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


Lack of oversight and enforcement of regulations was cited as a concern by at least one person in each state, but many Wisconsin respondents cited it as a major problem. Although some in Wisconsin felt that Community Based Residential Facilities (CBRFs) were over-regulated, most felt that the regulations were excellent but provided a good example of how regulations by themselves do not guarantee quality. All agreed that the major reason for lack of oversight and enforcement was inadequate funding.

On the other hand, Wisconsin's new assisted living model -- called Residential Care Apartment Complexes (RCACs) -- was developed as a minimal regulation model, and many felt that this model required more oversight. Several noted that the state's ombudsman program was not authorized to oversee the care of residents in RCACs and that consumer advocates in the state were working to amend the statute to allow them to do so.

One respondent noted that after several years of a consultative approach to RCACs, the state had realized that more oversight is needed and is now issuing citations. Initially, the state had only one staff person statewide for a new industry that built 5000 units in five years, which one respondent noted did not provide sufficient opportunity for consultation. With recent nursing home closures and reduced nursing home capacity, the state has transferred some of the nursing home enforcement staff to oversee RCACs.

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