Medicaid in Residential Care. Conclusions


RCFs play an important role in state strategies to change the balance of the long-term services and supports system. Many states provide Medicaid coverage for services in RCFs through HCBS waivers, state plan personal care, and research and demonstration waivers. As a result, policy makers are increasingly interested in the characteristics of facilities that serve Medicaid residents and how they compare to non-Medicaid-participating facilities. In addition, to better understand the needs of residents, policy makers want to know more about the characteristics of Medicaid RCF residents and how they compare to non-Medicaid residents.

For many policy-relevant characteristics, Medicaid and non-Medicaid facilities and residents are similar, especially in terms of the ADL and IADL disability levels, the services offered and used, and the staffing available. Although a more detailed analysis would be required for a definitive answer, the lack of differences in staffing levels suggests that Medicaid residents are not disadvantaged relative to non-Medicaid residents in terms of the availability of facility personnel.

On four dimensions, however, there are important differences. First, Medicaid residents are more likely to be under age 65 and to have severe mental illness and intellectual and developmental disabilities; non-Medicaid residents are more likely to be aged 65 and older and to have Alzheimer's disease and other dementias. Consistent with that difference, non-Medicaid facilities are more likely to have dementia or Alzheimer's special care units or to exclusively serve people with Alzheimer's disease. A question for further research is how well equipped RCFs are to provide services to people with severe mental illness, intellectual and developmental disabilities, and Alzheimer's disease. Second, Medicaid residents are much more likely to have living arrangements that offer less privacy than non-Medicaid residents. In particular, almost half of Medicaid residents live in multiperson rooms compared to less than a quarter of non-Medicaid residents. Thus, Medicaid residents are less likely to live in "homelike" environments. Third, although Medicaid reimbursement levels are not available from the survey, data are available on facility charges. Although staffing levels are very similar, non-Medicaid facilities charge substantially more than Medicaid facilities, although the reasons for this difference is not clear. Fourth, and finally, Medicaid residents exhibit more behavioral problems and are prescribed more medications to control those behaviors than are non-Medicaid residents, raising questions about facility staffing and training levels in these facilities.

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