Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Insufficient Capacity in the Waiver Program


The unanimous opinion of all those interviewed was that the number one issue for the CBA waiver program is the lack of funding, and there is pressure from providers to fund more waiver slots.

  • The large waiting list for CBA waiver slots is preventing access, rather than affordability or provider availability issues. In addition, the number of slots is not uniform across the State. Elderly persons in their own homes can get services through the Frail Elderly Program, but the CBA waiver is the only program that serves elderly persons in assisted living settings.

  • A disincentive for providers is that the state can not guarantee CBA waiver slots. An additional concern is that facilities are restricted in reducing the number of beds available to CBA waiver clients even when there are no CBA waiver clients in that area to fill the beds. Although it is possible to increase the number of CBA waiver beds in a given facility fairly easily, reducing a slot usually takes three months after the request has been submitted, during which time the facility is losing money on the empty bed.

One respondent felt that there was not much of a demand for assisted living in the waiver program.

  • Many individuals would rather stay in their own homes and receive services than go to an ALF, thus the pressure might be less on expanding access to assisted living than expanding in-home options.

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