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. Gregory, S.R. and Gibson, M.J., Across the States: Profiles of Long Term Care, Public Policy Institute, AARP, November 2002.

  2. The state is currently revising the formula for determining the amount of assets that can be retained.

  3. The state does not use any of the options for less restrictive income or resource methodologies for determining financial eligibility in the medically needy program.

  4. The state is currently revising the formula for determining the amount of assets that can be retained.

  5. The discretionary allowance is not in addition to a personal maintenance allowance.

  6. Prior to 1995, a person could be eligible for the state supplement without being eligible for SSI.

    Since 1995, a person must be eligible for some federal benefit to be eligible for the supplement. Persons ineligible under current law who were receiving the state supplement in 1995 continue to receive it under a grandfathering provision.

    The state does not use less restrictive income disregards when determining eligibility than it does when determining eligibility for SSI. It uses the following Section 1902(r)(2) less restrictive resource methodologies for this group: income used to pay court ordered fees and guardianship and guardian ad litem fees is excluded.

  7. The state does not use Section 1902(r)(2) less restrictive income or resource methodologies for this group.

  8. Personal communication from state staff. Data on the number of persons receiving Medicaid personal care in residential care settings are not available.

  9. While there are no data on how many were receiving personal care services through the state plan, given that the number receiving COP and waiver services was 2,363, only about .5 percent of the 11.5 percent could have been receiving services through the personal care state plan option.

  10. The SSI-E benefit (a state SSI supplement for persons with high needs) also used to be limited to persons in CBRFs no larger than eight beds.

  11. Most county contracts are for cost-based rates. Allowable cost distinguishes between what costs can be paid for with state/federal funds and what cannot; it says nothing about how much the rate is. The State requires an audit where publicly purchased services cost more than $25,000 per year. If the audit shows costs that were not allowable, which have been paid for in the rate, they must be returned.

  12. Some facilities have an arrangement with a Medicaid-certified home health or personal care agency to either (1) provide and bill Medicaid for these services or (2) "lease" their staff to the Medicaid-certified agency in order to be able to bill Medicaid. In 2001, eight percent of waiver recipients living in RCACs had personal care services billed to the Medicaid card (state plan), averaging $367/month. The state does not have comparable data for CBRF or AFH residents at this time.

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