Residential Care and Assisted Living Compendium: 2007. Enabling Medicaid Beneficiaries to Pay for Room and Board

11/30/2007

Medicaid beneficiaries with limited income may not be able to pay residential care facilities’ room and board rates. As noted earlier, Medicaid pays for room and board only in institutions, except in limited circumstances such as for the provision of respite care and for meals served as part of a day care program. For Medicaid purposes, room and board comprises real estate costs (debt service, maintenance, utilities, and taxes) and food.The costs of preparing, serving and cleaning up after meals can be covered as a waiver service.

Although Medicaid beneficiaries are responsible for room and board costs, states have a range of options to make them affordable.

  • Limit the amount facilities can charge Medicaid clients for room and board to the federal SSI benefit, which in 2007 is $623 per month minus a small personal needs allowance (PNA);
  • Provide a state supplement to the SSI payment for persons living in residential care settings, and limit the amount that can be charged to the combined SSI plus state supplement payment;
  • Use the 300 percent of SSI standard for waiver eligibility and set the participants’ maintenance allowance at a level that allows residents to retain sufficient income to pay for room and board;
  • Provide housing subsidies for low income persons;
  • Allow family supplementation to increase the funds available for room and board, particularly to pay the difference in cost between a shared and a private room; and
  • Use the federal Food Stamp Program, when possible, to reduce board costs.

Each of these options is discussed below.

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