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


No one felt that regulations posed a major obstacle to affordable assisted living in Wisconsin.

  • The RCAC regulations have strong support from assisted living providers and, judging by the rapid growth of the industry in the state, they have not been an obstacle to development. Most facilities exceed the minimum physical plant and staffing requirements included in the regulations.

Several respondents had concerns about too much regulation in the CBRFs and too little in the RCACs, particularly given that RCACs certified to serve waiver clients are less regulated than CBRFs, even though they are permitted to provide up to 28 hours of care per week, including nursing care. One provider felt that the CBRF regulations were more stringent than nursing home regulations, and another expressed concern that the state will adopt a nursing home enforcement approach in assisted living settings, noting that this approach is not working in nursing homes.

One respondent expressed concerns that the state regulates facilities that serve very different types of people under the same rules.

  • CBRFs range from 5 to 203 residents -- there are even CBRFs for unwed mothers and veterans and TBI and DD and corrections clients -- all under the same regulations (there are a few changes in the regulations for correctional clients -- some of the residents' rights provisions don't apply.) The state needs to regulate differently for different populations in different settings. Some standard nomenclature is needed. Assisted living is a generic term -- it can be applied to any setting. I have no answer to the question of what to call the different facilities and why.

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