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


There was general agreement that room and board costs in RCACs and many CBRFs were unaffordable for waiver clients.

  • If you're low income you will need assistance to be in a residential care facility. If you run out of money and there is no COP money available, you will have to go to a nursing home. If you don't meet the nursing home level of care criteria, then you're in trouble.

  • I don't' know of any CBRFs who accept SSI as full rate. The SSI payment does not cover the cost of room and board. Even facilities with high functioning elderly charge more than SSI. RCACs can't get by on the SSI rate either.

  • An industry survey in 2000 found that the average room charge without meals was $841 per month, but the typical waiver client's income is in the $545-$725 range.

  • We use CBRFs more than RCACs, primarily because the RCACs won't contract with us because we won't pay them what they charge the private pay. We will only pay the industry median.

One respondent noted that while room and board costs are a barrier, there is no way to supplement these costs without cost shifting to other public funding sources, such as COP (the state's general revenue funded HCBS program). Others felt that each facility should be able to afford to take a few Medicaid residents. Some counties opt to use COP funding to pay for room and board for a few waiver clients in smaller CBRFs.

  • The state should limit room and board charges. The average cost of an assisted living facility is $2500 -- how can a person on SSI afford this? It is best to have facilities cross subsidize -- have a small percentage of Medicaid residents, and a majority private pay. A mix of clients also helps to assure quality for the publicly-funded residents.

A number of respondents felt that using state dollars with no federal match to pay for room and board gives too large a proportion of the states HCBS funds to the residential care industry.

Several respondents discussed the need to develop a greater supply of affordable assisted living facilities and stated that state and federal policy needs to create incentives to build more affordable units.

There was disagreement about whether the state should cap the amount that can be charged to Medicaid clients for room and board. Some felt that without a cap, Medicaid clients would never have access to "real" assisted living, meaning a facility with private rooms and baths and sufficient services to age in place. One noted that the issue had been discussed but rejected by the state's legislators, who wanted the market alone to decide the rates.

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