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


There were some issues among those interviewed regarding the content of the state's licensing and regulatory requirements for ALFs, although no one felt that regulations posed a major obstacle to affordable assisted living in Texas.

  • The legislature has moved to set up a more punitive environment related to the assignment of administrative penalties (fines), in part because the legislature has come under increasing pressure from advocacy groups concerned about care and searching for more complete regulations.

  • Over the past three legislative sessions, we have advocated for quality standards and enforcement tools.

  • I am concerned that ALFs are moving too much towards the medical model, with the result that the facilities will turn into nursing homes, much like the old intermediate care facilities we had pre-OBRA 87.

  • There is a need for regulations that focus on the services people need. The current licensing standards are too focused on life/safety code distinctions.

  • Many providers do not have well developed and realistic plans for how they would care for someone in an emergency

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