Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Cost Sharing Requirements

12/01/2003

Persons in Group B who are receiving waiver services must share the cost of services if income remains after certain deductions. These deductions are:

  1. A Personal Maintenance Allowance, which is a combination of three items:

    • the basic needs allowance ($732) for room and board and personal expenses
    • the earned income disregard (first $65 and one half of the remainder)
    • a $20 disregard
    • a special housing amount (which equals certain housing costs in excess of $350 per month, including rent or mortgage payments, insurance, property tax, utilities). For people in residential care facilities, the state "carves out" the rent from the facility's room and board costs. The amount carved out is similar to the housing expenses allowed for other waiver participants.
  2. A Family Maintenance Allowance.

  3. Exempt income (e.g., to pay court ordered expenses such as child support).

  4. Health insurance premiums.

  5. Out-of-pocket medical remedial expenses.

Allowable deductions cannot exceed $1,114. Income over this amount is the cost sharing obligation.

Individuals residing in Community Based Residential Facilities or Residential Care Apartment Complexes are permitted to keep a discretionary allowance to cover incidental personal expenses.5 The counties determine the amount they are allowed to keep. The minimum and typical amount is $65 per month, the maximum permitted is $240 per month.

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