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


Each type of residential care setting must meet its own licensing and regulatory requirements, which can include physical plant requirements. For example, adult foster care and boarding care establishments have physical plant requirements and rules regarding shared rooms. Minnesota does not require residential care settings registered as housing-with-services establishments to meet any additional specific physical plant requirements.

Regarding the provision of private rooms for low-income, publicly supported individuals, their availability depends on the residential care setting and its location. Some market-rate projects--whether apartments or board and lodges--can provide private rooms or apartments for Medicaid waiver clients, particularly where the state's Group Residential Housing (GRH) supplement (see Room and Board Payment below) is adequate or where the private pay rental revenue from other residents can help subsidize the costs of the low-income resident.

The Medicaid waiver program strongly supports the provision of private rooms and counties will negotiate placements with residential care settings in order to provide Medicaid clients with privacy. A few settings have private foundations that can help low-income residents pay the shortfall between what they (or the GRH supplement) can pay and the actual costs.

However, in many board and lodging or adult foster care settings, Medicaid wavier clients may share a room with another resident, while private pay residents may have the option of paying higher rents for a private room. A GRH client living in a shared room could move to a more expensive private room if the family was willing and able to pay the difference between the GRH rate and the rent.

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