Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Definitions and Terminology


The service systems for different populations use very different and sometimes contradictory terms to describe non-institutional provider-operated residential care settings. In the service system for older adults and younger adults with physical disabilities, the generic terms traditionally used for these settings are foster care and residentialor congregate care. Consumer preference for the assisted living model of residential care--which provides both privacy and autonomy--has led providers to market all types of residential care settings as assisted living--whether or not they provide private units or operate with a service philosophy that ensures resident autonomy. Thus, assisted living has become a generic term for many different types of residential care settings for older adults.9

Because states regulate residential care settings, the terms they use for them vary considerably. For example, states use 31 different names for adult foster care, including adult family home, family care rest home, adult residential care home, elder group home, and assisted living establishment, to name but a few.

In the service system for people of all ages with developmental disabilities, the generic term residential settings includes the entire range of living options: institutions (ICFs/ID), provider-owned and/or -operated facilities such as group homes, foster care, a family member’s home, and a person’s own home. The ID/DD system also uses the term community residential program, which may include both community (i.e., small) ICFs/ID as well as group homes. As with the aging services system, states have hundreds of different names for ID/DD residential programs, including residential habilitation facilities, group residences, or residential treatment facilities, among others.

The enormous variability in the terms states use for the same or similar residential care settings can create considerable confusion. Therefore, this Primer will use the terms defined in the Box below.

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