Residential Care and Assisted Living Compendium: 2007. Flat Rates

11/30/2007

Under a flat rate system, providers receive the same monthly payment regardless of the amount of services and staff assistance a resident requires. As in the health care system, flat rates for residential care create incentives for facilities to admit residents with lighter care needs, rather than those with multiple impairments in ADLs, cognitive impairments, or health needs. Twelve states use flat rate reimbursements, examples of which are described below.

  • Florida pays facilities $32.20 a day for services provided through the waiver program and $9.28 a day for personal care services provided through the Medicaid state plan.

  • Massachusetts uses Group Adult Foster Care (GAFC) -- a Medicaid state plan service -- to cover services in residential care settings. Using the state plan to cover services allows Medicaid to serve people who are frail but are not eligible to enter a nursing home following a tightening of the LOC criteria. The state pays a flat daily service rate of $37.75 for Medicaid beneficiaries.

  • Colorado’s Medicaid monthly rate for services is $1474.98 a month ($47.58 a day). The rate covers oversight, personal care, homemaker, chore, and laundry services. The state limits room and board charges for Medicaid beneficiaries to $571 a month.

  • Georgia pays a flat rate of $35.04 a day for waiver services provided to residents of group homes serving 7-24 people. The state limits room and board charges for Medicaid beneficiaries to $528 for a combined monthly rate of $1,569.

  • Illinois has different daily service rates for each of its seven regions, ranging from $50.76 to $66.92.Rates are set at 60 percent of the weighted average nursing facility rate for the region and are adjusted annually to reflect changes in the rates paid to nursing homes.

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