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

12/01/2003

A big hurdle in developing the waiver was obtaining consensus among the consumer advocates and providers regarding occupancy rules in assisted living facilities. The consumer advocates wanted single occupancy to be required for waiver clients, while the providers wanted double occupancy to be the standard because existing providers already had double occupancy rooms in many facilities.

CBA waiver provider participation standards require the assisted living facility to provide each client with a choice of a private or semi-private room. The Texas Waiver Handbook also states that the facility must provide each participant with a separate living unit. However, in practice, dual occupancy rooms and apartments are not excluded from the waiver program. Most assisted living facilities serve a predominantly private pay clientele and single occupancy units are not always available

There are no data indicating the percentage of CBA waiver participants typically served in dual occupancy or dormitory units, but respondents did not think that the percentage was that different from the percentage of private pay residents in dual occupancy or dormitory units. As of December 31, 2002, 1787 CBA clients were in single occupancy apartments, and 952 CBA clients were in double occupancy apartments.

The CBA waiver contracts specify which of the three housing options will be available for CBA waiver clients. Providers may not deliver CBA waiver services in a housing option which is not specified in the contract. If the AL/RC provider wishes to limit the types of apartments in a facility that are available to CBA waiver participants, this must be specified in the contract. Without this specification, all types of apartments in the facility must be available to CBA waiver participants.

If the facility limits the type of apartment available for CBA waiver clients and there is no apartment of that type available, they can refuse to accept any CBA waiver client, based on not having space available. This would apply both for a client wanting to move into the facility from the outside, or to a private pay client currently in the facility who has spent down to CBA waiver eligibility. The client would then have to move to another assisted living facility or to an adult foster care home.

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