State Residential Care and Assisted Living Policy: 2004. Notes

03/31/2005

  1. The data were reported by state licensing agencies. Partial information was reported for some categories in Delaware, Kentucky, Minnesota, New Jersey, New York, New Mexico and West Virginia. (See Table 2-1 in Section 2 for each state's information.) While these numbers do not include facilities licensed by state Mental Retardation/Developmental Disabilities (MR/DD) agencies, some individuals with MR/DD may be living in facilities licensed as residential care/assisted living.

  2. The number of residents receiving Medicaid in residential care settings is slightly underreported because it does not include data from Kansas. Kansas' reporting system does not differentiate between waiver clients served in their own homes and those served in residential care settings. Additionally, Alabama and the District of Columbia have not yet implemented approved 1915(c) waivers.

  3. The six states were Florida, Minnesota, Oregon, North Carolina, Texas, and Wisconsin. Oregon is the only state of the six that requires assisted living providers to offer private apartments. (See Janet O'Keeffe, Christine O'Keeffe, and Shula Bernard. Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Report prepared for the U.S. Department of Health and Human Services, Office of Disability, Aging, and Long-Term Care Policy. [http://aspe.hhs.gov/daltcp/reports/med4rcs.htm])

  4. 42 U.S.C. 1396r.

  5. Wendy Fearnside, Program and Planning Analyst, Bureau of Aging and Long Term Care Resources, Wisconsin Department of Health and Family Services.

  6. Catherine Hawes, Ph.D. and Charles D. Phillips, Ph.D., M.P.H. A National Study of Assisted Living for the Frail Elderly: Final Summary Report. Texas A&M University System Health Science Center. US DHHS, Office of the Assistant Secretary for Planning and Evaluation, contract number HHS-100-94-0024 and HHS-100-98-0013. November 2000. [http://aspe.hhs.gov/daltcp/reports/finales.htm]

  7. Oregon defines a "unit" as an individual living space constructed as a completely private apartment, including living and sleeping space, kitchen area, bathroom and adequate storage areas.

  8. Ruth Gulyas. The Not-for-Profit Assisted Living Industry: 1997 Profile. American Association of Homes and Services for the Aging. Washington DC. 1997. Also, 2000 Overview of the Assisted Living Industry. The Assisted Living Federation of America and Coopers and Lybrand. Washington, DC. 2000.

  9. Ronald K. Tinsely, Robert G. Kramer, et al. Overview of the Assisted Living Industry. Assisted Living Federation of America. Fairfax, VA. 2000.

  10. Hawes et al., op. cit.

  11. National Survey of Assisted Living Residents: Who Is The Customer? National Investment Conference and the Assisted Living Federation of America. Washington, DC. 1998.

  12. "Assisted Living: Quality of Care and Consumer Protection Issues." GAO. T HEHS-99-111. April 26, 1999.

  13. Some state summaries do not include this information because it was not readily available.

  14. _____. Assisted Living: Examples of State Efforts to Implement Consumer Protections. U.S. General Accounting Office. GAO-04-684. Washington, DC. April 2004.

  15. Thomas Clark, Director of Professional Affairs for the American Society of Consulting Pharmacists Medication Use and Pharmacist Impact in Assisted Living Facilities, located at http://www.ascp.com/public/pr/assisted/2003/rximpact.pdf.

  16. The Beer's List identifies medications to avoid or use within specified dose and duration ranges for elderly persons, and medications to avoid in elderly persons with specific diseases.

  17. Due to rounding, the percentages add to 102.

  18. Catherine Hawes, Ph.D., et al. op.cit.

  19. The Board of Directors comprises representatives from four consumer or advocacy groups (AARP, Paralyzed Veterans of America, Alzheimer's Association, Consumer Consortium on Assisted Living); four provider associations (American Association of Homes and Services for the Aging, Assisted Living Federation of America, American Seniors Housing Association and National Center for Assisted Living); and three representatives from professional organizations or associations (National Cooperative Bank Development Corporation, the Pioneer Network, America Assisted Living Nurses Association).

  20. Medicaid spending for services delivered in residential care settings is not reported separately.

  21. Data provided by Brian Burwell, The MEDSTAT Group. Memorandum, 2004.

  22. Jones, A. "The National Nursing Home Survey: 1999." National Center for Health Statistics. Vital Statistics 13(15) 2002.

  23. Rhoades, Jeffrey A. and Krauss, Nancy A. Nursing Home Trends, 1987-1996. Rockville, MD: Agency for Health Care Policy and Research; 1999. MEPS Chartbook No. 3. AHCPR Pub. No. 99-0032.

  24. American Health Care Association. Based on CMS-OSCAR form 671:F41-F43. 2003.

  25. States can use either a fixed per capita amount for each beneficiary or they can average expenditures across waiver beneficiaries. The latter method provides more flexibility because it allows some beneficiaries to exceed the nursing facility cost as long as costs for others in the program are lower and the average waiver cost does not exceed the average nursing facility cost. States have the option of setting a cap on waiver services at a percentage of nursing home costs (e.g., 80 percent).

  26. Except in 209(b) states which have a Medicaid income eligibility threshold that is lower than the federal SSI payment.

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

  28. Many states have a state supplement for residential care settings that may be too low to cover more intense services needs and higher capital costs in some residential care settings.

  29. See http://www.ssa.gov/pubs/statessi.html.

  30. Stone. J.L. (2002). Medicaid: Eligibility for the Aged and Disabled. Congressional Research Service. Report prepared for Members and Committees of Congress.

  31. For further information, see: "A Technical Assistance Guide for Housing Resources and Strategies," prepared by the Technical Assistance Collaborative Inc. for the Rutgers Center for State Health Policy Community Living Exchange Collaborative, funded by CMS to assist Real Choice Systems Change Grantees. http://www.nashp.org/Files/Final_Regional_Forum_guide.pdf. Also, Ruth A. Gulyas. How States Have Created Affordable Assisted Living: What Advocates and Policymakers Need to Know. AARP. Washington, DC.

  32. Payments in 209(b) states might affect Medicaid eligibility since it is not linked to SSI eligibility.

  33. Medicaid Eligibility Groups and Less Restrictive Methods of Determining Countable Income and Resources. CMS memorandum. 5/11/2001.

  34. Some of the information in this section is taken directly from Smith, O'Keeffe, et al., Medicaid Home and Community Services: A Primer. [http://aspe.hhs.gov/daltcp/reports/primer.htm]

  35. Wisconsin has a special waiver to assure community placement for individuals who want to transfer when their nursing home closes.

  36. Stone. J.L. (2002). Medicaid: Eligibility for the Aged and Disabled. Congressional Research Services. Report prepared for Members and Committees of Congress.

  37. Robert Jenkens, Deputy Director, Coming Home Program, Vice President, NCB Development Corporation. Personal communication, June 2004.

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