In order for all of us to understand reimbursement for Assisted Living communities I offer this explanation. If you do not have $2,500 to $4,000.00 a month of private funds you will need to understand Special Assistance funds and Medicaid PCS funds.

In 1945 North Carolina developed the first licensure law in the nation in order to pay for the care of its elderly and disabled adults who had low incomes. The State/ County Special Assistance for Adults Program was established via a wavier from social security and state legislation. It established a level of care other states do not have. A level between being in the home and nursing home for adults without the financial resources to be in private Assisted Living communities.

North Carolina Special assistance is not a reimbursement system to facilities. The recipients who qualify or their guardian/ representative payees receive a supplemental payment. To be eligible their assets must be $2,000 or less. This supplemental payment bundled with certain personal private funds is then used to purchase room and board in a licensed adult care home.

The General Assembly sets the maximum rate an Adult Care Home can charge someone who receives special assistance for room and board. Currently the rate is $1,182.00 per resident per month. Special Assistance for Alzhemer's patients is a seperate rate of $1,515. But Special Assistance does not make up that entire rate; it supplements private income the person receives from places such as Social Security, Supplemental Security Income (SSI), Veteran’s benefits or other retirement benefits. The average special assistance monies, which supplements cost of care for the individual is approximately $450.00 a month, thus it is an average capitated monthly rate.

In addition to Special Assistance paid to the resident for cost of care to live in a licensed adult care home, the adult care home may receive additional assistance from Medicaid for personal care services. An ACH receives $16.62 per day per resident in an ACH with 30 beds or fewer and $ 18.21 daily in an ACH with 31 or more beds for 1.1 hour of Medicaid eligible reimbursement for personal care assistance with eating, dressing, ambulating, toileting and medications. This is not the same Medicaid program funded by county funds for nursing homes. It is a state optional program.

With these two sources of public money, a low-income elderly or disabled person who needs assistance with activities of daily living and supervision can receive care in a licensed Adult Care Home. So based on the size of the home it cost $57.00 to $58.00 a day to provide room, board, personal care and supervision.

Care in Adult Care Homes for low-income elderly and disabled has been an extremely compassionate and worthy program for over 60 years. Consider what your own daily rate for expenses are overall and you do not require a person to provide for you personal care assistance or supervision.

Governor Purdue released her new budget but this is only the beginning of the process and endeavor to infuse money into a sinking ship. The industry has been working with the Department of Health and Human Services to develop a wavier program on the federal level to satisfy the Centers for Medicaid and Medicare who have been upset over the inequity in the Adult Care provision of personal services and the Home Health provision of personal services to name one of their concerns.

They will propose to take the 9 million in state and county special assistance money found in the Governor's budget and pull down additional federal matching money in an attempt to infuse at least $200.00 more per resident per month a much needed boost in payment for care.

On my next posting I will explore current reimbursement and why it is so vital to put additional money into Adult Care Homes where a majority of our elderly and disabled who need 24 hour care find themselves.

Welcome to my blog where I would love to share with you thoughts regarding care for Seniors in North Carolina. These days one has to be very creative in finances and resources to be able to provide quality care in an Assisted Living home. Particularly, if that home predominately serves individuals who receive publicly assisted funding from the state and county along with medicaid funds for personal care. Hopefully as we explore these issues it will enlighten you as to ways of operating and managing that will make your business more viable and your residents more satisfied. I have been involved in the regulatory end of elder care since 1990 and the provider side since 1996. Starting out in 1990 I became qualified as a federal health-care surveyor as the new OBRA regulations were being implemented for nursing homes. I was trained as a complaint investigator for hospitals, home health and nursing homes. In 1996 I provided consultation for Assisted Living homes through my own company and later became a Certified Assisted Living Administrator for 28 homes in NC as part of my duties as Director of Operations for 32 Assisted Living properties in 4 states for an Assisted Living Corporation. I tell you these things to say I believe I have expertise to share. Look forward to an information exchange with you.