Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Identifying and Addressing Administrative and Legal Barriers


States need to analyze their Medicaid regulations and administrative policies to identify any institutional bias that might make it difficult or impossible for some people living in nursing homes to be served in the community. For example, if a state does not use the 300 percent of SSI income rule for its HCBS waiver program, some institutional residents will not meet the financial eligibility criteria for waiver services, even though they can be appropriately served in the community. (See Chapter 2 for a discussion of Medicaid’s financial eligibility rules.)

In addition, if Medicaid’s maintenance needs allowance is too low to permit individuals to pay for room and board costs in the community, nursing home residents may be unable, simply for financial reasons, to transition to the community--whether to an independent living arrangement or a residential care facility. (See Chapter 2 for a discussion about financial criteria and Chapter 5 for a discussion of state policies to help Medicaid beneficiaries afford room and board costs.)

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