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

12/01/2003

In 1988, personal care was added to the Medicaid state plan. Medicaid personal care services may be provided in a person's home or in a residential care facility--including Community Based Residential Facilities and Residential Care Apartment Complexes and Adult Family Homes. However, services may not be provided in a Community Based Residential Facility that has more than 20 beds.

To be reimbursed for the provision of personal care services, Community Based Residential Facilities and Residential Care Apartment Complexes may employ people to provide the care that is then billed by a Medicaid certified provider (i.e., independent living centers, county or home health agencies). Alternatively, the county may secure services through an agency that provides personal care. Even if the facilities directly employ people to provide personal care, the county, home health agencies or independent living centers still has to bill for the pre-authorized hours provided because Medicaid does not allow Community Based Residential Facilities or Residential Care Apartment Complexes to be certified providers. If a residential care facility wants to be reimbursed for Medicaid personal care, it must have a billing partner, typically a county. The rationale for this restriction is that it ensures county oversight of the care recipient's entire care plan and assures that duplication of services does not occur.

In FY 2002 Medicaid provided personal care through the state plan to 10,408 individuals at a cost of $105.6 million. The FY 2003 personal care budget is $115.4 million. Data on the number of persons receiving personal care in residential care settings are not available.

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