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


There was a consensus among all those interviewed that the CBA waiver program was a very good program and that coverage of assisted living was a success for a variety of reasons.

  • The assisted living program has made extraordinary progress and is considered a model for other states. For example, our mandated disclosure statements are being used by other states.

  • The state has met its goals of supporting individuals' desires to live in an integrated community setting under the CBA waiver program and in Community Care (which covers those receiving personal care services not under the CBA waiver). For some advocates, living in an ALF is not considered to be a true choice because clients overwhelmingly prefer their own home. However, because some individuals may not have homes, the ALF option is still necessary.

  • The State and legislature put forth a good effort to meet the Olmstead requirements through Rider 37, which has enabled those in nursing facilities to transition into the community and to receive CBA waiver services. We felt very strongly that efforts to move those in nursing homes into community settings--including ALFs--was critical.

  • There were fears that the nursing home industry might fight the continuation of Rider 37. However, the state has to support the Olmstead decision, giving some "teeth" to the State agencies' support for the continuance of Rider 37.

  • The most successful aspect of the program is the ability of individuals to age in place, the stability of the CBA waiver program staff, the ease in managing the CBA waiver program compared with other states, and the willingness of CBA waiver staff to listen to provider concerns and to address them whenever possible.

Two respondents mentioned that the room and board payment for Medicaid waiver clients was not sufficient to cover the costs and needed to be addressed.

  • Many of the non-profit providers receive supplemental funding and contributions from members of churches, faith-based organizations and foundations. The state has asked for a state supplement for room and board to be funded in recent legislative sessions, but has not been successful. It's not likely to be approved in the next legislative session due to the large budget deficit.

  • The state should adopt a state supplement for room and board as exists in other states, which could lead to an expansion of providers if additional CBA waiver slots were funded.

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