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


  • Residential Care Facilities (RCFs) serve six or more residents. Many of them are small and even though they typically have shared rooms, they are more homelike than nursing homes. The state has two classes of RCFs. The regulations contain staff ratios for Class I and Class II facilities that vary by time of day and the number of residents.

  • RCFs used to serve both the elderly and persons with serious mental illness (SMI) and developmental disabilities (DD) until the Senior and Disabled Services Division (SDSD) transferred oversight of RCFs in which more than half of the residents had SMI or DD to the state mental health agency. SDSD kept responsibility for the RCFs in which more than half of the residents were elderly persons. Over the following years, the RCFs assigned to the different agencies admitted only SMI, DD, or elderly persons. As a result, RCFs now serve a homogenous population.

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