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


  • The reimbursement methodology for CBA waiver Assisted Living/Residential Care (AL/RC) services is based on clients' needs as determined by their TILE classification (Texas Index for Level of Effort). The state developed the TILE classification system to group nursing home residents on the basis of the level of effort needed by a licensed nurse to meet their needs and their functional abilities. TILE classifications are numbered TILE 201 through 211, with TILE 201 indicating the highest intensity of care.

  • Private pay clients are not assessed for TILE levels and facilities are free to charge different rates for private pay residents.

  • Effective September 2000, the state approved rate increases for CBA waiver AL/RC providers. However, the appropriations for these increases are contingent upon the adoption of agency rules that promote increased wages and benefits for attendants, thereby reducing staff turnover and attrition. Providers have a choice of participating in the Attendant Compensation Rate Enhancement option; those who choose not to will receive a single attendant compensation rate regardless of the client's TILE classification.

  • Almost half of AL/RC providers have chosen this payment option. State staff reported that participating providers have additional monitoring and reporting requirements, but in return have less recruiting and training costs. In addition, by offering higher rates for attendants, the facility will be more competitive than those offering lower rates. For example, if a participating provider has a client residing in an assisted living single occupancy apartment with a TILE of 210, the client would receive a rate of $47.55 per day. For a nonparticipating provider the rate for this same type of client would be $ 39.69.

  • There are 11 different TILE levels, 201 to 211, but the CBA waiver decided to combine some of the levels for a total of six payment levels. In 2003, the rates were as follows:

    • apartment assisted living ranged from $46.13 to $60.27 per day;
    • residential care apartments from $39.54 to $53.68 per day;
    • non-apartment residential care range from $23.60 to $37.74 per day.

View full report


"med4rcs.pdf" (pdf, 3.73Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®