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


Overall satisfaction was expressed with the program; there was pride in the lack of a waiting list and in the fact that many people have been served in settings outside the nursing home.

  • It's worked pretty well--providers have been happy.

  • We're really happy with our program--it provides flexibility for the community to build a program that is right for them.

  • On the housing side, because Minnesota did not have the resources to build assisted living for low income seniors, the waiver assisted living program was built on the idea that assisted living services would be mobile. There was already a large stock of housing where low income seniors resided so that the Minnesota approach to assisted living was viewed as a successful way to deal with the housing piece of residential care.

  • Originally we thought housing with services establishments would be for people headed to nursing homes--to provide another option for people who didn't feel that they could stay in their own home or when services could not be delivered in their home settings. We do find that nursing home admissions have decreased and people are staying in their homes longer. Assisted living is another option for people whose needs cannot be met in their own homes.

  • Minnesota generally has pretty good delivery--many of the providers are religious organizations--church related entities are major real-estate holders and provider entities. A climate where the care is good--many are nursing home managers trying to avoid the over regulation, but they are concerned about assuring quality in these looser entities.

  • Minnesota has senior housing stock that has been subsidized--now they are attempting to introduce varying levels of services to enable aging in place--through Assisted Living Plus. Adding assisted living waiver services to these settings mean that buildings stay occupied, the state does not have to subsidize purpose built facilities, and the people served are able to remain in their apartments.

  • The cooperation between housing and services is due to the fact that human services is all under one big umbrella. An individual who was hired to straddle housing and services sits on joint committees and understands both perspectives. I believe this makes a difference in terms of coordination.

  • The most successful part is that we are not creating senior Medicaid ghettos. In an assisted living place, if the residents aren't talking to each other about who's paying--you don't know who is private and who is Medicaid. Of course, rich seniors will live in nicer places. Medicaid coverage provides more options for seniors. One of the goals of covering assisted living services through the waiver program is to allow seniors who have spent down in assisted living to stay there as long as their needs can be met.

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