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


Most respondents were optimistic about the future of assisted living, although realistic about the barriers to Medicaid funding as noted in the previous section.

  • Assisted living has to expand because it is cost effective. It is the best option for nursing home diversion.22

  • State plans to expand have not been articulated in writing, but are being discussed. There is a work group now trying to control the growth of nursing home beds. There is a moratorium on new beds, but some were already planned before the moratorium went into effect.

  • Right now there is a task force meeting to study ways to reduce the nursing home bed base. The nursing home industry doesn't want more Medicaid clients because the reimbursement is well below real costs. They are making money with Medicare, but they can't expand because of the moratorium.

  • Expansion of publicly-funded assisted living is inevitable. The future looks great, we have to look at how we spend our dollars because there are going to be less of them.

Other reasons given for optimism is that the ALE waiver is popular with the legislature and Assistive Care Services has received real support.23 One respondent was very optimistic about expansion in rural areas.

  • The Robert Wood Johnson Coming Home program has helped to develop affordable assisted living in rural areas where before there was only the nursing home option. Grant dollars are available to develop programs that are maybe a little different then what we have seen already.

One respondent reported that the state could expand in-home services.

  • There is an amendment to the state constitution which would exempt from zoning regulations people applying for the conversion of single family residences to two family homes, so they can keep an elderly relative at home. It will be significant. It would not need licensing if it was only for relatives, and services could be funded through some of the State programs or the Aged and Disabled Adult waiver.

  1. The Nursing Home Transition Program, which began last year, provides funding for eligible nursing home residents who can be cared for under the ALE Medicaid Waiver. Separate funding for these residents was again provided for the 2002-2003 fiscal year at $2,300,000. The Capitated Nursing Home Diversion Program increased funding to $30,916,013 and will create approximately 100 additional slots for this program. The state also directed AHCA and DOEA to jointly develop a plan to expand the opportunities for diversion projects in rural and underserved areas of the state.

  2. The Assisted Care Services (ACS) State Plan Amendment maintained current funding for the 2002-2003 fiscal year at $32,871,249, which includes $3,200,000 for program growth. The Assisted Living for the Elderly (ALE) Medicaid Waiver maintained current funding for the 2002-2003 fiscal year at $30,754,351.

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