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


Waiver applicants have to meet the same level of care criteria as nursing home applicants. Two additional criteria are applicable for Assisted Living for the Elderly waiver applicants:

  • Has a diagnosed degenerative or chronic medical condition requiring nursing services that cannot be provided in a standard licensed assisted living facility but are available in assisted living facilities licensed to provide Limited Nursing Services or Extended Congregate Care Services; or

  • Is a Medicaid-eligible resident awaiting discharge from a nursing home who cannot return to a private residence because of the need for supervision, personal care services, periodic nursing services, or a combination of the three; and

  • Is receiving case management, is in need of assisted living services as determined by the community case manager, and is determined to meet eligibility criteria.

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