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


Personal care services were added to the Medicaid state plan in 2001 and are provided through a program called Assistive Care Services. Persons who live in their own homes are not eligible to receive personal care services through the Assistive Care Services program. Only persons who need an integrated set of services on a 24-hour basis and who live in licensed assisted living facilities or licensed adult family care homes may receive Medicaid funded personal care services. These services are also available to residents of some mental health residential treatment facilities, which serve primarily younger adults with mental illness. Services must be based on need as confirmed by an assessment and provided in accordance with an individual service plan for each resident.

Prior to the addition of personal care services to the Medicaid state plan, the state paid for some personal care services in residential care settings with a state supplement through the Optional State Supplementation (OSS) program, which is funded by general revenue funds. (OSS is not provided to individuals who live in their own homes.) Once personal care services were added to the Medicaid program, the state reduced the OSS payment and used the money saved to provide the state match for Medicaid personal care services.

Prior to Medicaid coverage of personal care services, residential care facilities that provided room and board and some personal care could receive up to $730 a month (the combined SSI+OSS payment level). Although the maximum OSS payment has been reduced,6 with the addition of Medicaid personal care service payments, residential care providers can now receive up to $847.80 per month to cover room and board and personal care services. This amount includes $569.40 paid from the resident's income for room and board, plus $9.28 per day for personal care services paid by Medicaid.

6. The maximum payment is $78.40 per month.

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