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MACPAC > TABLE 5. State Room and Board Affordability Policies for Residential Care Settings by State, 2016

TABLE 5. State Room and Board Affordability Policies for Residential Care Settings by State, 2016

Published On

April 30, 2018

State  Room and board charge limit Maximum monthly optional state supplement (OSS) Monthly personal needs allowance (PNA) SSI special income standard for § 1915(c) and § 1915(k) waiver programs1 Family supplementation
Alabama N/A N/A N/A N/A N/A
Alaska – $1002 $100 – Allowed2
Arizona SSI – PNA None $101.10 N/A Allowed for room upgrades3
Arkansas SSI – PNA None 66 ✓ Allowed for items not included in room and board rate (e.g., phone and cable TV service)
California (SSI + OSS) – PNA $412 $131 – –
Colorado Capped at $675 $651 Resident’s income minus room and board cap ($675 in 2016)4 ✓ Allowed
Connecticut Not available Calculated individually, based on per diem rate of licensed facility and difference between the resident’s income and SSI federal benefit, minus PNA $29.95 ✓ No policy5
Delaware Not available $140 $131 N/A Allowed
District of Columbia Not available

$585.00 for residents in RCS with fewer than 50 residents.

$695.00 for residents in RCS with more than 50 residents

 $100 ✓ No policy5
Florida No limit for waiver participants. Capped at $757.40 for adult family care home residents accessing personal care state plan services6 $78.406 $54 for adult family care home residents accessing personal care state plan services. Basic room and board rate plus 20 percent of federal poverty level for waiver participants6 ✓ Allowed
Georgia SSI – PNA – $114 ✓ Allowed
Hawaii (SSI + OSS) – PNA $759.90  $50 N/A ―
Idaho SSI – PNA $453 $100 ✓ Allowed
Illinois SSI – PNA Amounts ranged from $1,233 to $1,277 per month depending on level of need and geographic area. $90 – Allowed
Indiana SSI – PNA – $52 ✓ –
Iowa Not available 299.55 $93 ✓ Allowed
Kansas Negotiated None Negotiated ✓ Allowed for non-covered services
Kentucky N/A N/A N/A N/A N/A
Louisiana N/A N/A N/A N/A N/A
Maine SSI – PNA $234 Not available N/A Allowed for a private room, telephone, television, and other non-covered services
Maryland SSI – PNA $650 $68 ✓ –
Massachusetts Not available $454 Not available ✓ No policy5
Michigan (SSI + OSS) – PNA $157.50/$179.307 $44 N/A –
Minnesota – $250 $95 ✓ Allowed
Mississippi Not available – Not available ✓ –
Missouri SSI + OSS Varies by facility type, from $156 for residential care facilities to $292 for assisted living facilities $45 N/A Allowed
Montana Set at medically needy income standard $94 $100 – –
Nebraska SSI – PNA $438 $60 – –
Nevada ― $391 $110 ✓ Allowed
New Hampshire Not available $207 $56 – Allowed on a case-by-case basis
New Jersey (SSI + OSS) – PNA $210.05 $107 N/A Allowed for room upgrades
New Mexico Negotiated between provider and resident $100 State does not specify N/A Allowed
New York Not available $694 Varies by facility type, from $141 to $19,319 N/A –
North Carolina Capped annually by North Carolina General Assembly Varies by resident, from $1,096 to $1,515 (residents of special care units) $46 N/A Allowed for a for a private room
North Dakota $683 for waiver and $633 for state plan – $144 for waiver and $100 for state plan7 – Allowed
Ohio SSI – PNA – $50 ✓ –
Oklahoma Limited to 90 percent  of SSI payment – $50 ✓ Allowed
Oregon Capped at $570 – $163 ✓ –
Pennsylvania N/A N/A N/A N/A N/A
Rhode Island Negotiated $332 $100 N/A –
South Carolina (SSI + OSS) – PNA $682 (average) $65 N/A –
South Dakota $693/month $791 $60 ✓ –
Tennessee State does not specify – State does not specify7 N/A Allowed up to the maximum allowable charges for room and board
Texas SSI – PNA – $85 N/A Allowed for amenities not included in the room and board rate
Utah Negotiated between provider and resident – $45 ✓ Allowed
Vermont (SSI + OSS) – PNA $223.94 $115 N/A –
Virginia SSI $686 in northern VA, $519 for rest of state $82 ✓ Allowed for goods and services beyond those covered by SSI payment
Washington SSI – PNA – $62.79 ✓ Allowed
West Virginia N/A N/A N/A N/A N/A
Wisconsin (SSI + OSS) – PNA $95.99 $45 ✓ Allowed to cover room and board, a private room, or for service enhancements that are not covered by the Medicaid payment
Wyoming – –2 $50 ✓ Allowed
Notes: SSI is Supplemental Security Income. RCS is residential care settings.
For certain states, information about Medicaid room and board policies, the PNA, and family supplementation policy was only available from a report published in 2009 (Mollica 2009). Information on personal needs allowances was unavailable for more recent years for Alaska, Arizona, the District of Columbia, Kansas, Michigan, Nebraska, Nevada, and New Hampshire. More recent information on family supplementation was unavailable for the District of Columbia, Hawaii, Kansas, Oregon, Montana, Nevada, New Hampshire, New Mexico, and Utah.
Dash (–) indicates state does not include or allow.
N/A is not applicable, as the state does not provide Medicaid coverage for services delivered in residential care settings.
1 Only includes states that use a 300 percent of SSI income standard for their § 1915 HCBS waivers that cover residential care services for individuals age 65 and older and those with physical disabilities.
2 Current information about the OSS was not available online or from other sources.
3 In a limited number of cases, the state covers room and board and some services through its General Relief Assistance program.
4 Residents are permitted to retain a PNA equal to the difference between the cap ($675 in 2016) and their income. For federal SSI recipients whose monthly incomes are $733 in 2016, the PNA is $58.
5 State had no policy that allowed or prohibited family supplementation.
6 The waiver program allows assisted living facility residents to keep an amount equal to the assisted living facility basic room and board rate plus 20 percent of the federal poverty level, which is the state’s personal maintenance allowance. The assisted living facility basic room and board rate is determined by Florida’s Department of Children and Families, and it is based on the cost of three meals a day and the semi-private room rate. The basic room and board rate varies by facility.
7 The Basic Care Assistance program limits the room and board rate that facilities charge to Medicaid-eligible residents to the SSI federal benefit of $733 minus a PNA of $100 in 2015. The state does not provide an SSI supplement.
8 State reports PNA is 300 percent of SSI ($2,199/month in 2016). Some states call the personal needs allowance the personal maintenance allowance, and vice versa, even though these are distinctly different allowances under federal Medicaid law.
Sources: 10A N.C. Admin Code 13F.0704 (2005). 455 Ind. Admin. Code IAC 3-1-12 (2011). Alaska Department of Health and Social Services (DHSS), 2016, General relief assistance (GRA), Juneau, AK: DHSS, http://dhss.alaska.gov/dpa/pages/gra/default.aspx. Carder, P., J. O’Keeffe, and C. O’Keeffe, 2015, Compendium of residential care and assisted living regulations and policy: 2015 edition, Washington, DC: ASPE, https://aspe.hhs.gov/basic-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition. Centers for Medicare & Medicaid Services (CMS), 2016, 1915(c) HCBS waiver applications, Baltimore, MD: CMS, https://www.medicaid.gov/medicaid-chip-program-information/by-topics/waivers/waivers_faceted.html. Centers for Medicare & Medicaid Services (CMS), 2015, Idaho Medicaid state plan, Baltimore, MD: CMS, https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/ID/ID-15-001.pdf. Colorado Department of Health Care Policy & Financing (HCPF), 2016, Telephone conversation with RTI International and MACPAC Staff, February 26. Colorado Department of Health Care Policy and Financing (HCPF), 2014, Becoming an alternative care facility provider, Denver, CO: HCPF, https://web.archive.org/web/20170222145102/https://www.colorado.gov/pacific/sites/default/files/ACF%20New%20Provider%20Training%20-%20FINAL.pdf . Delaware Department of Health and Social Services (DHSS), 2015, 2016 adult foster/residential care payment levels, Dover, DE, http://dhss.delaware.gov/dhss/dmma/files/dmma_an_01_16.pdf. Florida Agency for Health Care Administration (AHCA), 2016, Telephone conversation with RTI International and MACPAC staff, March 3. Georgia Health Services Network, 2016, Medicaid waivers, Monroe, GA: Georgia Health Services, http://www.georgiahealth.us/medicaid-waivers/. Haw. Code R. § 17-1724.1-63 (2016). Idaho Department of Health and Welfare, 2015, MedicAide newsletter for providers, February 2015, Boise, ID: Molina Medicaid Solutions, https://www.idmedicaid.com/MedicAide%20Newsletters/Forms/All.aspx. Illinois Department of Human Services (DHS), 2015, Cash, SNAP, and Medical manual, WAG 11-03-03-a: Sheltered care rate schedule, Springfield, IL: DHS, http://www.dhs.State.il.us/page.aspx?Item=16033. Social Security Administration (SSA), State assistance programs for SSI recipients, January 2011, Washington, DC: SSA, http://www.socialsecurity.gov/policy/docs/progdesc/ssi_st_asst/2011/ne.html. Maine Department of Health and Human Services (DHHS), 2016, MaineCare benefits manual, Chapter II, Section 97: Private room and other non-covered services, Augusta, ME: DHHS, https://www1.maine.gov/sos/cec/rules/10/ch101.htm. Mollica, R.L., 2009, State Medicaid reimbursement policies and practices in assisted living, Washington, DC: National Center for Assisted Living, American Health Care Association, https://www.ahcancal.org/ncal/advocacy/Documents/MedicaidAssistedLivingReport.pdf. New York Office of Temporary and Disability Assistance (OTDA), 2015, SSI and SSP benefit levels effective January 1, 2016, Albany, NY: OTDA, http://otda.ny.gov/policy/directives/2015/INF/15-INF-10-Attachment-1.pdf. Ng, T., Harrington, C., Musumeci, M, Reaves, E. 2015. Medicaid home and community-based services programs: 2012 fata update. Washington, DC: Kaiser Family Foundation. Available at http://kff.org/medicaid/report/medicaid-home-and-community-based-services-programs-2012-data-update/. Ohio Admin. Code 5160:33-03-6 (2016). O’Keeffe, J. O., Saucier, P., Jackson, B., Cooper, R., et al., 2010, Understanding Medicaid home and community services: A primer, 2010 edition, Washington, DC: Assistant Secretary for Planning and Evaluation, https://aspe.hhs.gov/understanding-medicaid-home-and-community-services-primer-2010-edition. Senior Planning, 2016, Oklahoma Medicaid long-term care eligibility, Phoenix, AZ: Senior Planning, https://www.seniorplanning.org/long-term-care-medicaid-eligibility/oklahoma/. Senior Planning, 2016, Utah Medicaid long-term care eligibility, Phoenix, AZ: Senior Planning, https://www.seniorplanning.org/long-term-care-medicaid-eligibility/utah/. Senior Planning, 2016, Wyoming Medicaid long-term care eligibility, Phoenix, AZ: Senior Planning, https://www.seniorplanning.org/long-term-care-medicaid-eligibility/wyoming/. SSA, 2015, SI 01415.047 federally administered optional supplementary payment programs for 01/15 payment levels, Washington, DC: SSA, https://secure.ssa.gov/poms.nsf/lnx/0501415047#c. Tennessee Division of Health Care Finance & Administration (HCFA), 2016, 2016 maximum room and board charges for persons receiving assisted care living facility services in the CHOICES program, Nashville, TN: HCFA, https://web.archive.org/web/20171016215537/https://www.tn.gov/assets/entities/tenncare/attachments/ACLFMemoMaximumRoomBoard.pdf. Wash Admin. Code § 182-515-1507 (2008). Wash Admin. Code § 388-105-0050 (2007).