Residential Care and Assisted Living Compendium: 2007. Limiting the Amount Facilities Can Charge for Room and Board

11/30/2007

States can limit the amount that can be charged for room and board by setting a combined “rate” for Medicaid beneficiaries that includes service costs and room and board costs, but the state only pays for services. This approach essentially caps the room and board rate that Medicaid beneficiaries pay. Other states simply limit by policy the amount that facilities can charge Medicaid beneficiaries for room and board. See Table 1-11 for a list of states that limit room and board charges. Medicaid programs that specify how much facilities may charge Medicaid beneficiaries for room and board usually limit the charges to the state’s SSI payment for a single elderly beneficiary living in the community, plus a state supplement, if any. This approach guarantees that Medicaid beneficiaries can afford room and board costs in facilities that accept Medicaid. If providers feel that the room and board rate is too low to cover costs, they may decide not to admit Medicaid beneficiaries. Only New Jersey has passed a law requiring that facilities licensed after September 2001 set aside 10 percent of their units to serve Medicaid residents within three years after licensing.

  TABLE 1-11. States That Limit Room and Board Charges  
Arizona
Colorado
Delaware
District of Columbia  
Georgia
Hawaii
Idaho*
Illinois
Indiana
Maryland
Minnesota
Mississippi
Montana
Nebraska
New Jersey
New Mexico
North Carolina  
North Dakota
Ohio
Oregon
Pennsylvania
South Carolina  
South Dakota
Texas
Vermont
Washington
Wisconsin

* The limit is “suggested.”


Persons in residential care settings who qualify for SSI receive a basic federal SSI payment ($623 per month in 2007). In settings that do not have housing subsidies, they retain a PNA, typically $30 or higher as determined by the state, and the remaining income is paid to the facility for room and board. If the resident lives in a HUD 202 subsidized unit in which the tenant’s share of the costs for rent and utilities is limited to 30 percent of the resident’s income, the resident may have additional income that could be used to pay for services. If a person is SSI eligible and received $623 a month, they will pay 30 percent of this amount for rent ($186.90), and have $436.10 left over to pay for services or other costs depending on the state’s cost sharing provisions.

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