Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Cost Sharing Requirements

12/01/2003

Persons who qualify for waiver services under the special income rule of 300 percent of SSI have a cost sharing obligation. The amount depends on the specific waiver and the monthly protected income, which varies according to a number of factors, including the person's living arrangement and the number of dependents.5

  • For those receiving waiver services in their own homes there is no cost-sharing obligation.

  • If an assisted living facility accepts the optional state supplement (OSS) rate for payment of room and board, OSS recipients may keep a personal maintenance allowance of $630.40, of which $54.00 is retained as a personal needs allowance, and the remainder-$576.40-is paid to the facility for room and board. Any income over $630.40 must be paid to the facility as the resident's share of service costs.

    Assisted living facilities may not charge more than the OSS rate for room and board for Medicaid eligibles. There is no limit on the amount they can charge private pay residents for room and board.


5. Cost sharing is required in only three waivers: Long Term Care Diversion Project (Nursing Home Diversion Waiver), Assisted Living for the Elderly and Cystic Fibrosis. There is no cost sharing required in other waiver programs, unless the individual qualified under an income trust.

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