State Medicaid HCBS Policy Factors Often Limit Beneficiary Access To Assisted Living

State Medicaid policies for home- and community-based services (HCBS) often limit whether Medicaid beneficiaries with disabilities can access HCBS in a residential care setting (RCS), such as an assisted living facility. Specifically, the Medicaid funding authorities that states use to fund HCBS delivered in an RCS directly and indirectly restrict beneficiary access to RCS beds via caps on maximum bed capacity, level-of-care criteria, and income eligibility restrictions.

In addition, access is also limited by RCS provider organization response to Medicaid rates that cover only the HCBS delivered by the RCS, not room and board. Medicaid-certified RCS . . .