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

12/01/2003

Residential centers are another type of setting in which Medicaid waiver services can be provided. The state defines a residential center as a building, or a complex of contiguous or adjacent buildings with 3 or more separate and distinct living units in each building, which residents rent or own. With such a broad definition, there are many types of residential centers.

Some are market-rate apartment buildings designed specifically to serve frail seniors, and some are either market rate or HUD subsidized apartment buildings that are arranging services for residents who are aging-in-place. Some HUD buildings arrange for services using the HUD service coordinator model, which is paid for by public housing funds.

The Class E home care provider license was created specifically for residential centers that were providing fairly light services, such as individualized personal care services or home management services (also called Assisted Living waiver services), and therefore does not allow the provision of Assisted Living Plus waiver services. In order to provide the higher level of care, the residential center would need to be licensed as a Class A provider or contract with a Class A agency to provide the services. If the residential center is registered as a housing-with-services establishment, it would also have the option of providing services under the Assisted Living Home Care Provider license.

Since the new licensure category of assisted living home care provider came into effect, at the same time as the assisted living plus service package, there are now fewer residential centers using the Class E license.

Residential centers do not have to register as a housing-with-services establishment unless they provide sleeping accommodations to one or more adult residents, at least 80 percent of whom are 55 years of age or older, and offer or provide, for a fee, one or more regularly scheduledhealth-related services or two or more regularly scheduled supportive services.

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