Assisted Living and Medicaid: Exploring the Unanswered Questions

By Carlson, Eric | Aging Today, March/April 2011 | Go to article overview

Assisted Living and Medicaid: Exploring the Unanswered Questions


Carlson, Eric, Aging Today


Increasingly, state Medicaid programs are offering to cover personal and healthcare services provided by assisted living facilities. But it's a new model, which means many policy questions remain unanswered, posing challenges for states, providers and beneficiaries.

In order to better understand these unanswered questions, the National Senior Citizens Law Center (NSCLC) conducted a study of states that cover assisted living services through a Medicaid Home and Community-Based Services (HCBS) waiver. (The study was funded through a grant from The Commonwealui Fund and formed the basis of several papers based on the findings.)

Through an HCBS waiver, a state is authorized to provide long-term services and supports to Medicaid beneficiaries whose healthcare needs would warrant nursing home admission. The waiver funding should be a win-win for both the Medicaid program and beneficiaries - the state spends less for HCBS than it would for nursing home services, and beneficiaries receive services and supports in a less institutional environment.

WHAT'S CONSIDERED COMMUNITY-BASED?

But the first question is whether assisted living care should be considered "community-based" in the first place. An assisted living facility is almost always less institutional man a nursing home, but an assisted living facility is more like a nursing home than it is a private home. Living units are often shared with people other than family members, staff is allowed in and out of units without requiring permission and residents don't have access to private bathrooms or a kitchen.

So far the Centers for Medicare and Medicaid Services (CMS) has considered assisted living services community-based when it comes to an HCBS waiver, but mere are indications that the CMS's position may be shifting. For example, in die Money Follows the Person (MFP) program - designed to transition nursing home residents into communitybased settings - an assisted living facility can only be considered communitybased if it provides single-occupancy units with a lockable front door.

Also, in 2009 the CMS requested public input on the interpretation of the term community-based, and it is expected to announce a broad policy on this issue during 201 1. The NSCLC and its partners in the Assisted Living Consumer Alliance (www.assistedliv ingconsumers.org) support an interpretation similar to the policy applied in MFP programs.

Quality of care is another important issue. When the Medicaid program covers nursing home services, the nursing home must comply with comprehensive quality standards set by the federal Nursing Home Reform Law.

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