The Joint Commission on Health Care received a staff briefing on its study of the affordability of assisted living facilities (ALFs) at its October 5 meeting. The presentation, which includes a series of policy options, is available at this link. The study was required to examine the accessibility and affordability of ALFs in Virginia, to include challenges associated with ALFs’ acceptance of residents who are supported by the auxiliary grant program; whether residents may be served in other settings, such as supportive housing or congregate care; and the structure and financing of assisted living programs in other states. Public comments are due by close of business on Friday, October 21 and may be submitted to firstname.lastname@example.org or via U.S. Mail to 411 E. Franklin Street, Suite 505, Richmond, VA 23219.
Although the draft report includes some discussion of potential changes to the Medicaid program to fund services for certain residents of ALFs, the bulk of the report is focused on enhancements to the auxiliary grant program. This program provides additional financial support to individuals who receive Supplemental Security Income and certain other low-income adults who meet age or disability criteria who need assistance with activities of daily living, and who reside in an ALF, adult foster care home, or supportive housing. Auxiliary grant payments are funded by the state (80 percent) and by localities (20 percent). An ALF provider who accepts an auxiliary grant recipient is required to accept the auxiliary grant as payment in full, and the current rate ($1609 per month, with a 15 percent cost of living differential in Northern Virginia) falls short of facilities’ cost to provide care (JCHC staff pointed out in the report that the median rates charged vary between approximately $3000-$5100 per month, depending on the level of care). The report notes that there has been a 41 percent decrease in facilities that participate in the auxiliary grant program since 2010. Auxiliary grant recipients are concentrated in some facilities, with almost two-thirds of auxiliary grant recipients residing in an ALF whose population is at least 40 percent auxiliary grant recipients; staff found more complaint-based and administrative violations in ALFs that accepted at least one auxiliary grant recipient when compared to ALFs that are purely private-pay.
The report notes that Medicaid may pay for services for eligible individuals within ALFs, although it cannot pay for room and board. The state could pursue new Medicaid waivers or state plan amendments to cover services and supports within ALFs, but ALFs would have to meet federal criteria for home- and community-based settings, and Virginia would need to change its standard for eligibility for Medicaid reimbursement of home- and community-based services (the nursing facility level of care, which is determined by each state) in order to benefit more than a limited number of ALF residents.
The report discusses several ways that auxiliary grant recipients could be served within the community, pointing out that adult foster care, although an allowable setting for auxiliary grant payments, is not widely offered, and that supportive housing options are limited by high housing costs relative to the auxiliary grant rate.
Policy options presented in the report are as follows:
- Increasing the base auxiliary grant rate to $2500 per month.
- Providing a one-time, lump sum payment to ALFs that accept a new auxiliary grant resident (the report notes that this payment could be made solely with state dollars, rather than the usual 80-20 state-local funding shares for the monthly payments).
- Expanding the list of eligible living arrangements for the auxiliary grant program.
- Developing a separate, higher rate for auxiliary grants in supportive housing settings.
- Increasing the personal needs allowance for auxiliary grant recipients (which has been largely unchanged since 2009) and indexing the allowance to future auxiliary grant rate increases. These funds allow auxiliary grant recipients to pay for items such as non-prescription medications, certain toiletries, clothing, or other items not furnished by the facility.
- Directing the Department of Social Services to update its regulations to require advance notice of a facility closure if it houses recipients of auxiliary grant or Discharge Assistance Program funding (which supports individuals leaving state hospitals).
- Requiring the Department of Social Services to share ALF licensing data with auxiliary grant program staff at the Department of Aging and Rehabilitative Services.
VACo Contact: Katie Boyle