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


Minnesota uses both the personal care option and the waiver program to cover services in residential care settings. In 1983, to reduce nursing home utilization, the state instituted a moratorium on new nursing home beds, and in 1988, implemented an Elderly Waiver program that provides services in a person's home and in residential care settings. At the same time, the state expanded the services in the Medicaid state plan to include personal care services. The state sought by these actions to maximize the number of supportive service options available to persons at risk of institutionalization. Personal care services --called Personal Care Attendant (PCA) services -- are available to eligible persons in their homes, apartments, registered housing with services, and adult foster care settings.

Minnesota uses a managed care model in its Medicaid program called the Pre-paid Medical Assistance Program (PMAP). Persons eligible for Medicaid are enrolled in PMAP and a capitated fee is paid to the PMAP managed care provider, who then becomes responsible for the delivery of all Medicaid state plan services, including PCA services. The PMAP covers PCA services in a person's place of residence, wherever that may be.

Technically, PCA services are available to an Elderly Waiver client in a residential care setting. However, because the residential care setting typically provides personal care to waiver clients under its own contract with the resident, PCA services from outside the setting (through the state Medicaid plan) are not used. PCA services under the Medicaid state plan are typically used in residential care settings such as adult foster care by persons with disabilities under age 65 who are not eligible for the Elderly Waiver program.

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