Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Enabling Medicaid Beneficiaries to Pay for Room and Board


Medicaid beneficiaries with limited income may not be able to afford the room and board rates in residential care settings, unless states take specific steps to make them affordable. As noted earlier, Medicaid pays for room and board only in institutions, except in limited circumstances, for example, when providing respite care. For Medicaid purposes, room and board comprises real estate costs (debt service; building maintenance, upkeep, and improvements; utilities; and taxes) and food.36 The costs of preparing, serving, and cleaning up after meals can be covered as a waiver service.37

Although Medicaid beneficiaries are responsible for paying for room and board, states have a range of options to help make the costs affordable.

  • Limit the amount facilities can charge Medicaid clients for room and board to the Federal SSI benefit, which in 2010 is $674 per month minus a small personal needs allowance.

  • Provide a state supplement to the SSI payment for persons living in residential care settings, and limit the amount these settings can charge to the combined SSI plus state supplement payment.

  • Use the 300 percent of SSI standard for HCBS waiver eligibility, and set the maintenance allowance at a level that allows residents to retain sufficient income to pay for room and board.

  • Allow family supplementation to increase the funds available for room and board, particularly to pay the difference in cost between a shared and a private room.

Each of these options is discussed below.

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