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


Most respondents felt that rates for assisted living services are generally adequate. Some, however, voiced concerns that the State set a maximum rate but allowed counties to negotiate lower rates. There is a desire to develop tools to help counties determine the number of hours of service needed by each individual, which would enable them to better match the reimbursement level to the services needed.

  • Sometimes working with individual counties can be a challenge. Funding is viewed generally as adequate; when it's not, it's a disagreement between the county and the provider. The state sets rate limits for each client--some counties go close to full rate--other counties try to come in under that rate.

  • Providers of market rate assisted living have taken in Medicaid at a little less than the going rate to fill beds.

  • Medicaid rates should be equal to the private pay market rates. By law the waiver rate has to be at or below what the private pay rate is. The State caps what the counties can pay for services but they have discretion in negotiating rates. You can have two places on the same street--one in one county and one in another--each getting a different rate.

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