ABSTRACT Residential care settings (RCSs) are community-based housing and supportive services providers. Medicaid beneficiaries' access to RCSs is of concern to policymakers and other stakeholders because most people prefer community-based to institutional services and RCSs are generally less expensive than nursing homes. To better understand Medicaid beneficiaries' access to state-licensed RCSs, we examined Medicaid policies in 50 states and the District of Columbia, interviewed seven subject-matter experts, and conducted four state case studies informed by reviews of state policies and interviews with 27 stakeholders. Factors identified as influencing Medicaid beneficiaries' access to RCSs include Medicaid reimbursement rates for RCS services, the supply of Medicaid-certified RCSs and RCS beds, and policies that affect RCS room and board costs for Medicaid beneficiaries. Shifting Medicaid spending toward community-based instead of institutional care may require attention to these interrelated issues of RCS payment, supply, and room and board costs.

中文翻译：

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医疗补助受益人获得居家护理环境的机会

摘要 住宅护理环境 (RCS) 是基于社区的住房和支持性服务提供者。医疗补助受益人获得 RCS 是政策制定者和其他利益相关者关注的问题，因为大多数人更喜欢基于社区的服务而不是机构服务，而且 RCS 通常比疗养院便宜。为了更好地了解医疗补助受益人获得州许可的 RCS，我们检查了 50 个州和哥伦比亚特区的医疗补助政策，采访了 7 名主题专家，并根据对州政策的审查和对 27 位利益相关者的采访进行了四个州案例研究. 确定影响医疗补助受益人获得 RCS 的因素包括 RCS 服务的医疗补助报销率、医疗补助认证 RCS 和 RCS 床位的供应、以及影响医疗补助受益人的 RCS 食宿费用的政策。将医疗补助支出转向基于社区而不是机构护理可能需要关注 RCS 支付、供应和食宿成本等这些相互关联的问题。