Medicaid in Residential Care. Facility Charges

09/01/2013

One reason RCFs are attractive to residents and state policy makers is that they charge less than nursing homes. Although Medicaid cannot cover room and board in these facilities, it can cover services in RCFs. The NSRCF facility survey collected the average monthly base rate facilities generally charge residents, but it did not collect information on Medicaid payment rates.4 Among facilities, the mean of the average monthly base rate for a single individual living in a one-bedroom apartment (not designated as special dementia units) is $3,284, almost $500 higher than that for a single individual living in room designed for one person (not shown).5 In addition to this base rate, facilities often charge fees for additional services that are not a part of the base rate. For each resident sampled, the NSRCF also collected data on the total amount individual residents were charged, which includes the base rate as well as any charges for additional services the resident received.6 The average total charge for residents in RCFs regardless of living arrangement is $3,166.

Figure 2 presents the average monthly base rate charged by the facility for a one-bedroom apartment and a private room (not designated as special dementia units), by Medicaid status (the chart on the left).7 In addition, the figure presents, at the resident level, the average amount charged the sampled residents in the month prior to the survey, by Medicaid status (the chart on the right). Again, actual Medicaid reimbursement amounts are not available at either the facility or resident level. The monthly rate charged for a single individual living in a one-bedroom apartment or private room is significantly higher in non-Medicaid RCFs ($3,500 and $2,993, respectively) than in Medicaid RCFs ($2,912 for a one-bedroom apartment and $2,587 for a private room). Similarly, at the resident level, the average total charge to non-Medicaid residents in the month before the survey is significantly higher than the charge to Medicaid residents: non-Medicaid residents were charged approximately $1,200 per month more. These differences are statistically significant at both the facility and resident level.

FIGURE 2. Average Base Rate at the Facility Level and Average Total Amount Facility Charged Residents in the Month Prior to the Survey, by Medicaid Status 

FIGURE 2a shows the average facility charge for a one bedroom apartment and a one person room, by Medicaid status.  It also shows the average total charge for residents in the 30 days prior to the survey, resident Medicaid status. BAR CHART: A one bedroom apartment for a regular unit--Medicaid Facilities ($2,912), Non-Medicaid Facilities ($3,500), Total ($3,284); A room designed for one person for a regular unit--Medicaid Facilities ($2,587), Non-Medicaid Facilities ($2,993), Total ($2,811).

FIGURE 2b shows the average facility charge for a one bedroom apartment and a one person room, by Medicaid status.  It also shows the average total charge for residents in the 30 days prior to the survey, resident Medicaid status. BAR CHART: Total charges last month--Medicaid Facilities ($2,183), Non-Medicaid Facilities ($3,402), Total ($3,166).

SOURCE: RTI International analysis of the NSRCF.

NOTE: Differences shown are statistically significant at p<0.001.

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