-salt meals, food allergies, and religious or cultural food needs.

Transportation is a key issue. Some centers may offer rides. Some families may need help through the aging network, a Medicaid plan, a PACE site, VA, paratransit, or another local service. Do not sign up until you know how the person will get there and back.

Ask these questions early:

• Do you provide door-to-door rides?
• Can you handle a wheelchair, walker, oxygen, or memory loss?
• What time is pickup and drop-off?
• Who pays for transportation?
• What happens if the caregiver is not home at drop-off?

If transportation is the barrier, ask your local Area Agency on Aging, Caregiver Resource Center, Medicaid plan care coordinator, or VA social worker for help. You can also use the care cost calculator to compare adult day care with home care hours and unpaid time off work.

How to find a program

Step 1: Call the right Illinois office

For most adults age 60 or older, call the Illinois Senior HelpLine at 1-800-252-8966. Ask for the local Care Coordination Unit. The Care Coordination Unit is the local office that helps screen for Community Care Program services.

You can also use the Illinois Department on Aging provider map to find local providers. For adult day service under CCP, make sure the center participates in the program and can accept the payment route you are using.

Step 2: Ask for the exact payment path

When you speak with a center, do not only ask, “Do you take Medicaid?” Ask a more exact question:

“Do you accept Community Care Program Adult Day Service, the Persons who are Elderly waiver, Medicaid managed care, VA Adult Day Health Care, PACE, or private pay?”

If they say yes, ask who must approve it. It may be the Care Coordination Unit, the Medicaid plan, the VA, PACE, or another care manager.

Step 3: Ask about a trial day

Some centers may allow a visit or trial day. Ask what happens if the person refuses to go, becomes upset, needs a higher level of care, or misses several days.

Step 4: Keep proof of every call

Write down the date, time, person’s name, phone number, and what they said. Keep copies of assessment notices, care plans, approval letters, denial letters, and center paperwork.

For more help with calls, use caregiver phone scripts and caregiver checklists.

Questions to ask before enrolling

• Are you an Illinois Department on Aging Adult Day Service provider?
• Which payment routes do you accept?
• Who approves the service before we start?
• Is there a waitlist?
• What days and hours are open?
• Do you offer full-day and half-day options?
• What meals and snacks are included?
• Do you provide transportation?
• Can staff help with toileting, transfers, eating, walking, and medication supervision?
• Do you serve people with dementia?
• What health needs would be too much for your center?
• What is the private-pay daily rate if benefits are delayed?
• What papers do you need from the doctor?
• How do you report changes to the caregiver?
• What happens if my loved one is sick or misses a day?