Residential Care and Assisted Living Compendium: 2007. Impact in Subsidized Housing

11/30/2007

HUD’s housing subsidy rules do not allow residential care settings to impose an additional charge for rent and utilities, but they can charge the resident for board (i.e., meal costs), or for services that are not covered by the Medicaid state plan or waiver program in a residential care setting. The amount of the permitted meal charge depends on the scope of the Medicaid service payment (i.e., whether it includes the cost of meal preparation). In all cases, Medicaid may not pay for food.27

Under HCBS waivers, the cost of preparing and serving food may be covered under the service payment. If preparing and serving meals is covered, the meal cost charged to tenants would be lower. If not, charges for a meal program would include the food, its preparation, serving, and cleaning up after meals. States covering personal care in residential care settings under the state plan may also allow payment for the preparation and serving of meals but not for the cost of food.

Medicaid beneficiaries with incomes over the SSI level must contribute income above the amount of room and board (minus a small PNA) to pay for services. Medicaid then pays the difference between the resident’s payment and the maximum service rate. Because beneficiaries in this category have more income than SSI beneficiaries, when they live in subsidized units, they will pay a higher rent, because the rent is calculated as a percentage of income. They also may have more income available to pay for services after the rental payment is made.


27. Capitated programs have more flexibility to pay for room and board costs than is allowed under standard Medicaid rules).

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