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


  • Adult Foster Care Homes provide a 24-hour living arrangement with supervision for individuals 18 years of age and older who, because of physical or mental limitations, are unable to continue independent functioning in their own homes.

  • Providers may serve up to three adult clients in a Department of Human Services (DHS) enrolled adult foster home. These homes do not have to be licensed but those accepting Medicaid clients have to meet Medicaid contracting requirements. Homes with four or more residents are called Small Group Homes and must be licensed under the assisted living licensing rules as a Type C facility, in addition to being enrolled with DHS. Providers must serve no more than eight adult clients in an enrolled Small Group Home. The CBA waiver program contracts with both licensed and unlicensed adult foster care homes.

  • Services reimbursed through the CBA waiver include meal preparation, housekeeping, personal care and nursing tasks, supervision, and the provision or arrangement of transportation. Nursing tasks may be delegated by a registered nurse to a foster care provider based on the provider's abilities and the needs of the participant.

  • The client pays the provider for room and board from their own income. Texas limits the amount that can be charged for room and board for Medicaid waiver clients in adult foster care to an amount equal to the SSI federal benefit rate minus a personal needs allowance of $85.00 which equals $467. There are no restrictions on the amount adult foster care homes can charge private pay residents.

  • CBA waiver clients can be served in private or shared rooms depending on availability and the preference of the client. Adult foster care homes cannot have more than two beds in any room and must provide at least 80 square feet of floor space in a single occupancy room, and at least 60 square feet of floor space per client in a double occupancy room.

  • There are three care levels in adult foster care homes, and as of September 2003, the payment rates are $18.71, $32.27 and $65.52 per day. The level of care required is based on an assessment and the recommendations of a Home and Community Support Services nurse.

  • Adult foster care providers cannot terminate services to a resident without the prior approval of the adult foster care caseworker or supervisor, unless the resident creates a serious or immediate threat to the health, safety, or welfare of the provider or the other residents of the foster home.

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