In addition to providing a technical description of how states use Medicaid to cover services in residential care settings, we wanted to gain an understanding of how the states and key stakeholders viewed this coverage. To ensure a cross section of views, in addition to interviewing state staff and program administrators we interviewed both providers and their representatives as well as consumer advocates.
We were interested in their views generally, such as whether they saw Medicaid coverage as a positive development in their long term care systems. We were also interested in knowing if they had any general or specific concerns about how the residential care system in their state was working for Medicaid clients. Specifically, we asked for their views on a range of issues, including barriers to the provision of Medicaid coverage of services in residential care settings, and licensing and regulatory requirements -- particularly those related to admission and discharge -- that affect the ability to age in place.
Although the purpose of our interviews was to gain a better understanding of Medicaid's coverage of services in residential care settings, nearly everyone we interviewed provided their views on issues related to the state's residential care system regardless of whom it serves: private pay, Medicaid-eligible residents, or a combination of both. Consequently, many of the respondents' views regarding the state's residential care system did not differentiate between Medicaid and private pay residents. For example, concerns expressed about discharge policies apply to both private pay and Medicaid clients. Nonetheless, respondents also had views about issues specific to Medicaid's coverage of services in residential care settings.
Respondents' views are categorized into six major headings:
- General Comments on the Residential Care System
- General Comments on Medicaid's Role in Residential Care Settings
- Licensing and Regulatory Requirements
- Staffing Issues
- Barriers to Expanding Medicaid Coverage of Services in Residential Care Settings
- Future Plans
The content of this section is based solely on the views of those we interviewed, all of whom were quite candid in their discussions with us. For an in-depth description of each state's Medicaid program and residential care system, and specific issues related to Medicaid coverage of services in residential care settings, please see the descriptions of each state in Appendices B through G.