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


In all of the states, nearly everyone interviewed believed that licensing and regulation were state functions and that there should be no national regulations for residential care. There was general agreement that major differences in the states' residential care systems and the heterogeneity of the population served in residential care necessitated different licensing and regulatory provisions. Some felt that federal regulations might stifle state creativity.

In Wisconsin, respondents felt that the licensing and regulatory provisions were good but needed fine tuning. Some stated that the Medicaid waiver program provided quite enough federal oversight. Even in states where considerable dissatisfaction was expressed about certain licensing and regulatory provisions, respondents did not see federal regulation as appropriate or needed.

On the other hand, model standards were viewed as both potentially helpful for informing state licensing and regulatory provisions and also as potentially problematic if they became minimum standards. Some respondents were concerned that model standards would lead to a nursing home regulatory model, which most viewed as both overly prescriptive and not particularly effective in assuring good quality care. Whatever people's views, consensus existed that model standards should not be mandated. As one person in Oregon stated succinctly: "Best practice models? Absolutely. National oversight? Not on your life."

At the same time, a few felt that some type of rating system for residential care settings would be helpful for consumers who currently find it very difficult to evaluate what is available. One respondent suggested a rating system with key features that would enable different settings to be compared in a meaningful way.

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