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


  • There is no limit on the number of beds in adult care homes. The current licensed capacity ranges from 7 beds to 200 or more. Most have a capacity of 40 to 60 beds.9

  • Facilities may serve up to four residents per bedroom. Bedrooms must be 100 square feet, excluding vestibule and closet, for single rooms and 80 square feet per bed for multiple occupancy rooms. One bathroom must be provided for every five residents and a shower for every 10 residents.

  • Facilities vary in the availability of private and shared rooms. Some facilities, mostly older ones, do not have private rooms unless they are too small for two residents. Others have a mix of private and shared rooms. The newer facilities have all private rooms and some with private baths, to meet the preferences of the private pay market. Because private rooms typically cost more than shared rooms, they are generally occupied by private pay residents.10

  1. One respondent noted that some owners believe a minimum of 60 beds are needed to make a profit.

  2. One respondent stated that people on Medicaid could not afford private rooms because Medicaid only pays for services, not for lodging.

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