Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Appendix A. Selection of States

12/01/2003

We used a number of criteria to determine which six states to include in the study:

  • Diversity in state options for covering Medicaid services in residential care settings: through the waiver, the state plan, or both;

  • Length of experience using Medicaid to pay for services in residential care settings;

  • A significant number of people served;

  • Geographic/regional diversity; and

  • Program diversity.

To inform the final selection, we also reviewed published information about each state's residential care systems and consulted several experts. Based on their input and our review of the literature, we selected Florida, Minnesota, North Carolina, Oregon, Texas, and Wisconsin.

Key features of the six states that were considered in making our selection are listed below.

Florida
Southeast region
  • Covers services in residential care through both the waiver program and the personal care option. State uses the 300 percent special income option. The state sets rates for services only and allows family supplementation of room and board costs. State uses flat rates and pays $28 a day. Nursing home/waiver level-of-care criteria are not stringent. The state has major litigation problems.
Minnesota
Midwest region
  • Covers services in residential care through the waiver program. Approximately 3190 participants. State uses the 300 percent special income option. The state sets rates for services and room and board and does not allow family supplementation.
  • Most states define and regulate residential care facilities. Minnesota defines assisted living as a service and not a place. The housing component is more like rental housing and is licensed like hotels. Other entities provide the services. The state has a housing subsidy program to help Medicaid clients pay for room and board.
North Carolina
Mid-Atlantic region
  • Covers services in assisted living through the personal care option. Approximately 18,533 Medicaid beneficiaries in residential care settings, the largest number of any state.
  • The state allows family supplementation in nursing homes and is currently looking at allowing it in residential care settings.
Oregon
Northwest region
  • Covers services through the waiver program since the early 1980s. Approximately 2572 participants. State uses the 300 percent special income option. The state sets rates for services and room and board and does not allow family supplementation.
  • The state uses nurse delegation extensively. They've enacted recent regulatory changes related to negotiated risk agreements.
Texas
Southern region
  • Covers services in assisted living through the waiver program. State uses the 300 percent special income option. The state also uses the state plan to cover personal care in small group homes under very specific circumstances.
  • The state legislature has authorized a "money follows the person" initiative, which allows funding from the state's nursing home budget to pay for waiver services for people who transition from nursing homes to the community.
Wisconsin
Midwest region
  • Covers services in residential care settings through the waiver program and the personal care option, and serves approximately 1018 participants. State uses the 300 percent special income option. State does not allow family supplementation. Counties negotiate rates with providers, which include a basic payment and variable payments based on client care needs.
  • The state has two different models of residential care, one highly regulated and the other not.

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