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


  • Required services in licensed assisted living facilities include but are not limited to: assistance with activities of daily living (ADLs), 24-hour supervision (periodic checks or visits to a client during each eight-hour shift to ensure that the client is safe), three meals a day and special diets, housekeeping and laundry, transportation and escort for Medicaid-covered medical appointments, and a planned program of social and recreational activities in the community.

  • Alzheimer's facilities must have a planned and structured program that encourages socialization, cognitive awareness, self-expression and physical activity.

  • Each of the following services may be provided according to the needs of the participant as authorized on the individual service plan as a waiver or non-waiver service. The case manager will make referrals for the services and coordinate delivery.

    • adaptive aids and medical supplies
    • skilled therapy services (occupational therapy, physical therapy, speech pathology)
    • nursing services
  • All services count towards the client's cost cap, whether they are reimbursed through the state plan or the waiver.

  • Nursing services consist of the full range of services provided by an RN or LVN within the scope of his/her state licensure. Nursing service can be brought into the assisted living facility for the participant and may be provided by RNs who have contracted with DHS, as well as nurses associated with licensed home and community support services agencies.

  • In 2001, licensing rules were amended to allow nurse delegation under the Nurse Practice Act in assisted living facilities. However, delegation of nursing tasks by agency RNs to facility attendants is not allowed. The facility must employ its own licensed staff to delegate nursing tasks.

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