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


We asked the respondents to make recommendations for other states interested in using Medicaid to fund services in residential care settings, based on their experience doing so in their own state. Most agreed that the regulatory model should not be based on a nursing home model.

  • Think through the need for both regulation and flexibility. It is a challenge to design a regulatory system that provides safety and quality for the consumer but does not impose a nursing home like regulatory environment.

  • Consider the Minnesota approach and disaggregate housing from services, particularly if there is an existing stock of elderly low income housing.

  • The biggest challenge is to design a regulatory system that provides safety for residents without bringing in the entire nursing home regulatory system.

  • Defer to folks in human services. From the housing vantage point--people were looking for capital to build affordable assisted living but it simply was not there. Section 202 HUD projects that provide housing and services--we have a high number of these, have a resource already--from our vantage point it was not practical to use a site specific, purpose built assisted living program.

  • I'd advise them that whatever the system--it needs to be consumer driven--consumers making choices--deciding whether services are adequate--that they focus on the contract between the individual and provider and let that be the guiding regulatory principle. Require lots of disclosure and transparency of information.

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