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


A number of respondents mentioned ongoing activities related to the Olmstead decision.

  • There are many advisory boards operating at the state level that are discussing long term care and Olmstead issues, with providers, consumers and advocates working together.

  • The appropriations Rider 37 has supported the Olmstead decision and allowed more than 900 nursing home residents to move into their own homes and ALFs. The state is asking for more CBA waiver slots in this next legislative session a continuation of Rider 37.

  • There is a pilot study using Olmstead relocation specialists to provide individuals in nursing homes with information on the full range of community options.

A number of respondents mentioned regulatory issues that the state is planning to address.

  • The state is aware of provider concerns with the 120 day bed hold rule and draft new rules are coming out shortly. Stakeholders are appreciative that the state shares draft rules to obtain input.

  • Draft CBA waiver rules were due to be circulated to providers months ago. The focus of these regulations is to increase the ability of assisted living residents to age in place, and to develop a monitoring process that involves more site visits and interviews rather than just fiscal and process reviews. While more operationally difficult, this type of review would yield more information on service outcomes. The licensing staff are more used to surveying facilities, but the State CBA waiver program staff are less familiar with this type of review. Both they and the providers are going to need training on the review process.

  • The state is developing a standardized care assessment process.

Another mentioned the state's ongoing data monitoring activities.

  • The state is tracking individuals transitioning out of nursing facilities into the CBA waiver program. Because their funding is supported by the nursing home budget, the state wants to see if there are cost savings, or whether those leaving the nursing facilities are merely replaced by new Medicaid clients.

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