Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Multi-Unit Assisted Housing with Services


Multi-Unit Housing with Services is a new type of residential care setting named by the 1995 legislation. However, it is more a housing model than a service model. The model was included in the legislation at the request of developers who were interested in a limited service model that did not have to be licensed or highly regulated, but could, nonetheless, be marketed as assisted living.

Because Multi-Unit Housing with Services facilities cannot have in-house personal assistance staff, they do not have to be licensed; they have only to register with the state. Although North Carolina statute defines assisted living as group housing with services that, at a minimum, include one meal a day, housekeeping, and personal care services, Multi-Unit Housing with Services facilities are required to provide protective oversight and social services only. They may choose to provide additional services such as meals and housekeeping, and they may arrange for hands-on personal care and nursing services provided by an outside agency.

Multi-Unit Housing with Services provide private residences--studios and one or two bedroom apartments with private baths and full kitchens or kitchenettes. Persons who live in Multi-Unit Housing with Services are considered to be legal tenants who live in their own rented units.

Persons living in Multi-Unit Housing with Services facilities could theoretically become eligible to receive Medicaid personal care or waiver services in this setting. However, persons who meet Medicaid's financial eligibility rules (those with incomes no higher than 100 percent of the federal poverty level or who spend down to eligibility) are unlikely to be able to afford the rent in these facilities. While some Multi-Unit Housing with Services facilities may set rents on a sliding scale, some facilities charge as much as $1500 a month as their base rate, which does not include any personal care services.

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