Regulatory Review of Adult Day Services: Final Report - Section 1. Relevant Medicaid Contracting Requirements


Relevant Medicaid Contracting Requirements All states fund ADS for elderly persons through either their Medicaid State Plan or waiver program. State primarily use 1915(c) waivers; Tennessee is an exception using an 1115 waiver. Providers of Medicaid-funded ADS must meet all applicable regulatory requirements whether they include licensure, certification, or some other arrangement. Over one-third of the states require ADS providers to meet additional Medicaid provisions. Exhibit 4 indicates the states that have additional Medicaid requirements.

Additional Medicaid requirements are generally for ADS providers who furnish adult day health care services to waiver participants. Many of the states with additional Medicaid requirements license or certify adult day care only, while the Medicaid requirements are for adult day health care. These requirements, often health services, are in addition to those required for licensure and include additional staffing (type and number) and training. Some examples follow:

  • Maine defines adult day health services and more extensively addresses services, staffing, and monitoring by waiver providers. Adult day health services provided under the Medicaid State Plan have the same or similar requirements as the waiver program.
  • Mississippi's additional requirements for Aged and Disabled Waiver providers include more detailed parameters for who can and cannot be served by, for example, describing individuals who are inappropriate for adult day service programs.
  • Missouri licenses adult day care but has additional requirements for Aged and Disabled Waiver providers of adult day health care, including more extensive staffing (type and ratios) requirements.
  • Oklahoma licenses adult day care but has additional requirements for ADvantage Waiver Program providers, including the provision of services not mandatory for adult day care providers, such as physical, occupational, speech/language, and/or respiratory therapy.
  • South Carolina licenses adult day care services but has additional requirements for Community Long-Term Care Medicaid Waiver providers related to nursing staff-to-participant ratios and care managers.
EXHIBIT 4. Additional Medicaid Waiver and/or State Plan Adult Day Services Provider Requirements by State
State Additional
State Additional
Alabama   Montana  
Alaska X Nebraska X
Arizona X Nevadac X
Arkansas   New Hampshire X
Californiac X New Jersey X
Colorado   New Mexico X
Connecticut   New York  
Delaware X North Carolina  
District of Columbia X North Dakota X
Florida X Ohio X
Georgia X Oklahoma X
Hawaii   Oregon  
Idaho X Pennsylvania  
Illinois   Rhode Island  
Indiana   South Carolina X
Iowa   South Dakota  
Kansas X Tennessee  
Kentucky   Texas X
Louisianab   Utah  
Maine X Vermont X
Maryland X Virginia X
Massachusetts   Washington  
Michigan   West Virginia  
Minnesota X Wisconsin  
Mississippi X Wyoming  
Missouri X TOTAL 26


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