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


Services provided in assisted living facilities (ALFs) vary depending on the type of license. Only facilities with an LNS or ECC license may provide services to waiver clients.

Standard License. Facilities with this license must provide housing, meals, and one or more personal care services. Personal care services include direct physical assistance with or supervision of a resident's activities of daily living and the self-administration of medication and similar services. The facility may employ or contract with a licensed person to administer medication and perform other specialized nursing tasks such as taking vital signs.

Any facility with a standard license can provide personal care services to Assistive Care Services (ACS) clients. All ALFs must have a standard license before they can apply for a specialty license.

Limited Nursing Services (LNS) License. Facilities with an LNS license may provide any of the services under a standard license and additional nursing services, such as ear and eye irrigations; replacing established self-maintained indwelling catheter or performing intermittent urinary catheterizations; applying and changing routine dressings for abrasions, skin tears, and closed surgical wounds; caring for stage 2 pressure sores; conducting nursing assessments if conducted by, or under the direct supervision of, a registered nurse; and for hospice patients, providing any nursing service permitted within the scope of the nurse's license, including 24-hour supervision.

Extended Congregate Care (ECC) License. Facilities with an ECC license may provide any of the services provided under a standard and LNS license including any nursing service permitted within the scope of a nurse's license, consistent with ALF residency requirements and the facility's written policy and procedures. A facility with this type of license allows a higher level of service, including total care with bathing, dressing, grooming and toileting, and enables residents to age in place in a residential environment despite mental or physical limitations that might otherwise disqualify them from residency under a standard or LNS license.

ECC facilities must make available a range of nursing services, including nursing diagnosis or observation and evaluation of physical conditions; ongoing medical and social evaluation to determine when the person's conditions cannot be met within the facility; routine measurement and recording of vital functions; administration of medications; and preventive regimens for residents likely to develop pressure sores.

The Medicaid waiver program reimburses for the following services for recipients in ECC settings: personal care, homemaker, attendant and companion, medication administration and oversight, therapeutic social and recreational programming, physical, occupational and speech therapy, intermittent nursing services, specialized medical supplies, specialized approaches for behavior management for people with dementia, emergency call systems, and case management.

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®