Assisted Living/Residential Care

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

Effective March 1997, the state carved out a portion of the residential care market that was most suitable for deregulation and created a new category of residential care setting (RCS), called assisted living, with its own specific regulations. The state's intent was to reduce regulatory burden, give providers the flexibility to be creative in dev

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

Sources of Public Funding for Services in CBRFs

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

General Revenue Funded Community Options Program The Community Options Program (COP) was originally designed as a home care program in 1982 and there was no separate funding source for individuals in residential care who required long term care services. Once the state approved funding of services in CBRFs through COP and the waiver program

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

CBRFs serve people who do not require care above an intermediate level of nursing care and need no more than 3 hours of nursing services per week. Nursing care includes anything that is covered by the state's nurse practice act, including tasks that can be delegated, e.g., dressing changes. Assistance with ADLs is not considered a nursing task. Nu

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

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

Newly constructed CBRFs must have at least 100 sq. ft. of floor area in each single and 160 sq. ft. in each double occupancy bedroom. Minimum bedroom floor area for existing buildings is 60 sq. ft. per resident for multiple occupancies and 80 sq. ft. for single occupancies in facilities serving ambulatory residents only, and 80 and 100 sq. feet

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

Community Based Residential Facilities (CBRFs) are group living arrangements that serve five or more residents and provide room, board, supervision and other supportive services. Residents have private or shared rooms and most have shared bathrooms.

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

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

Adult Family Homes (AFHs) serve up to 4 residents. Those serving up to 2 residents need to be certified by county certifying agencies and those serving 3 or 4 residents need to be licensed by the state to be reimbursed for waiver services.

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

Wisconsin has three types of residential care settings (RCS) and separate licensing and regulatory requirements for each of them: Adult Family Homes (AFHs), Community Based Residential Facilities (CBRFs), and Residential Care Apartment Complexes (RCACs). The state has never had a moratorium on, or a certificate of need program for, RCS.

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

The information in this appendix is presented in three major sections:

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

Kerry Adair, Provider Funding and Contracting Pine Tree Lodge, a Veranda Living Assisted Living Facility Gerardo Cantu, Director, CBA Waiver Program Texas Department of Human Services Candice A. Carter Texas AARP, State Affairs Dee Church, Section Director for Client Eligibility, Long Term Care Services Texas Departme

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

Aged, Blind and Disabled Medicaid Eligibility Survey http://www.masterpiecepublishers.com/eligibility/ Case Manager Community Based Alternatives Handbook http://www.dhs.state.tx.us/handbooks/cm-cba-hb/appendix/XIV/index.htm Community Care for the Aged and Disabled Handbook http://www.dhs.state.tx.us/handbooks/ccad/ Community Based Alternativ

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

Gibson, M. J. and Gregory, S. R., Across the States 2002: Profiles of Long-Term Care , AARP, 2002. Kassner, E. and Williams, L., Taking Care of their Own: State-funded Home and Community-based Care Programs for Older Persons , AARP, September 1997. Kassner, E. and Shirley, L., Medicaid Financial Eligibility for Older People: State Variat

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

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

Only one respondent had a specific recommendation for other states interested in using Medicaid to pay for services in residential care. It's important to have good lines of communication between the program and licensing staff when developing the licensing requirements for assisted living and establishing program operating procedures. The T

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

A number of respondents mentioned ongoing activities related to the Olmstead decision. There are many advisory boards operating at the state level that are discussing long term care and Olmstead issues, with providers, consumers and advocates working together. The appropriations Rider 37 has supported the Olmstead decision and allowe

Suggested Changes to Improve the Medicaid-Funded

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

A few respondents did not make specific suggestions about Medicaid, but instead noted that there were general areas that the state needed to pay more attention to. With increased emphasis on aging in place, more attention to quality might be needed in ALFs. There have been some reports that the quality issues in ALFs--regarding food, activit

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

The amount of paperwork involved in accepting CBA waiver clients and the difficulties in dealing with a state agency keep some providers from serving these clients. For example, when a CBA waiver client is involved in an incident in an ALF, the facility has to go through two different report processes, one with the regulatory agency and the ot

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

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:

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