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


Anyone who is eligible for SSI is automatically eligible for Medicaid. If the family of a resident in a Community Based Residential Facility makes a payment directly to the facility for a private room, the SSI payment will be reduced by one third, and the family must make up this difference as well as paying the additional cost for the private room.

If someone is not eligible for SSI, the Medicaid program does not consider money paid to a Community Based Residential Facility for a private room to be in-kind income to the Medicaid beneficiary because the payment is not made in return for a service. Medicaid only considers in-kind payments to be income to the beneficiary if they are "regular, predictable, and in return for a service."

In Wisconsin, family members often make voluntary contributions to cover room and board, or the cost of a private room in residential care facilities, or to provide service enhancements, i.e., to pay for something individuals would not be getting under Medicaid, such as monthly hairdressing services.

There is some disagreement at the county level about allowing voluntary family contributions. Some counties fear that it can set a precedent and an expectation, and that some Community Based Residential Facilities and Residential Care Apartment Complexes might start to require it. Even though federal law prohibits such requirements, there is no way for the counties to monitor facility practices. If a family chooses to contribute, some counties require documentation in writing that if the contribution stops, it will not be picked up by any other public funding source.

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