Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Suggested Changes to Improve the Medicaid-Funded Residential Care System


Most of the recommendations were tied to funding and eligibility issues.

  • I would like to see greater expansion of assisted living by tapping into all the potential funding sources. We need to have Housing and Elder services talking to each other.

  • People should be able to get the state supplement and remain in their homes. Sometimes, a nursing home resident is discharged to a homeless shelter because they don't have enough money to pay rent.

  • I would raise the financial eligibility to 400 percent of SSI. There are many people who are middle class and have a parent who can pay $1,000 a month for an ALF, but they have no extra money to pay for medications, etc. I recommend a sliding scale for cost sharing.

  • The budgetary and insurance barriers could be overcome through cost of living adjustments and tying waiver reimbursement to a percentage of nursing home costs in each area. We also need tiered rates, and reimbursement that covers the extra cost of liability insurance.

  • The number one reason that people go into nursing homes is that they don't have a caregiver. I would change the Aged and Disabled Adult waiver, because it does not pay a caregiver subsidy like the state programs do, which is significant in keeping frail elders out of a nursing home.

  • I wish there were more targeting of the lower income folks. Right now, one-third of the folks on the waiver qualify at the 88 percent Poverty Level, and the other two-thirds are above that threshold. The waiting list should not be prioritized by acuity but by income.

  • The reimbursement for providers participating in the Assisted Living Waiver should be adjusted annually to cover increases in expenses, including liability insurance costs.

  • You need a program that says here is a pot of money, not earmarked for nursing homes, tie the money to the individual not to the program. Tie the Medicaid to an individual care plan, not to a program

  • We need tiered rates and we require a case manager to assess on a semi-annual basis, so the provider can report changes in levels of care.

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