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

12/01/2003

  1. Long term Care Task Force: Reshaping Long term Care in Minnesota.

  2. The State applies the following §1902(r)(2) less restrictive resource methodologies for Group C: household/personal goods are excluded and a more liberal homestead exclusion is allowed for certain long term care residents.

  3. Asset limits for the Minnesota Supplemental Aid program are lower, i.e., $2,000 for an individual and $3,000 for a couple.

  4. "If the community or institutionalized spouse establishes that the community spouse needs income greater than the monthly maintenance needs allowance determined in this paragraph due to exceptional circumstances resulting in significant financial duress, the monthly maintenance needs allowance may be increased to an amount that provides needed additional income." (Minnesota Statutes 2003, Chapter 256B.058: Treatment of income of institutionalized spouse.)

  5. O'Keeffe, J., People with Dementia: Can They Meet Medicaid Level-of-Care Criteria for Admission to Nursing Homes and Home and Community-Based Waiver Programs? AARP, August 1999.

  6. The 300 percent of SSI rule is for the aged only. CRS Report for Congress, Medicaid: Eligibility for the Aged and Disabled, updated July 5, 2002.

  7. The State applies the following §1902(r)(2) less restrictive resource methodologies for Group C: household/personal goods are excluded and a more liberal homestead exclusion is allowed for certain long term care residents.

  8. Asset limits for the Minnesota Supplemental Aid program are lower, i.e., $2,000 for an individual and $3,000 for a couple.

  9. "The commissioner shall seek to amend the federal waiver and the medical assistance state plan to allow spousal impoverishment criteria as authorized under United States Code, title 42, section 1396r-5, and as implemented in sections 256B.0575, 256B.058, and 256B.059, except that the amendment shall seek to add to the personal needs allowance permitted in section 256B.0575, an amount equivalent to the group residential housing rate as set by section 256I.03, subdivision 5." (Minnesota Statutes 2003, Chapter 256B.0915, subdivision 2: Spousal impoverishment policies)

  10. CRS Report for Congress, Medicaid: Eligibility for the Aged and Disabled, updated July 5, 2002.

  11. O'Keeffe, J., People with Dementia: Can They Meet Medicaid Level-of-Care Criteria for Admission to Nursing Homes and Home and Community-Based Waiver Programs? AARP, August 1999.

  12. Asset limits for the Minnesota Supplemental Aid program are lower, i.e., $2,000 for an individual and $3,000 for a couple.

  13. Minnesota Statute 144D.

  14. Typically Board and Lodge with Special Services entities would not have a special care unit unless it registered as a Housing with Services Establishment to enable it to receive waiver payments. If it is not registered as a Housing with Services Establishment, it cannot serve waiver clients, but may be receiving GRH Supplemental Service payments for non-elderly clients who are ineligible for waiver services (usually dual diagnosed with mental illness and chemical dependency).

  15. Minnesota Statues 2003, Chapter 144D.065, Establishments that serve persons with Alzheimer's disease or related disorders.

  16. Under Minnesota law, most agencies or individuals regularly providing home care services to clients for a fee are required to have a Minnesota home care license. Some individuals do not need to be licensed or registered if they provide limited types of services for 14 or fewer hours a week to only one client. Family members and volunteers providing such services without charge generally do not need a license. When Minnesota's home care license requirements were implemented, only services provided in single-family homes and apartments were covered. Although the Housing with Services Contract Act created no new licensing program, it did extend the existing home care licensing requirements to additional types of residential settings--including, board and lodging establishments and corporate adult foster care homes, if they meet the Contract Act criteria.

    The home care license requirements spell out the services the agency or individual is allowed to provide and other requirements such as those related to the training and supervision of unlicensed caregivers, assessment of client needs, and the development and implementation of clients' service plans. Some home care providers are also Medicare-certified and must meet federal Medicare requirements in addition to the state licensing requirements. Liability insurance is a requirement for licensure.

  17. Certified Boarding Care Homes are considered nursing homes and are eligible to receive Medicaid payments. However, these homes may only provide "light" care and cannot provide skilled nursing home care.

  18. When the Housing-with-Services Contract Act was passed in 1995, it was designed to apply to various types of buildings serving seniors, rather than settings serving other groups, such as persons with developmental disabilities. To distinguish which buildings served seniors, the state used the definition from the federal Fair Housing Act, which requires that 80 percent of the residents be age 55 or older.

  19. The state purposely excluded housekeeping services, meal programs, routine van transportation to shopping or recreational activities from the definition of supportive services so that the providers of these services would not have to meet all the requirements of the Contract Act.

  20. There is an erroneous belief that Minnesota's Medicaid waiver program only provides assisted living services to elderly persons living in private apartments with a full kitchen. It stems from the fact that when the Elderly Waiver service packages were first created, the package of services that were provided in apartment settings (where there were individual kitchens) was labeled "assisted living" while a very similar package covering essentially the same services could be provided in settings where residents did not have individual kitchens. The latter package was given a different name--residential care services. Both service packages covered the same types of personal care and health-related services, but they had two different labels. Consequently, many people made the assumption that because the service package labeled assisted living could only be provided in apartments with kitchens that these kinds of services could not be provided in other types of settings. (Personal communication)

  21. A Rule 203 license for 5 people is only available if all residents are at least 60 years old and none have a serious and persistent mental illness or a developmental disability; otherwise the setting must be licensed as a board and lodge by the Minnesota Department of Health. (Source: DHS Bulletin #00-25-4.)

  22. Ibid.

  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.

  24. A personal needs allowance and any income allocated for a community spouse is disregarded.

  25. The amount is based on the following formula: $552 (SSI payment) minus $20 disregard and $72 personal needs allowance + $81 (Minnesota Supplemental Aid (MSA) maximum) + $139 Food Stamps. The state does not get reimbursed from the Food Stamp program, but the state has a workgroup that is looking at how to get food stamps for persons in residential settings. The state uses the $139 figure to estimate what a person would need to live in the community, as that is the maximum Food Stamps benefit provided to a single person.

  26. Supervision may not be provided by a resident who is receiving services.

  27. Although this level receives the lowest reimbursement, the people in this category may in fact need extensive supervision. O'Keeffe, J. op.cit.

  28. Rate equalization exists only in that the service payment rate for a "public-pay" client shall not exceed the service payment rate for a "private-pay" client.

  29. The Alternative Care Program's monthly service cap is limited to 75 percent of the monthly service cap in effect for persons assigned the same case mix classification as persons receiving Elderly Waiver services.

  30. Mollica, R. J., State Assisted Living Policy: 2002, National Academy for State Health Policy, 2002.

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