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A Trip to the Hospital May Put Assisted Living Residents on Medicaid at Risk of Eviction

Assisted living facility residents covered by Medicaid are at risk of being evicted if they leave the facility, even for a temporary hospitalization, the National Senior Citizen’s Law Center (NSCLC) warns in a recently released White Paper on the problem. Ironically, Medicaid officials in most states have the power to prevent these evictions but in most cases are not exercising it.

Most state Medicaid programs pay for services not just in nursing homes but in assisted living facilities, which are meant to provide a home-like alternative to nursing homes. But there is a crucial difference between nursing homes and assisted living facilities. The Nursing Home Reform Law authorizes Medicaid to pay a nursing home to hold a room for a Medicaid recipient who is temporarily absent due to hospitalization and entitles the resident to return to the first-available room.

In contrast, Medicaid does not make similar payments on behalf of residents of assisted living facilities and the facilities are not required to give admission priority to returning residents. This difference in treatment, the NSCLC asserts in its report, “Medicaid Payment for Assisted Living: Residents Have a Right to Return After Hospitalization,” diminishes the value of assisted living facilities as a community-based alternative to nursing home care. If assisted living facilities truly seek to offer “home or community-based” services, says the advocacy group, residents should have the peace of mind of knowing that they won’t be evicted if they are absent for a few days or weeks.

Keep in mind that in Rochester, there are very view assisted living options which accept Medicaid as a payor.

The NSCLC points out that in most cases states could remedy the situation. Most states pay for assisted living care though a Medicaid waiver program. In 2000, the federal Centers for Medicare and Medicaid Services (CMS) advised states that it would authorize the issuance of “retainer payments” to Medicaid waiver home and community based service providers during a Medicaid recipient’s temporary absence, such as for hospitalization. The guidance described the retainer payments as being comparable to room-hold payments for nursing home residents. However, it appears that most of the states either do not understand the federal guidance or have not implemented it. Exceptions include Georgia, Illinois, Montana and Washington, all of which make retainer payments to assisted living facilities on behalf of residents who are temporarily absent.

The NSCLC makes a number of recommendations:

  • CMS should clarify that Medicaid-funded retainer payments are available for temporary absences from an assisted living facility;
  • State governments should authorize retainer payments up to the federally allowed maximum;
  • Federal Medicaid law should be changed to entitle residents of assisted living facilities to room holds, room-hold payments and readmission to the next available room after temporary absences;
  • Room holds should apply regardless of the reason for an absence.

To view NSCLC’s White Paper and other materials on the issue, including a News Release and a Policy Brief, click here.