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Publisher: Scripps Gerontology Center
Published Date: June 2007

Executive Summary

In the 2006/2007 biennium budget, the Ohio Legislature authorized the Ohio Department of Aging to develop and evaluate an Assisted Living Medicaid Waiver Program. The waiver program received approval from the Federal Centers for Medicare and Medicaid Services (CMS) to begin program operations in July 2006. The waiver is administered by the Ohio Department of Aging and operated through the regional network of PASSPORT Administrative Agencies. This study evaluates program performance for the initial implementation period, July 2006 through March 2007. During that period the program enrolled 134 participants. As of June 1, 2007, 193 individuals had entered the program and 190 were on a waiting list to enroll, but had been unable to find an assisted living facility. As of June 1, 2007, 54 assisted living residences were certified for participation in the program.

Key Evaluation Findings

• Enrollment in the program was slower than originally anticipated. Although Ohio’s implementation experience is similar to other states, several issues were raised in the evaluation on this topic. First, there was universal agreement that the program eligibility criteria should be expanded to include current assisted living residents. Second, there was wide-scale agreement that the personal allowance ($50 per month) was not adequate for many residents, particularly in light of the new Medicare Part D co-pay requirements, which do not apply to nursing home residents. Third, as of June 1, 2007, the number of participating facilities statewide was 54, and of the 190 consumers on the program waiting list, 95% reported that there was no facility available. There are approximately 279 facilities in the state that meet the assisted living waiver requirements, indicating that in order to meet program goals either new facilities will need to be developed or a much higher proportion of current facilities will need to participate in the program.
• Participants in the Assisted Living Waiver Program report high levels of disability. Half have four or more impairments in their ability to perform activities of daily living such as bathing and dressing; three quarters have three or more activity limitations. Assisted living waiver residents on average report higher levels of disability when compared to PASSPORT participants, but are not as impaired as nursing home residents.
• Assisted living waiver participants report high levels of satisfaction with the enrollment process, with 85 to 90% rating the help from assisted living facilities and case managers as good or excellent. Residents reported high levels of satisfaction with the facilities, although in select areas suggestions for improvements were identified. Our case study interviews with residents, on-site coordinators, and case managers indicate that the program is doing a good job in helping residents achieve privacy, autonomy, and choice in the services they receive.
• The waiver program classifies residents into three tiers for the purposes of establishing reimbursement rates for services. Tier 1 service rates are $50 per day, Tier 2 $60, and Tier 3 $70. The 2007 room and board rate is $573 per month, which is added to each service rate. None of the residents were placed in Tier 1 and only 10% of residents were classified as Tier 2. The average rate across all regions of the state, combining room and board and service was $2,711. The statewide average rate by region for Medicaid nursing home care was $5,059. That the vast majority of assisted living residents are placed in Tier 3 (90%) suggests that the classification strategy needs to be carefully reviewed as the program moves forward.
• Overall, the program appears to be receptive to input from stakeholders; however, respondents identified a series of program implementation issues that require examination. Such comments are typical for a program of this nature and suggest that it will be important for the Assisted Living Waiver Program to set up a mechanism for ongoing program modifications and improvements.
• This study provides an important first look at the program. However, because of the slower than expected build-up and the short time frame of the evaluation, results should be viewed as preliminary in nature. As the program expands both the number of consumers and the type and number of facilities that participate in the waiver, ongoing monitoring of data on the profile of residents, quality, and costs will be essential.

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