Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Rider 28 of the General Appropriations Act, 76th Legislative Session (3)


As part of its Olmsted initiative, the State has tried to increase the ability of individuals in nursing facilities who could transition into the community to do so through the CBA waiver program. Because there are too few slots in the waiver program relative to demand, the State is using a money follows the person initiative to fund home and community care.

Under Rider 37, when there are insufficient slots or funding in the CBA waiver program, funding follows the individual from the nursing home into the community. The cost of services comes from the nursing home budget instead of the CBA waiver budget. Thus, individuals in nursing homes who are Medicaid eligible can move to the community and receive home or community residential care even when CBA waiver funding is not available.

During a recent twelve-month period, 952 individuals have taken advantage of Rider 37, with about 45 percent transitioning to residential care. Many of those who transitioned were between the ages of age 21 and 64.

The lack of CBA waiver slots can result in a person who spends down in the community having to enter a nursing home for a month in order to apply for funding under Rider 37. The state is grappling with the question of what to do with funds when persons funded through Rider 37 are no longer served. Currently, the money that funded their care is being returned to the nursing home budget.

3. The provisions of Rider 28 were originally contained in Rider 37 in the 76th legislative session. The number was changed during the 78th legislative session.

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