Should All States Permit the Use of Medicaid for Assisted Living?

by Robert Slutsky on Feb. 15, 2018

Civil & Human Rights Elder Law 

Summary: The question of using Medicaid funds for assisted living is a big one for many in the elder care field. As we have discussed before, Medicaid is a joint state and federal program.

The federal law lists broad eligibility rules, The states will get roughly half of the Medicaid expenditures reimbursed if they do not make their eligibility rules stricter than the federal law.

Pennsylvania is in compliance, and in some cases, is more generous than the federal rules. The federal nursing home Medicaid payment rules are intended only to provide funds for eligible residents receiving nursing care. Pennsylvania, like most states, has sought a waiver from that federal rule seeking to use the nursing home funds for home and community based services. What has not occurred is the use of these funds for assisted living or personal care residents which is likely available under the Waiver program or with a quick application.

With Medicaid, Many Older Adults Would Thrive in Assisted Living

Often older adults who would qualify for nursing care but would thrive in a less restrictive environment like an assisted living community are forced into the nursing home because they run out of funds. Some states, like New Jersey, allow Medicaid funds to be used for this less restrictive level of care, resulting in lower costs to the government and better quality of life for the resident. Pennsylvania has assisted living regulations that intend such a result but the regulations are so restrictive and inappropriate for senior communities that very few choose to seek licensing as an assisted living. Further, even for those that have this licensing, there has yet to be a dollar of Medicaid funds released to any of the licensees.

Part of the problem, it appears, is that the rules on assisted living licensing in PA requires facilities to put certain amenities in the room that work for the disabled community but could place impaired elders at risk (like cooking facilities). But I do not think that is the only reason (as conceivably those amenities could be disabled for a demented resident). The bigger issue is that before communities are going to staff of and put large amounts of money out for assisted living licensing, the state must actually honor its promise and make the funds available. Thus far PA has not done this.

It would seem (from my simplistic perspective) that allowing properly licensed assisted living communities to receive Medicaid funding would reduce the stress on nursing homes by making more beds available for rehab and allow people who are impaired but could function at a higher level enjoy a higher quality of life in a less institutional atmosphere and save the taxpayers money.

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