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

Some stated that low rates were a barrier to the expansion of assisted living, and one respondent felt that Medicaid rates were low across all settings, not just in ALFs. Another said that Texas is limited in its funding for Medicaid programs, noting that the state ranked 47th in terms of its reimbursement rates. Another disagreed:

  • The CBA waiver payment rates used to be much lower, but there have been increases to make the rates more competitive with private pay rates. There are now enhanced rates in exchange for the provision of better wages, workers' compensation coverage, and benefits to facility staff. These rates might be at risk though, given the large state budget deficit.

One respondent said that the state's bed hold policy was a major cost problem for providers.

  • The state requires providers to hold a bed for 120 days when a resident is placed in other care (e.g., hospital or rehabilitation unit). The room and board rate is only about $14.00 a day, much less than the private pay rate. The 120 day rule applies each time a client has an out-of-facility placement, so if a resident returns on the 120th day and stays for 2 days, but then has another emergency, the provider has to hold the bed for another 120 days.

    The facility often knows the likelihood of the client's return better than the case managers, who are sometimes resistant to making decisions before the 120 days, even if it seems obvious that the resident can't return. The state should lower the number of days (it used to be 90 days) or limit it to one 120-day period per year per client.

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