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

12/01/2003

  • Wisconsin does not set room and board rates for RCACs. This policy is based on a philosophy of local control and a belief that the state does not have the information needed to set accurate rates. Counties negotiate the room and board rates for publicly funded clients. As part of a Robert Wood Johnson funded project, the state is developing rate setting methods for counties and facilities to use.

  • Facilities are free to charge both private pay residents and Medicaid waiver clients whatever they want. In January 2000, monthly RCAC charges ranged from $625 to $3,700 per month. The average total charge was $1,881 per month, allocated as follows: rent $841, meals $259, services $781.

    Based on the special income standard for waiver clients (300 percent of SSI) and required cost sharing for services, the typical amount of income that Medicaid waiver clients have available to spend on room and board is $667 a month (the minimum amount is $312 and the maximum is $1,591). Those eligible for Medicaid through the community financial eligibility standard have no more than this amount. Thus, the great majority of persons eligible for Medicaid waiver services and state plan personal care services will not have sufficient income to pay for room and board in an RCAC without a subsidy. Some may be eligible for Food Stamps, which could make the RCAC more affordable.

    If people spend down to Medicaid eligibility in RCACs, some providers (e.g., mission driven non-profits, or religious orders) have an endowment fund to subsidize the cost of care for a limited number of residents.

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