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

12/01/2003

  • The state has several reimbursement levels for personal care provided in adult care homes:

    • Basic level--one hour of personal care per day.

    • Enhanced level I--assistance with eating

    • Enhanced level II--assistance with eating and toileting

The rates are based on the size of facility. In facilities with 1 to 30 residents, the basic daily rate is $14.71, which pays for one hour of personal care. In facilities with 31 or more residents, the basic rate is $16.11 per day. The enhanced rates are per diem add-ons to the basic rate and are the same for both sizes of facilities. Enhanced daily rates are provided when a resident needs assistance with: ambulation (+ $2.64); toileting (+ $3.69); eating (+ $10.33); eating and toileting (+ $13.18).

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