Respondents in all states cited similar barriers to expanding Medicaid coverage of services in residential care settings, including a lack of funding for long term care programs generally and insufficient funding for waiver programs in particular. In the two states that do not limit the amount that providers can charge Medicaid clients for room and board, several noted that room and board charges were unaffordable for Medicaid clients.
Inadequate service rates were cited by some in every state as a disincentive for providers to serve Medicaid beneficiaries, particularly in states that restrict room and board payments to SSI levels. On the other hand, in states with relatively high rates, such as Wisconsin, some were concerned that providers are making too much of a profit. In states with relatively low rates, such as Florida and North Carolina, there are concerns about inadequate care.