Content by Keyword: Medicaid

Most respondents suggested changes to address the specific issues and barriers they had identified. The overriding issue is that more people need services than services are available, so we need to generate revenue to make it possible to serve more people. We also need to downsize nursing home capacity. We need more affordable facili

There were major differences in views regarding service rates and whether they constituted a barrier to serving Medicaid clients. Some, but not all, providers felt the state's rates were too low or "wholly inadequate." Most other respondents felt that the RCAC and CBRF combined market rate (room, board, and services) was too high and that the vari

A few respondents commented that access can be limited due to maldistribution of assisted living facilities. It's a big issue in Family Care where you're supposed to have a choice. In some of the counties, there may not be a facility within 100 miles. This is a major access issue. The RWJ project is supposed to address this. There is also a

A few respondents stated that many of the counties did not want to use public funding in residential care settings, because they subscribed to a philosophy that favored homecare. One stated that many counties thought some CBRFs, particularly larger ones, were more like institutions. Given that the COP and waiver program are intended to provide alt

There was general agreement that room and board costs in RCACs and many CBRFs were unaffordable for waiver clients. If you're low income you will need assistance to be in a residential care facility. If you run out of money and there is no COP money available, you will have to go to a nursing home. If you don't meet the nursing home level of

There was a consensus that the major barrier to providing affordable assisted living in Wisconsin is insufficient capacity in the statewide waiver program. Even though the Medicaid waiver program provides services in residential care settings, few people benefit because of the long waiting lists. There are over approximately 9000 elderly and worki

Respondents noted a number of barriers, but overall, the consensus was that the costs are too high and that it is not possible to get assisted living costs low enough for people with low incomes to pay for themselves. Providers think $2000 a fair price; $1600 a month is the minimum for good care. Most folks don't have this. They have $500 a

Respondents varied considerably in their views about these agreements. Some felt that such agreements can be useful for both providers and residents, enabling a less "paternalistic" approach to service delivery. Some felt they should not be mandated, while others that they should be required in all residential care settings.

No one interviewed raised issues about admission requirements, but many had concerns about retention requirements. Some were concerned about their affect on the ability to age in place. A key complaint about RCACs is premature and/or involuntary discharge. The average time spent in RCACs is fairly short -- approximately 18 months -- and fift

With few exceptions, respondents agreed that national or model standards for assisted living would not be helpful. One respondent felt that model standards are intended to be minimum standards, but in many instances become maximum standards. Most felt that each state's long term care system is unique and what is appropriate for one state is not ap

A number of respondents felt that the state needed better standards for dementia care. One stated that the industry opposes regulation in this area, but another disagreed: We need regulations for dementia care but the industry is not opposed. They just don't want nursing home style regulations. The better providers are not against regulation

Some respondents, both providers and those representing consumer interests, felt that the industry needs more outcome-based regulations. We're concerned that the legislature will be pushed to apply nursing home type regulations to assisted living and we do not want this. There are always stories in the newspaper about someone being hurt in a

Many felt that insufficient regulations inevitably lead to problems and if the media picks up on it and reports the problems, then the pendulum swings the other way with a demand for regulation to address the problems, such as a need to assure a higher quality of staff in CBRFs and RCACs.

The majority felt that the regulatory requirements for oversight in both CBRFs and RCACs were inadequate, and as a result the state was not enforcing regulatory standards. I don't have a good answer to how you keep the bad providers out. More regulations in nursing homes have not solved the problem. The quality of care in Wisconsin is good c

No one felt that regulations posed a major obstacle to affordable assisted living in Wisconsin. The RCAC regulations have strong support from assisted living providers and, judging by the rapid growth of the industry in the state, they have not been an obstacle to development. Most facilities exceed the minimum physical plant and staffing re

There was a consensus among the respondents that the state's home and community services program -- both the state funded portion and the Medicaid portion -- were exceptionally good. Most felt that the state's goal in using Medicaid to cover services in residential care settings is to provide an alternative to nursing homes for people who can not

Several expressed concerns that the residential care system was very confusing for the public. Consistency in terms would help because the current situation is very confusing to people who can't figure out the difference among all the options: CBRFs, RCACs, assisted living. In Wisconsin, "Consumer Beware" is the operative condition b

Because many of the same residential care facilities serve both private pay and Medicaid residents, most respondents expressed views about the industry as a whole. When it created RCACs the state had an idea of a clientele that never materialized -- younger and healthier. If Wisconsin did it over again -- I doubt they would do RCACs.

In addition to consulting with eleven state staff and policy makers regarding the technical details of the state's programs, we also interviewed four of them. In addition, we interviewed eleven stakeholders, including representatives of residential care provider associations, residential care providers, consumer advocates, the state ombudsman prog

Medicaid Personal, supportive and nursing services provided in RCACs are reimbursable through Wisconsin's HCBS waiver program. Waiver funds pay for services appropriate for the individual participant. However, most counties have long waiting lists for their waiver program and in some cases the wait can be from one to three years or more.