Payment Options
Group Adult Foster
Care
Administered by The Executive Office of Elder Affairs, Group Adult Foster Care (GAFC) is a Medicaid program that reimburses providers for providing administrative and clinical oversight and daily assistance with personal care services to financially and clinically eligible elderly and disabled individuals who are at risk of institutionalization.
In order to qualify, participants in GAFC must:
- Be aged 22 and older;
- Meet financial criteria;
- Reside in a certified assisted living residence (only for SSIG eligibility);
- Be serviced by a certified GAFC provider;
- Have physician authorization of a medical diagnosis that deems GAFC an appropriate program for their needs;
- Require daily assistance with at least one Activity of Daily Living (ADL), which is related to a medical diagnosis; and
- Receive clinical approval from an Aging Services Access Point (ASAP)
Elder Affairs reimburses the provider for the provision of personal care services and the administration of the program. Effective April 1, 2008, the per diem reimbursement rate is $40.33. Approximately $1,150 per participant per month is reimbursed to the provider for services, while the resident remains responsible for the rent. See Supplemental Security Income Living Arrangement G (SSIG) for a detailed explanation of assistance with rent.
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Supplemental
Security Income (SSI) and Assisted Living
Supplemental Security Income (SSI) is a joint federal and state program administered by the Massachusetts Department of Transitional Assistance (DTA). SSI is a separate program from Social Security and supplements an individual’s existing income in order to assure a minimum standard of living for the individual’s particular living arrangement. Each of the five SSI living arrangements is associated with a different benefit amount:
- SSIA—the individual bears the full cost of living expenses (lives alone);
- SSIB—the individual has shared living expenses;
- SSIC—the individual lives in the household of another;
- SSIE—the individual lives in a licensed rest home; and
- SSIG—the individual lives in certified assisted living.
As of January 1, 2008, the maximum SSIG benefit amount was set at $1,091/month plus a $20 disregard. The Social Security Administration does not recognize the first $20 of an individual’s income. Thus the total amount is $1,111. For a couple the SSIG benefit amount is $818.50 plus a $20 disregard for a total of $838.50
In order for an individual to access the SSIG benefit s/he must:
- Live in certified assisted living;
- Be clinically eligible for and participate in Group Adult Foster Care (GAFC);
- Have monthly gross income less than $1,077; and,
- Have assets less than $2,000 ($3,000 for a couple).
SSIG beneficiaries use the benefit to “buy” room and board in assisted living. The SSIG benefit makes up the differences between the individual’s income from other sources and the SSIG benefit amount. For example, Mrs. R’s gross monthly income is $550 comprised of $400/month Social Security and $150/month pension. If Mrs. R lived in certified assisted living and participated in Group Adult Foster Care, her monthly SSI check
would be $561/month, which is the difference between $1,111 (the SSIG benefit amount) and $550 (Mrs. R’s gross monthly income). SSIG beneficiaries use the benefit to “buy” room and board in assisted living.
Medicaid is a state and federal health insurance program for the poor, and is administered in Massachusetts by The Executive Office of Elder Affairs (Elder Affairs). If an individual is financially eligible for any of the five SSI living arrangements, s/he is “categorically” eligible for Medicaid benefits. In other words, if the individual is low-income and eligible to receive money from the state to bring her/him up to the minimum income for her/his living arrangement, then s/he is automatically eligible for health insurance coverage through Medicaid.
The combination of SSIG benefits paid directly to the resident, the resident’s Social Security benefits and other personal income and GAFC reimbursement by Medicaid paid to the certified GAFC provider, totals approximately $2,200/month. While this amount generally does not cover all expenses incurred by the assisted living provider, it has encouraged providers to make more units available to low-income, frail elders.
For more information contact Pamela Gardner at Executive Office of Elder Affairs 617-727-5550 and the Social Security Administration at 1-800-772-1213 or visit www.ssa.gov.
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Program
of All-inclusive Care for the Elderly (PACE)
The PACE model of care is a national insurance program funded jointly by Medicare and Medicaid. PACE provides and coordinates all needed preventive, primary, acute and long term care services so that older individuals can continue living in the community. The PACE model is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.
PACE serves individuals who are:
- Aged 55 or older;
- Certified by their state to need nursing home care;
- Able to live safely in the community at the time of enrollment; and
- Living in a PACE service area
Although all PACE participants must be certified to need nursing home care to enroll in PACE, only about seven percent of PACE participants reside in a nursing home nationally. If a PACE enrollee does need nursing home care, the PACE program pays for it and continues to coordinate his or her care.
Delivering all needed medical and supportive services, the program is able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their homes for as long as possible. Care and services include:
- Adult day care that offers nursing; physical, occupational and recreational therapies; meals; nutritional counseling; social work and personal care
- Medical care provided by a PACE physician familiar with the history, needs and preferences of each participant
- Home health care and personal care
- All necessary prescription drugs
- Social services
- Medical specialists such as audiology, dentistry, optometry, podiatry, and speech therapy
- Respite care
- Hospital and nursing home care when necessary
For more information visit the National PACE Association’s website at www.npaonline.org.
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Low Income
Housing Tax Credits
The Low Income Housing Tax Credit is a federally authorized program that assists in the production and preservation of affordable rental housing for low-income families and individuals. The program supports a broad range of activities including acquisition, new construction, and rehabilitation of existing rental properties. Tax credits can be used to support the acquisition and/or rehabilitation of existing structures for rental use, including distressed or failed properties, or the new construction of rental projects.
In Massachusetts, the Department of Housing and Community Development (DHCD) is allocated a per capita dollar amount each year to be awarded to housing providers according to strict application requirements. Due to the high demand and limited supply of tax credits, the credits are awarded on a very competitive basis. Low-Income Housing Tax Credits are a dollar-for-dollar reduction to the owner’s federal tax liability each year for up to ten years that the community remains in compliance with program regulations.
If the housing owner has a large federal tax liability, s/he may keep the credits and use them against the liability. Generally speaking though, the owner “sells” the credits to a company (i.e., Proctor and Gamble) or syndication company (i.e., SunAmerica), and the money brought in by the sale is used as financing for the assisted living community. The new owner of the credits claims the credits against their federal tax liability for a period of ten years as long as the housing provider remains in compliance for at least 30 years.
One of the most important requirements of the Housing Credit program is to set aside a certain percentage of the total number of units in the community for households whose gross annual income is at or below the income limit established annually by the Department of Housing and Urban Development (HUD). The owner must make a set-aside election of 20/50 or 40/60, which means that at a minimum, if the owner chooses 20/50, 20% of the total units in the community must be rented to residents with gross annual incomes less than or equal to 50% of the area median gross income (AMGI) adjusted for household size, or if the owner chooses 40/60, the same formula is used. Some owners include deeper levels of affordability (a greater number of units) to make their applications for credits more appealing. In addition, ten percent of the total units must be reserved for persons or families earning less than 30% of area median income. Many housing providers who have been awarded tax credits use GAFC participants to meet this set-aside requirement.
In accordance with the regulations, the housing provider may only charge the tax credit residents the “rental” fee established by HUD. The Housing Credit program does not, however, cover services not associated with use and occupancy of the unit, therefore, the assisted living residence may charge service fees in addition to the rental fee.
For more information contact DHCD’s division of Private housing at 617-727-7824 or visit www.mass.gov/dhcd/components/housdev/want/dvlper_r/tax_cr.htm.
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Section
8 Housing Program
Section 8 is the federal government’s largest affordable housing assistance program. The program’s goal is to help elderly, disabled, and families with very low incomes afford housing in the private market. The Section 8 program is administered by local Public Housing Authorities (PHA). Benefits can be either a mobile voucher or “project-based”.
- Mobile vouchers allow eligible recipients to choose any rental unit of their choice, including assisted living, as long as the landlord is a willing participant, and the unit meets the required levels of health and safety. When a tenant with a mobile voucher moves, the rental subsidy moves with her/him.
- Project-based Section 8 is attached to a particular building and does not move with the tenant. A PHA can “project-base” up to 20% of its Section 8 funds.
- To be eligible, a tenant’s income may not exceed 50% of the area median income. The tenant’s portion of the rent may range from 30% to no more than 40% of the tenant’s monthly adjusted income. The PHA determines a payment standard for the dwelling unit based on Fair Market Rents (FMR) of modest rental housing in the area. The difference between the two numbers determines the amount of the PHA rent subsidy, which is paid directly to the landlord from the PHA. Rents in an assisted living residence can be up to 110% of FMR. If the Section 8 is used in a building financed with Low Income Housing Tax Credits then the Section 8 rents may be set as high as the rents charged for the LIHTC-financed apartments.
Additional information is available on the HUD website at www.hud.gov/offices/hsg/mfh/progdesc/progdesc.cfm or 617-994-8555.
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Assisted
Living Conversion Program (ALCP)
Funding under the ALCP is provided to private, non-profit owners of the following types of housing developments which have been in operation for at least five years with designated occupancy by the elderly:
- Section 202
- Project-based Section 8
- Section 515
- Section 221 (d)(3), and
- Section 236.
- Grant recipients may use the funding to cover the cost of converting some or all of the existing project units into an Assisted Living Residence to serve elders in need of assistance with activities of daily living. Retrofitting to add or modify common areas and service spaces including a dining facility and central kitchen are also eligible uses of the grant funds.
Funding for supportive services is not an eligible use of grant funds. The facility must be certified by EOEA.
For more information about the Assisted Living Conversion Program (ALCP), please contact the Executive Office of Elder Affairs 617-727-7750.
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Veterans'
Benefits: "Aid and Attendance Program"
The Veteran’s Administration offers a benefits program for veterans and their spouses who live in nursing homes, assisted living residences or are receiving home care. The “Aid and Attendance” (A&A) program is an improved pension program for veterans who require “care and assistance on a regular basis.” This assistance is for eligible veterans or surviving spouses who have medically documented needs, such as assistance with ADLs due to blindness, limited mobility, physical limitations or mental cognitive problems, including Alzheimer’s disease.
The A&A benefit is in addition to the monthly pension and is available only for veterans and their spouses receiving a pension from the Veteran’s Administration.
To qualify, the veteran must meet certain eligibility criteria, such as:
- Any War Veteran with 90 days of continuous active duty, at least one day during a period of war
- Honorable Discharge
- “Permanently and totally disabled” because of a non-service connected condition (Note that veterans living in a nursing home due to mental or physical incapacity, who are blind or are living in an assisted living residence are presumed to need the required level of service.)
- Surviving spouse of a War Veteran whose marriage ended due to death of veteran
- Individual(s) must qualify both medically (unable to live independently) and financially.
- The person cannot have over 80K in assets, excluding home and auto
- Income cannot exceed $18,234 per year (with no dependents) or $21,615 per year (with one dependent). A surviving spouse’s income cannot exceed $11,715 per year (with no dependents) or $13,976 per year (with one dependent).
For more in formation visit:
http://www.va.gov/opa/vadocs/current_benefits.htm http://www.vba.va.gov/bln/21/pension/vetpen.htm#7
To apply, please contact:
VA Benefits: 800- 827-1000 for the Veteran Service Office (VSO) in your area
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MASS •
ALFA
135 Beaver Street, Suite 202
Waltham, MA 02452
Telephone 781-622-5999
Fax 781-622-5979
massalfa@massalfa.org
