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Life Health > Long-Term Care Planning

When assisted living facilities take Medicaid

By Allison Bell

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State Medicaid programs are well known for paying for nursing home care.

Today, more Medicaid long-term care (LTC) benefits money is going to another type of provider — the assisted living facility (ALF).

An ALF — or, in the language of the U.S. Department of Health and Human Services (HHS), a residential care facility — is a facility that houses older people or younger people with chronic health problems but does not necessarily meet the same standards a skilled nursing facility has to meet.

Angela Greene and other researchers at RTI International recently looked at the residential care facilities that take Medicaid benefits in a study for HHS.

The researchers compared facilities that take at least some Medicaid patients with facilities that refused to have anything to do with Medicaid by using data from the government’s 2010 National Survey of Residential Care Facilities.

About 43 percent of the 31,000 facilities had at least one resident getting Medicaid LTC benefits, and Medicaid paid for some LTC services for 19 percent of the residents.

The researchers focused on facilities that mainly serve older people and young people with physical disabilities. But the facilities also served some younger people with developmental problems or serious mental illness.

Here’s a look at some of the ways the facilities that took residents with Medicaid LTC benefits differed from the other facilities.

Facilities that took Medicaid offered more services

Medicaid facilities cared for people with more serious problems with activities of daily living (ADLs), and they offered more services.

The RTI researchers found, for example, that most of the facilities in both groups offered special diets, basic health monitoring, help with ADLs, incontinence care and transportation to medical appointments and stores.

Residents in Medicaid facilities were more likely to be young people with intellectual limitations, rather than older people who need help with ADLs, and the Medicaid facilities were more likely to offer transportation to sheltered workshops and supported employment programs.

Thirty-one percent of the Medicaid facilities offered residents transportation to educational programs, compared with just 24 percent of the non-Medicaid facilities.

Another example: 49 percent of the Medicaid facilities offered skilled nursing services, compared with 31 percent of the non-Medicaid facilities.

Staffing and privacy

The RTI researchers found that the Medicaid facilities had roughly the same ratio of staffers to residents, and roughly the same mix of staffers, as non-Medicaid facilities.

But the non-Medicaid residents were much more likely to have private rooms, or rooms that resemble apartments.

About 27 percent of the Medicaid residents lived in private rooms, and 28 percent lived in apartments.

About 46 percent of the Medicaid residents had one or more roommates.

Meanwhile, just 22 percent of the non-Medicaid residents had roommates. Thirty-three percent of the non-Medicaid residents had private rooms, and 45 percent lived in apartments.

Which facilities will take Medicaid?

One problem with using Medicaid to pay for assisted living facility care is that the facilities generally prefer to get private money from the residents’ savings, families or private long-term care insurance (LTCI) benefits.

The RTI researchers looked at what factors made it more likely that facilities would participate in Medicaid.

Residents were much more likely to take Medicaid in states with Medicaid programs that encouraged residents to use assisted living facilities.

Facilities in chains were substantially more likely to take Medicaid, but for-profit facilities that were not part of chains were less likely to take Medicaid.

Facilities that offer a high percentage of private rooms were also less likely to take Medicaid.

“Behavior problems”

The RTI researchers found that the Medicaid residents were much more likely than the non-Medicaid residents to have problems such as:

  • Being excessively noisy;
  • Refusing to bathe;
  • Being physically aggressive; or
  • Making unwanted sexual advances.

That may be partly because the residents with Medicaid LTC benefits were more likely to have developmental disabilities, serious mental illness, Alzheimer’s disease and other conditions that affect behavior, the researchers say.

But “Medicaid residents exhibit more behavioral problems and are prescribed more medications to control those behaviors than are non-Medicaid residents, raising questions about facility staffing and training levels in these facilities,” the researchers conclude.

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