State Residential Care and Assisted Living Policy: 2004. TABLE 2-6. Comparison of State Reimbursement Policy

03/31/2005

  State   Coverage   Payment  
Method
  Rates   Rates
  Include  
R&B
R&B
  Limits  
Family
  Supplement  
Personal
Needs
  Allowance  
SSI
Payment
  Standard1  
  Date     Method  
AL NA Waiver submitted TBD $30.00 $564.00
AK 1993 Waiver Tiered $70.54-$93.70 N No No policy $100.00 $907.00
AZ 1989 Waiver Tiered $34.67-$87.10* Y $497.10 Y $66.90 $564.00
AR 1993
2003
State plan
Waiver
Care plan
Tiered
$790.40 cap
$39.51-$49.91
N No No policy $30.00 $564.00
CA Planning Planned TBD $111.00 $853.00
CO 1984
1987
Waiver
State funds
Flat $36.03/day N $518 Y $46.00 $564.00
CT 2003
NR
Waiver
State funds
Tiered $65/day cap N % of income* N $164.00 $1692 cap*
DE 1999 Waiver Tiered $940-$1460 N $598 N $106.00 $704.00
DC Approved Waiver TBD No policy $70.00 $564.00
FL 1997
2001
Waiver
State funds
Flat
Flat
$28/day
$9.28/day
N No Y $54.00 $642.40
GA 1981 Waiver Flat $31.04/day N $475 Y $89.00 $564.00
HI 2000 Waiver Flat $58.46/day* N $418 No policy $150.90 $568.90
ID 1999
2000
Waiver
State plan
State funds
Care plan
Care plan
Capped/NF cost
$921.92*
N
N
$497*
$497*
Y $67.00 $564.00
IL 1999 Waiver Regional variations $45.54-$61.94 N $474* N $90.00 $564.00
IN 2001 Waiver Tiered $45.86-$61.68 N $512 No policy $52.00 $564.00
IA 1990 Waiver Care plan Cap of $1,025 N No Y $30.00 $564.00
KS 1997 Waiver Care plan Varies N No Y $30.00 $564.00
KY NA   NS $906.00
LA NA Planned   NS $564.00
ME 1970s
1990
State funds
State plan
Waiver
Care plan
Cost based/ case-mix
Varies & % of income Y $50.00 $574.00
MD 1993
1986
Waiver
State funds
Tiered $1611-$2031* Y $420 N $60.00 $564.00
MA 1992 State plan Flat $37.75 per day N N No policy NS $1018.00
MI 1983 State plan Flat $174.38 N N Y $44.00 $724.30*
$721.50
MN 1988
1991
Waiver
State funds
Case-mix $1029-$2392* N $674 Y $72.00 $752.00
MS 2001 Waiver Flat $33.18/day N $520 No policy $44.00 $564.00
MO 1993
1973
State plan
State funds
Care plan Varies/capped at NF cost N N Y $25.00 $720.00
$856.00
MT 1994 Waiver Care plan $520-$1800* N $525   $100.00 $625.00
NE 1998 Waiver Flat (rural/urban variations) $1520-2150* Y $504 N $60.00 $564.00
NV 1993 Waiver Flat $20, $45, $60/day N N No policy $88.00 $914.00
NH 1999 Waiver Flat $50/day
$1250/month*
N
Y
N
Y
Y $50.00 $758.00
NJ 1997 Waiver Setting* $2130.55-$2430.55 Y $631.50 Y $80.50 $714.05
NM 1996 Waiver Flat $50.50/day N $1024 No policy $30.00 $664.00
NY   State plan Case-mix Varies by county and case-mix N N Y $70.00*
$115.00
$969.00-
$999.00*
NC 1995 State plan Case-mix Varies/$49.62 max* N $1066 Y $46.00 $1132.00
ND   Waiver
State funds
Care plan
Care plan
$80/day cap
$40/day cap
N
N
$375
NR
Y
Y
$60
NS
$564.00
OH NA   $50.00 $850.00
OK NA   $50.00 $564.00
OR 1990 Waiver Tiered $1144-$2399 Y $455.70 N $110.00 $565.70
PA 2000 Waiver demo Care plan Cap 80% of NF N $898.30 N $60.00 $958.30
RI  
1999
Waiver Flat
Flat
$37/day*
$1400
N
Y
N
N
N $100.00 $1159.00
SC 2002 State plan Flat $12.80/day N $865.00 N $47.00 $912.00
SD 1988 State funds
Waiver
Flat
Flat
$1094
$43.92/day
Y $534.00 N $30.00 $1094.00
$564.00
TN NA   NS $564.00
TX 1994
1985
Waiver
State funds
Tiered $23.21-
$59.88/day
N $479 N $85.00 $564.00
UT 2000 1915 (a) Negotiated Negotiated Y NA Y $45.00 $560.00
VA* NA   $62.00 $833.00-
$958.00
VT 1996
1999
Waiver
State plan
Tiered
Flat
$42-$55
$30.25*
N $564 N $47.76 $592.66 III
$735.94 IV
WA 1991 Waiver Tiered See summary Y $453.16 N $58.84 $564.00
WV 2004 Waiver approved $69.00 $627.00
WI 1997 Waiver
State funds
Care plan
Care plan
Cap $77.81*
No cap
N $626.77 Y $65.00-
$240.00
$647.78*
WY 2001 Waiver Tiered $32-$40/day N N No policy NS $564.00
GENERAL NOTES:
TBD: To be determined
NR: Not reported
NA: Not applicable
NS: Not specified
  1. SSI Payment standard includes a state supplement, if available. The standards include an amount retained by the beneficiary as a personal needs allowance (PNA). The PNA varies by state.

AZ: Payments vary by three levels of care and by setting: adult family care, assisted living homes, assisted living centers.
CT: Pilot program with the Housing Finance Agency to create affordable assisted living. The SSI rate in residential care homes is based on the rate for the facility but cannot exceed $1,692 less a personal needs allowance of $90.70. The payment is lower in the assisted living pilot. The PNA is $164 and there is a meal allowance of $300 and up to a $400 allowance for rent.
HI: This rate is for facilities of six or more beds; the rate for five or less is $1066.90.
ID: The room and board amount is a suggested cap. State plan service cap is based on a rate of $13.40 an hour, maximum 16 hours per week.
IL: In addition to the Medicaid payment, participating facilities receive an average of $97 a month in food stamp benefits.
MD: Additional amounts are allowed for assistive equipment and environmental modifications which may be more likely to be applied to in-home settings.
MI: Payment rate for Homes for Aged is $724.30; Adult Family Care, $721.50. PNA is the same for both categories.
MN: Statewide average costs with caps that vary by county.
MT: Actual rate depends on a scoring of functional needs.
NE: Rates vary by urban/rural and single/double occupancy.
NH: Elderly housing with services sites receive $50 a day; licensed facilities receive $1,250 a month.
NY: Payment standards and the PNA varies by groupings of counties.
NC: Rate varies using a base rate and additional components determined by the combination of ADL needs.
RI: A regular waiver and a pilot program are operating. The room and board charge for both programs is set by the facility. The regular waiver pays the difference between $1,400 and the room and board charge. Room and board is not related to the Medicaid payment under the pilot waiver. SSI beneficiaries participating in the two waivers retain a PNA of $100. SSI beneficiaries not in the waiver retain a PNA of $55. Facilities receive one month prospective payment and would hold the unit for the remainder of the month.
VA: The state continues to support residents with state funds who were formerly covered by a Medicaid waiver that was not renewed. The SSI benefit varies by grouping of the counties.
VT: $30.25 for residents receiving Assistive Community Care Services (ACCS); the higher tiers include ACCS and Medicaid waiver services. Room and board of $564 is allowed in facilities participating in the ACCS program. The SSI rates for Level III and IV are in facilities that do not participate in ACCS.
WI: Actual rates negotiated by counties. Cap is based on 85 percent of the cost of nursing facility care. Family supplementation allowed by the state agency; counties set their own policy. PNA amounts are also set by counties. Residents in certified RCACs may qualify for an additional state supplement of $95.99 if they have exceptional needs.
WV: A pilot program in public housing in four counties was approved in August 2004.

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