Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. General Comments About the State's Residential Care System


Because residential care facilities serve both private pay and Medicaid residents, a few respondents expressed views about the industry as a whole, and about particular issues the long term care system is facing, including a liability insurance crisis.

  • Litigation has been occurring more and more in the nursing homes and is starting in assisted living facilities. Texas is usually named alongside Florida as being in the same litigation crisis. ALF licensure does not require liability insurance, but nursing facilities will be required to have liability insurance as of September 2003.

  • Providers will challenge the State on liability issues. The 2003 legislative session is going to address tort reform.

  • An error in the regulations has led to increased liability for providers. The current regulation states that assisted living providers are responsible for care and services. It is supposed to say that providers are responsible for coordinating all care and services. Often, assisted living facilities do not provide the services themselves, but arrange for them to be provided by outside entities.

Several expressed satisfaction with the state's efforts to involve all stakeholders in the regulatory process and for keeping them informed.

  • The State was very inclusive in seeking input before it promulgated the assisted living rules. Agencies, providers, and advocates/consumers have always had the opportunity to discuss their concerns about regulations. Consequently, the regulations reflect the intent of the legislation because of the good communication. The State has built a framework for assisted living in terms of regulations and has built in accountability.

  • The state operates an informative website for providers that is very good at keeping them current on new policy and regulatory changes. Providers also appreciate the availability of training sessions. There are some concerns about the quality of training for CBA wavier case managers.

One respondent expressed concerns about unlicensed assisted living facilities.

  • There are approximately 3,000 small unlicensed facilities that are receiving SSI payments. Some are operating legally by not providing services, but others are offering and providing substandard services illegally.

Another was very pleased with the state's approach to nurse delegation.

  • The state has been very progressive in moving towards nurse delegation. This is very important given the nursing shortage, the higher cost of nurses, and the potential for over-medicalization in ALFs.

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