Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Residential Care Facilities

10/29/2010

For individuals who live in residential care facilities--whatever their age or type of disability--in order to receive waiver services, the facility must be specifically included as a setting for service provision in the state’s waiver program. As noted earlier, states must have licensure, certification, or some other standards for their operation, including required provider qualifications and methods to ensure facility oversight and monitoring. States must include a description of these standards and provider qualifications in the HCBS waiver application.19 HCBS waiver requirements include “portability,” that is, the service funding is an individual benefit for the beneficiary and is not tied to the facility; individuals can move from one type of setting to another as their needs change. States may also use the State Plan Personal Care optional benefit to provide personal care in these facilities, as does North Carolina. However, Medicaid personal care services cannot duplicate or replace services that are part of the residential care facilities’ existing service package. They can only be used to supplement existing services.

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