How To Obtain Affordable Assisted Living

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States are increasingly including affordable assisted living services in their Medicaid strategies to provide non-institutional options to eligible individuals and reduce state long-term care expenditures. Over forty states provide funding for residential care or assisted living settings through their Medicaid or other programs. While these programs are often limited in size with substantial waiting lists, they are an ideal option for low-income individuals who need long-term care services and can’t remain at home.

Finding high quality assisted living settings that meet the Center for Excellence in Assisted Living’s definition and are willing to accept Medicaid payment levels is difficult. The number of quality providers willing to accept Medicaid has been bolstered by high vacancy rates and the expansion of Medicaid programs.

Unfortunately for Medicaid eligible residents, the private pay market is picking up. As funded residents move out of their units, providers can fill them with higher revenue, private pay customers. In at least one case, a large national company is evicting funded residents in an initiative to increase revenues.

Recent market trends indicate the need for a strong focus on strategies to expand and stabilize the supply of assisted living projects willing to serve Medicaid eligible individuals. The Coming Home Program, a program of NCB Capital Impact supported by The Robert Wood Johnson Foundation, has created policies, programs, and demonstrations as models for states and communities. By combining Medicaid services funding with housing subsidy programs carrying mandatory affordability periods ranging from 15 to 30 years, the projects guarantee a stable supply of affordable assisted living.

However, this can be difficult for sponsoring organizations under the best of circumstances and impossible when agency staff and programs do not work together to remove obstacles and align requirements. Strong partnerships are required for communities and local organizations to succeed. At the policy level, such partnerships must include the state regulatory, Medicaid, and housing agencies. At the development level, the lead state agency must work with organizations interested in developing affordable living to resolve obstacles and to give all parties the confidence to move forward.

Under Coming Home, state assisted living Medicaid programs were implemented and revised, state housing subsidy programs were aligned and more than 30 affordable assisted living projects were created.

To address the likely increasing scarcity of high quality affordable assisted living, states, advocates, and communities need to join together.

Robert Jenkens is the Director of the Coming Home Program -NCB Capital Impact and a Board Member of CEAL.

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