Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Board and Lodge Homes (also known as Residential Care Homes)


Residential care homes are licensed as Board and Lodge Homes with Special Services under Chapter 157.17 and are not required to register as Housing with Services Establishments because they have their own regulations under that chapter.23 They serve a predominantly non-elderly population, but occasionally serve an elderly resident. The governing statute refers to these homes as Residential Care Homes, and the services provided are called residential care services.

If a Board and Lodge Home meets the housing-with-services criteria--i.e., 80 percent or more of its residents are aged 55 or older and they are providing services according to the rule--they must register as a Housing with Services establishment, obtain a home care license, and provide the services under that home care license. If a provider does not acquire a home care license, arrangements can be made for a licensed home care agency to provide the necessary services. Waiver services delivered in this setting are then no longer called Residential Care services, but are called either Assisted Living services or Assisted Living Plus services, depending on which package of services is provided.

  • Settings may vary greatly in size, some resembling small homes and others large apartment buildings. Residents have private or shared rooms, but do not have individual kitchens.

  • In addition to three meals per day, many settings offer a variety of supportive services (such as housekeeping and personal laundry) or home care services (such as help with dressing and bathing, medication administration, etc.) and may also provide a full range of health-related assisted living services.

  • Board and Lodge Homes in which assisted living waiver services are provided are mostly high-end homes which typically provide a private room and private bath with congregate dining, i.e., no private kitchen or kitchenette. Older settings will have some double rooms, but the recent trend has been to develop private rooms with a private bath.

23. These settings were grandfathered in with the passing of the Housing with Services Contract Act. A moratorium was put into place so that no more settings of these types could be developed and there remain approximately 125 in the system. See section titled Background under Residential Care Facilities.

View full report


"med4rcs.pdf" (pdf, 3.73Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®