Respondents in two states felt that some providers did not participate in the Medicaid program due to what was perceived as excessive paperwork. In Florida, one noted that quarterly inspections of Extended Congregate Care Facilities were a barrier to getting more providers into the program because of the substantial paperwork required.
In Texas, a few respondents said that the amount of paperwork involved in accepting waiver clients and the difficulties of dealing with a state agency keep some providers from serving these clients. For example, when a waiver client is involved in an incident in an ALF, the facility has to go through two different report processes, one with the regulatory agency and the other with the waiver program agency. Another said that the waiver program's audit process and the potential fines for what are essentially "clerical errors" are a disincentive for some providers to take waiver clients.
In some states, particularly North Carolina and Texas, respondents noted that residential care providers had to deal with too many agencies, which increased operation costs through the duplication of effort on both the part of the provider and the state.