State Residential Care and Assisted Living Policy: 2004. Limitations of Using Waiver Programs to Cover Services in Residential Care and How States Have Addressed Them

03/31/2005

A major challenge facing policymakers who support a comprehensive range of home and community services is finding the resources to expand their availability. Waiver services are not an entitlement and most waiver programs operate with a specific appropriation based on a number of budgeted "slots." Although states may cover services in residential care settings through a waiver program, limited slots may lead to a waiting list for services. On the other hand, nursing home care is an entitlement, and its budget is likely to rise each year through rate increases. In the event of a budget deficit, non-entitlement services are the most vulnerable to budget cuts. States are addressing this issue in several ways.

  • Colorado, Oregon and Washington have shifted resources from institutions to home and community services by creating a single appropriation for long-term care services, sometimes called "pooled funding" or "unified funding."

  • Arizona, Florida, Massachusetts, Minnesota, New York, Texas, Utah, Wisconsin and states with PACE programs have capitated funding for long-term care services, which gives contracting organizations the flexibility to approve the most appropriate service for beneficiaries.

  • Kansas, Maryland, and Texas have adopted a "Money Follows The Person" policy, which allows funding appropriated for nursing homes to be spent on home and community services for individuals who relocate from a nursing home. Texas has a one year waiting list for waiver services. Since they adopted this policy in 2001, the state has relocated 3,400 people from nursing homes to community settings. Twenty-six percent moved to their own home; 37 percent moved in with family members; and 32 percent moved to a residential care setting.

  • Illinois uses funds from its nursing home appropriation in a demonstration waiver program that provides services for residents of Supportive Living Facilities (SLFs). The program was built on the premise that about 10 percent of nursing home residents could be served in residential care settings with access to supportive services 24 hours a day. Because the program is funded from the nursing home budget rather than the waiver budget, the state is able fund all approved SLF slots and there is no waiting list. Although the waiver was approved to serve 5,000 participants, in November 2001, the state placed a moratorium on new SLFs due to budget difficulties, which is still in effect.

  • Vermont enacted a law in 1996 allowing the Department of Aging and Disabilities to shift funding for 234 nursing home beds over 4 years to fund home and community services. It has allowed the Department to increase HCBS waiver slots for in-home and residential care settings, with priority for people at immediate risk of nursing home placement. Funds redirected but not spent remain available for home and community services in subsequent years. During the first 3 years of the program, 200 nursing home beds were taken off-line. Since enactment, spending on home and community services rose from 11.6 percent of total long-term care spending to 31 percent in 2002.

All of these financing strategies give states a mechanism to assure that people who can be served in the community are not required to stay in nursing homes because of a waiting list for waiver services.

View full report

Preview
Download

"04alcom.pdf" (pdf, 212.04Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom1.pdf" (pdf, 654.07Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom2.pdf" (pdf, 566.6Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-AK.pdf" (pdf, 189.06Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-AL.pdf" (pdf, 185.52Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-AR.pdf" (pdf, 417.61Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-AZ.pdf" (pdf, 194.53Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-CA.pdf" (pdf, 185.56Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-CO.pdf" (pdf, 190.03Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-CT.pdf" (pdf, 191.73Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-DC.pdf" (pdf, 174.39Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-DE.pdf" (pdf, 181.57Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-FL.pdf" (pdf, 214.18Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-GA.pdf" (pdf, 188.2Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-HI.pdf" (pdf, 174.09Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-IA.pdf" (pdf, 180.15Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-ID.pdf" (pdf, 194.3Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-IL.pdf" (pdf, 211.87Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-IN.pdf" (pdf, 191.49Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-KS.pdf" (pdf, 185.93Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-KY.pdf" (pdf, 181.73Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-LA.pdf" (pdf, 175.83Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-MA.pdf" (pdf, 194.61Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-MD.pdf" (pdf, 191.88Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-ME.pdf" (pdf, 197.55Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-MI.pdf" (pdf, 197.84Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-MN.pdf" (pdf, 197.76Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-MO.pdf" (pdf, 186.65Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-MS.pdf" (pdf, 178.68Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-MT.pdf" (pdf, 625.75Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-NC.pdf" (pdf, 632.84Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-ND.pdf" (pdf, 632.04Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-NE.pdf" (pdf, 633.94Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-NH.pdf" (pdf, 622.4Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-NJ.pdf" (pdf, 630.32Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-NM.pdf" (pdf, 624.59Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-NV.pdf" (pdf, 625.02Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-NY.pdf" (pdf, 671.88Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-OH.pdf" (pdf, 617.34Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-OK.pdf" (pdf, 626.4Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-OR.pdf" (pdf, 648.61Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-PA.pdf" (pdf, 611.04Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-RI.pdf" (pdf, 625.46Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-SC.pdf" (pdf, 623.16Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-SD.pdf" (pdf, 624.49Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-TN.pdf" (pdf, 622.33Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-TX.pdf" (pdf, 636.97Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-UT.pdf" (pdf, 621.24Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-VA.pdf" (pdf, 629.52Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-VT.pdf" (pdf, 658.07Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-WA.pdf" (pdf, 677.93Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-WI.pdf" (pdf, 642.21Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-WV.pdf" (pdf, 629.83Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"04alcom-WY.pdf" (pdf, 623.59Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®