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Factors to Consider WhenChoosing Coverage Options: Two Illustrative Services 101ices in facilities licensed as board-and-care facilities,and others have created assisted living as a Medicaidreimbursed service even though the state may not havean assisted living licensing category.The comparability requirement does not permit statesto deny personal care services to persons in board-andcarehomes. However, states are not required to paytwice for the same service (i.e., if the board-and-carefacility provides personal care services, the beneficiarywould be unlikely to demonstrate a medical need forpersonal care services from another provider andtherefore would not be eligible for services).11. Loretta Williams, National Association of StateUnits on Aging, with data from Mollica, R.L. (June1998). State assisted living policy: 1998. Prepared for TheOffice of the Assistant Secretary for Planning andEvaluation, Office of Disability, Aging, and Long-TermCare Policy. Washington, DC: Department of Healthand Human Services.12. Residents may be asked to leave under the followingconditions: (a) their needs exceed the level of ADLservices provided by the facility; (b) the resident’sbehavior interferes with the rights and well-being ofothers; (c) the resident has severe cognitive decline andis not able to respond to instructions, recognize danger,or make basic care decisions; or (d) the resident has amedical condition that is complex, unstable, or unpredictableand appropriate treatment cannot be provided.13. Loretta Williams, National Association of StateUnits on Aging, with data from Mollica, R.L. (June1998). State assisted living policy: 1998. Prepared for TheOffice of the Assistant Secretary for Planning andEvaluation, Office of Disability, Aging, and Long-TermCare Policy. Washington, DC: Department of Healthand Human Services.14. An RCF is both (a) a setting in which personal careis provided and (b) a provider of personal care services.Arkansas allows personal care services to be providedin a person’s home or other setting, such as anRCF. The state also allows RCFs to enroll in Medicaidas providers of personal care services. About 1500Medicaid beneficiaries live in Arkansas RCFs.15. The flexible standard used in Arkansas allows aperson with mental impairments to be served in anRCF if the facility is capable of providing the necessarycare and the individual’s physician agrees that the settingis appropriate.16. National Center for Assisted Living (1998). Facts andtrends: The assisted living sourcebook. Washington, DC:Author. Some information on this report is on the website:www.ncal.org.17. This discussion focuses on payments by familymembers. However, payments may also be made by aspecial needs trust on behalf of its named beneficiary.Many families set up such trusts for adult children withdisabilities to ensure that they will be adequately takencare of throughout their lives.Annotated BibliographyNational Association of State Units on Aging(NASUA) (1999). Advocacy practices in assistedliving: A manual for ombudsman programs.Washington, DC: Author. (122 pages)Developed specifically to provide technical assistanceto ombudsmen, this manual contains informationthat will be useful to policymakers who aredeveloping assisted living regulations or publiclyfunded assisted living programs. Included in themanual are an overview of assisted living trendsand regulatory developments, benchmarks and aself-assessment questionnaire, an inventory ofgood practices and advocacy initiatives, and a listof assisted living resources. The publication is avail-
Guide to Chapter 6Lessons from the Transitioning Experience with ICFs/MR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104General Factors to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105Obstacles to Look for . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112Annotated Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
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Understanding MedicaidHome and Comm
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viiiUNDERSTANDING MEDICAID HOME AND
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IntroductionPeople of all ages with
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Introduction 31998—is the group m
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Introduction 5This Primer has been
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CHAPTER 1Medicaid Coverage of Home
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Medicaid Coverage of Home and Commu
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CHAPTER 2Financial Eligibility Rule
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Financial Eligibility Rules and Opt
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Health and Functional Criteria for
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