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


Group Residential Housing (GRH) is a state-funded income supplement program that pays for room-and-board costs for low-income adults in a licensed or registered setting with which a county human service agency has negotiated a monthly rate. In FY 2002, the state spent approximately $75 million serving a monthly average of 12,425 disabled and elderly people. Approximately 9 percent of GRH recipients are seniors receiving Elderly Waiver services.

Aged, blind or disabled adult individuals with incomes no higher than the maximum GRH payment and assets no higher than $2,000 are eligible for the GRH program.24 If a person is eligible for the GRH program, he or she is eligible for Medicaid. To be eligible for the program, individuals must also be at risk of institutional placement or homelessness.

The amount of the GRH payment is based on a federal/state standard of what an individual would need, at a minimum, to live in the community. The maximum GRH room and board payment limit in 2003 is $680.25 A person eligible for SSI and receiving $552 would get the full state supplement of $81, retain a personal needs allowance of $72, and then the GRH payment would make up the difference of $119. If income is from a source other than SSI, there would be the same $20 SSI disregard applied, and then the personal needs allowance deduction of $72, and the GRH program would pay the balance up to $680. The GRH payment is made directly to the provider of housing on behalf of the eligible person.

The GRH rate is automatically adjusted each year based on changes made in the SSI benefit rate, changes in the value of Food Stamps for an individual, and change in the personal needs allowance.

  • Residential care settings eligible for GRH supplements include Adult Foster Care Homes, Board and Lodging Establishments, non-certified Boarding Care Homes and various residential settings registered under the Housing with Services Act. A county human service agency must approve placement in the GRH setting. There are over 4,800 GRH settings in the state.

  • Although three meals per day are provided by many assisted living programs, other assisted living programs in apartment buildings where residents have their own kitchens may offer only one or two congregate meals per day. These latter settings would not qualify for a GRH payment because it includes a full board component of three meals a day.

  • If the base room and board rate pays for a bed in a double room, a resident's family may pay extra for a private room, but settings with GRH agreements must be able to accommodate clients whose income limits them to the GRH rate. To contract with a county to be a GRH setting, a provider has to have at least one unit available for the GRH room and board rate. Family supplementation of the GRH rate may only occur if the other unit is "substantially better" such as being larger, better view, better amenities etc.

  • GRH does allow payment within limits for room and board costs if a person is temporarily absent from the establishment and is expected to return. GRH can pay up to 18 days per episode of absence, not to exceed 60 days in a calendar year, for a GRH recipient who is temporarily absent.

  1. A personal needs allowance and any income allocated for a community spouse is disregarded.

  2. The amount is based on the following formula: $552 (SSI payment) minus $20 disregard and $72 personal needs allowance + $81 (Minnesota Supplemental Aid (MSA) maximum) + $139 Food Stamps. The state does not get reimbursed from the Food Stamp program, but the state has a workgroup that is looking at how to get food stamps for persons in residential settings. The state uses the $139 figure to estimate what a person would need to live in the community, as that is the maximum Food Stamps benefit provided to a single person.

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