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


The state does not require persons in Group B who are receiving waiver services in their own home to share the cost of services.

For people in Group B who are living in residential care settings, the cost sharing amount is equal to the client's remaining income after all allowable expenses have been deducted. These deductions include:

  1. the cost of the client's maintenance needs allowance, which is equal to the SSI federal benefit rate of $552 per month. The client keeps $85 as a personal needs allowance and the remainder is used to pay for room and board costs;

  2. the cost of the maintenance needs of a spouse if the spouse is the only dependent of the recipient. This amount is equal to the monthly SSI federal benefit rate less the spouse's income;

  3. the cost of the maintenance needs of the client's dependent children. This amount is equivalent to the Aid to Families with Dependent Children (AFDC) basic monthly grant for children or a spouse with children, using the recognizable needs amounts in the AFDC Budgetary Allowances Chart;4 and

  4. the costs incurred for necessary medical or remedial care, which are not covered by Medicare, Medicaid or any other third party insurance, including the cost of health insurance premiums, deductibles and co-insurance.

If any income remains after all these deductions, the cost sharing amount is applied only to the cost of services covered by the waiver program and specified on the client's individual service plan and must not exceed the actual cost of services delivered. Clients must pay the cost sharing amount to the provider contracted to deliver authorized waiver services.

4. Although the AFDC program no longer exists, allowable maintenance costs are still tied to the basic monthly grant when it did exist.

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®