We asked our respondents, particularly those who worked for the state, if they had recommendations for other states seeking to use or expand Medicaid funding in residential care settings. Most of the recommendations came from Oregon state staff, in large part because their program has been in effect for a long time. Oregon's system is often held up as an ideal because over 80 percent of Medicaid clients receiving long term care services are served in home and residential care settings.
The recommendations provide guidance for other states who want to offer a range of residential care options for both the low income private pay market as well as the Medicaid population. Virtually all of these recommendations assume that a state will be using a waiver program to pay for services in residential care settings. Key points made in all the recommendations are summarized below.