While you might intuitively think that living arrangements refers to a locations’ ability to provide the necessary levels of care for the potential recipient, that would be incorrect. The State takes for granted that the living arrangement will be appropriate to the needs of the individual. Living arrangements fall into two basic categories. Either the individual is living at home alone, with a spouse, adult child, or a relative, or they are living outside his/her home in assisted living, a group home, nursing home, or memory care unit (to name a few).
While a home is always considered a valid living arrangement, once placed outside the home, only those places that have taken the time to become a care provider for ALTCS and have a contract in place with one or more of the program contractors (who implement the actual benefits portion of the program) are considered approved living arrangements. It basically comes down to: has the location agreed to keep their environment up to standards and appropriate to the clients they accept, as well as accept the dollar amount that the State has set for that level of care? Living arrangements are about contracts and payment. If a place does not participate in the program, then there is no method for payment or agreement from the living arrangement to accept only the amount that the State sets. It’s true the State demands a discount and pays less than you or I would as a private pay consumer. As a taxpayer, I applaud their efforts to minimize costs; as planners, we recognize that many of these living arrangements function on very narrow profit margins and could not stay open on what the State is offering and thus opt out. Regardless of the reason, if they have not taken the appropriate measures to become a provider and have contracts in place, then they are an inappropriate living arrangement. In years past, the State would issue a ten-day move notice to the customer. This would alert any prospective living arrangement that everything has been reviewed and as soon as they are admitted to an appropriate living arrangement the case would be approved. That was years past; now the State just issues a denial of benefits based on inappropriate living arrangements and tells the applicant to “come back when you have moved to someplace that takes ALTCS”.
While we are not placement experts, we work with many who are and can assist in making sure the living arrangement is appropriate and ALTCS approved.