Residential care settings (RCSs) are community-based housing and supportive services providers. Many RCSs predominantly serve older adults and younger people with physical disabilities. Medicaid beneficiaries’ access to these RCSs is of concern to policymakers and other stakeholders because providing community-based—rather than institutional—services is potentially less expensive and preferred by most people. To better understand Medicaid beneficiaries’ access to RCSs that focus on older adults and young people with physical disabilities, we examined Medicaid policies in 50 states and the District of Columbia, interviewed subject matter experts (n=7), and conducted four state case studies informed by reviews of policies and interviews with stakeholders (n=27). Interviewees identified numerous factors influencing Medicaid beneficiaries’ access to these RCSs, including the supply of Medicaid-certified RCSs relative to the older adult population, Medicaid reimbursement rates, initiatives that affect room and board costs for Medicaid beneficiaries, and policies that may incentivize RCSs to serve Medicaid beneficiaries. These factors can affect Medicaid beneficiaries’ access to RCSs by limiting the number of RCSs that participate in Medicaid, restricting the number of beds that RCSs allot to Medicaid beneficiaries, and by determining whether room and board rates will be affordable for Medicaid beneficiaries. The implications of these findings vis-à-vis implementation of federal Medicaid home and community-based services rules and continued implementation of managed long-term services and supports programs are discussed.
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