Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Affordability of Room and Board Charges


A few respondents noted that private pay residents may spend down to Medicaid eligibility and not be able to afford room and board. However, they noted that there were no data to know to what extent this was or could be a problem.

  • The rent piece is the hardest to subsidize. Families can supplement what the resident can afford to pay for room and board when the resident is getting Alternative Care or Elderly Waiver services. If the state lodging supplement covers a shared room, the family can pay for a private room.

  • For people who go into purpose-built assisted living--if they spend down, the Elderly Waiver or Alternative Care can cover the services but it's typically the rent that becomes a problem. They may not be able to afford the rent and have to move to other subsidized housing where the rent is cheaper.

  • Many providers who don't take Medicaid payment are concerned about continuing to serve those who spend down.

  • There's a lot of discussion about spending down--but no data. There is a recognition that this is happening but we are not tracking it. We've had calls that rates are going up beyond the calculations of the elderly regarding what they thought they could afford.

  • People talk about it and worry about it but as for how often that happens we don't know. We will be doing an analysis of that by looking at the number of people applying for the waiver while in Assisted Living. We hear anecdotally that this is happening, but not a large enough number to cause major concern. Most people who leave purpose built assisted living go on to nursing homes but it's not clear whether that's due to increased frailty or spend down.

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