Tuesday, October 8, 2013
The alphabet soup for deciphering housing and long term care options can be daunting. ALs, CCRCs, NHs (or my old favorite, SNFs), NORCs. Are the differences real or just part of marketing?
Those bright, hard-working folks at the National Senior Citizens Law Center (NSCLC) know the differences, including what is or isn't eligible for Medicaid coverage from state to state. Even better, they're willing to share their expertise, offering a webinar on the "Pluses and Minuses of Assisted Living, for Policy-Makers and Consumers." I would add "students" to that list of important participants.
Date: Tuesday, October 15 (Yikes -- that is soon!)
Time: 2:00 to 3:00 p.m. (Eastern time)
Details and on-line registration are here. And even though there's no cost for this session, I suspect that if you find yourself appreciating this kind of programming, and want to see more offerings, someone at NSCLC just might accept your (tax deductible) donation!
Friday, October 4, 2013
Across the US, there are some 1,800 Continuing Care Retirement Communities (CCRCs). These are typically upscale settings that offer a range of housing options, services, activities and health care. Residents of CCRCs often have common interests, not just within their individual community's setting, but in the "larger" community of residents throughout the nation, and thus the idea of a National Continuing Care Resident's Association (NaCCRA) was born.
NaCCRA has two annual gatherings, as well as regular meetings at the chapter level in individual states. NaCCRA's Fall 2013 Meeting will be in Dallas, in conjunction with the LeadingAge Annual Meeting. Here are some of the planned NaCCRA sessions and related LeadingAge sessions:
Saturday, October 26: NaCCRA Board Meeting (starting at 5:30 p.m.)
Sunday, October 27:
9:00 - 9:15: General Business Meeting
9:15 - 11:45: "Imagining CCRCs of the Future," a moderated discussion, involving residents and other guests. (Moderators: Ron Herring, resident of The Glebe, Daleville, VA & Katherine Pearson, Professor of Law, Penn State Dickinson School of Law)
1:00 - 3:00: Opening General Session for LeadingAge
3:50-5:00: LeadingAge Concurrent Educational Sessions (24 sessions!), including:
- Progress toward Resident Engagement: One Year Later: Moderator Ron Herring (NaCCRA), Speakers: Ellen Handler, President of New Jersey's resident association (ORANJ); Marilyn Kennedy (COO for Episcopal Senior Communities); May Anna Colwell (CCRC resident and board member)
- Financial Ratios for CCRCs
- Urban Design Concepts to Reinvent Aging Communities Anywhere
- Governance Roundtables: Practical Solutions for a Better Board
The LeadingAge programming, with concurrent educational sessions throughout, continues on Monday through Wednesday, October 27-30. CCRC residents can register for the combined NaCCRA/LeadingAge meetings on line. Registration for the combined Meetings is without cost for CCRC residents!
For additional thoughts on CCRCs, from informed, resident perpsectives, visit NaCCRAU, a Learning Center for current and future residents.
LeadingAge is holding its annual meeting in Dallas this year, October 27-30, with a very busy and interesting schedule of events, including educational workshops. The workshops and associated meetings offer a deep well of cutting edge information about aging services, relevant to both the industry and the public.
So what is LeadingAge? To use their words, it is an association of "6,000 nor-for-profit organizations" that provide services to seniors, persons with special needs, and their families. The history of the organization as advocates for aging service providers traces to 1961. For a number of years it was known as the American Association of Homes and Services for the Aging (AAHSA), recognized as a leading trade group for non-profit providers, especially on the housing side, including Continuing Care Retirement Communities, Assisted Living facilities, and Nursing Homes. AAHSA initiated a self study in 2008, and in 2011 announced its change of name to LeadingAge. As with any strong trade group, LeadingAge keeps a close eye on legislation, public finance, and policy developments, both at the national and state levels.
My experience is that with the name change came a broadening of the association's identity, including greater involvement by older persons as individuals, volunteers, consumers, and users of aging services.
Larry Minnix is the long-time head of LeadingAge, with deep experience in the industry of aging services.
Monday, September 30, 2013
"Perdue tried to get help from Meals on Wheels Atlanta. In mid-April of 2012, she was twenty-seventh on a waiting list of 120. In November, she was still on the list, which had grown to 198. Her daughter finally found another program.
Such is the world of food rationing for the elderly—the hidden hunger few ever see. Tenille Johnson, one of two case managers at Meals on Wheels Atlanta, said there were others on the list who were even more in need than Perdue. In 2012, the program served 106,000 meals—up from 84,000 three years before—and it will serve about 114,000 this year. “We’ve been able to up our game and reduce the waiting list to between 145 and 160 seniors, but the need has outpaced us,” says executive director Jeffrey Smythe. “The numbers are going up more quickly than we projected. We have waiting lists all over the metro Atlanta area, even in suburban counties.”
The Nation writer first reported on underfunding for programs assisting home-bound elderly in 1998. "Little has changed in the last fifteen years," she reports. Except, as her article demonstrates in detail, the need is greater, on a nation-wide basis.
"The National Association of Area Agencies on Aging says nearly 60 percent of all Older Americans Act programs had waiting lists in 2010, but the ones for home-delivered meals are particularly urgent, since food is so basic to good health."
Remember the Older Americans Act (OAA), first enacted in 1965? Meals on Wheels was once a core component of OAA's programming, and administered to the states through Area Agencies on Aging. Charities, churches and other nonprofits have not been able to cover the gap in funding. As discussed earlier on this Blog, Congress still has not reauthorized the OAA,and as Lieberman's article demonstrates, there are very real consequences to Congressional gridlock and Congress's failure to address even uncontroversial programs while rehashing party-politics on the Affordable Care Act.
Hat tip to Kevin Schock, Penn State Law, for spotting this timely article.
Tuesday, September 24, 2013
For a number of years, I have taken on the interesting task of researching resident rights and financing or governance issues for "Continuing Care Retirement Communities" or CCRCs, an important part of the network of senior living options in the U.S. One of the many strengths of CCRCs is the way residents and administrators pull together to respond to a crisis or handle a challenge.
Frasier Meadow Retirement Community, a CCRC in Boulder, was hit hard by the recent devastating flooding in Colorado. The Assisted Living area was severely damaged, requiring relocation of AL residents. The good news is that the relocations were accomplished safely, and the hard work of clean-up and reorganization has begun. Regular updates on the Frasier website and social media connections have helped to keep families and friends up-to-date.
Hat Tip to Walt Boyer, board member at the National Continuing Care Resident's Association or NaCCRA, for information on Frasier's early recovery efforts.
Tuesday, August 27, 2013
We are seeing a lot of information coming out from the federal government as a result of the Windsor ruling. Most recently, a colleague sent me a link from the IRS site with Answers to Frequently Asked Questions for Same-Sex Couples (last updated July 2, 2013). Among the 8 FAQ (in no particular order) are: "Can same-sex partners who are legally married for state law purposes file federal tax returns using a married filing jointly or married filing separately status?"; "Can a taxpayer use the head-of-household filing status if the taxpayer’s only dependent is his or her same-sex partner?"; and "If a taxpayer adopts the child of his or her same-sex partner as a second parent or co-parent, may the taxpayer (“adopting parent”) claim the adoption credit for the qualifying adoption expenses he or she pays or incurs to adopt the child?".
Meanwhile, over at Social Security, Acting Commissioner Carolyn W. Colvin issued a statement on August 9th "that Social Security is now processing some retirement spouse claims for same-sex couples and paying benefits where they are due." SSA offers several articles on benefits for same-sex couples.
The U.S. Department of Labor (by the way, they have a nifty little intro page about their upcoming 100 year anniversary) issued a revision to Fact Sheet 28F that includes in the definitions spouses in same-sex marriages. LexisNexis Legal Newsroom on Labor and Employment Law, has an interesting article on the extension of FMLA as a result of Windsor, written by Barran Liebman LLP attorneys.
Further, on August 14th, 2013, the Department of Defense announced that it was extending spousal benefits to same-sex spouses of civilian employees as well as uniformed service members. The DoD indicated the benefits would be available no later than September 3, 2013 for those with a valid marriage certificate.
"Entitlements such as TRICARE enrollment, basic allowance for housing (BAH) and family separation allowance are retroactive to the date of the Supreme Court's decision. Any claims to entitlements before that date will not be granted. For those members married after June 26, 2013, entitlements begin at the date of marriage."
The Secretary of Defense sent a memo that explained the actions and noted that since not all jurisdictions allow same-sex marriage, the DoD will issue a "non-chargeable leave" policy for military personnel who have to travel to a state to be married, with an immediately-effective memo supplementing the existing leave policy.
Stay tuned-we will keep you posted with further updates.
Photo by Kim Dayton, © 2013
In August, PBS's Frontline aired a story on the assisted living industry titled "Life and Death in Assisted Living," asking questions about safety both for residents and staff, and pointing to the potential need for greater regulation. Emeritus Senior Living, the country's largest assisted living company responded strongly to the story, rejecting the use of what it viewed as "isolated incidents" as grounds for stricter or more nationalized regulations.
Now there is news that Emeritus has settled a state court lawsuit that claimed Emeritus underpaid workers at facilities in California. The follow-up is reported by ProPublica, a nonprofit "independent newsroom" that conducts investigative journalism, often partnering with major media, including PBS on the assisted living stories. Details of the reported $2.2 million settlement are available here. In California, settlements of class actions must be approved by the court.
Saturday, August 10, 2013
In many states, the "county home" is a dying institution. Some would say, "good riddance," and yet a careful review of the history of public care for older adults reveals states with well-run, publicly-supported alternatives for long-term care.
Arizona has a unique history. In 1909, handwritten-legislation was enacted in the territory to establish a house "for aged and infirm Arizona pioneers." Designed by female architect W.S. Elliot, construction was completed in 1911, a year before Arizona was admitted as the 48th state. Admission criteria required proof that an individual had been a resident of Arizona "for not less than twenty-five years and ... active in the development of Arizona ... and who shall have reached the age of sixty years or over."
Now in its 102nd year of operation, the Arizona Pioneers' Home has capacity for 150 residents. It continues with funding from several sources, including state land trusts, a miner's hospital fund, and the state's general fund. In addition, residents pay for a portion of their care, according to their incomes. The annual budget is reported to be appoximately $50 million.
Criteria for admission has changed over the years. The threshold age for admission is now 70 and residents must have a history of at least 50 years of residency in the state, with more relaxed standards for miners.
Situated on a hill with dramatic views overlooking Prescott (the mile-high territorial capital for Arizona), the Arizona Pioneer's Home is a well-known landmark. The state and its residents appear to take pride in its history, with a website devoted to famous (and sometimes infamous) early residents of the house. The home and grounds have been kept up-to-date.
Perhaps that sense of pride explains the state's continuing public commitment to care.
Tuesday, April 17, 2012
A Statement from Secretary Sebelius on the Administration for Community Living
All Americans – including people with disabilities and seniors – should be able to live at home with the supports they need, participating in communities that value their contributions – rather than in nursing homes or other institutions.
The Obama administration and my department have long been committed to promoting community living and finding new mechanisms to help ensure that the supports people with disabilities and seniors need to live in the community are accessible.
Today, with the creation of the new Administration for Community Living (ACL), we are reinforcing this commitment by bringing together key HHS organizations and offices dedicated to improving the lives of those with functional needs into one coordinated, focused and stronger entity.
The Administration for Community Living will bring together the Administration on Aging, the Office on Disability and the Administration on Developmental Disabilities into a single agency that supports both cross-cutting initiatives and efforts focused on the unique needs of individual groups, such as children with developmental disabilities or seniors with dementia. This new agency will work on increasing access to community supports and achieving full community participation for people with disabilities and seniors.
The Administration on Community Living will seek to enhance and improve the broad range of supports that individuals may need to live with respect and dignity as full members of their communities. These support needs go well beyond health care and include the availability of appropriate housing, employment, education, meaningful relationships and social participation.
Building on President Obama’s Year of Community Living, the ACL will pursue improved opportunities for older Americans and people with disabilities to enjoy the fullest inclusion in the life of our nation.
the Pan American Health Organization and the World Health Organization have recently published Guidelines for Mainstreaming the Needs of Older Persons in Disaster Situations in the Caribbean: A Contribution to World Health Day 2012 Aging and Health.
This publication offers a series of directives that aid in incorporating into risk management processes and programs the concerns and other questions for consideration at different levels of working with and relating to this group of persons. The goal is to aid them in maintaining the highest possible level of health and functional capacity in emergency and disaster situations.
Monday, April 16, 2012
New report offers stats: Residents Living in Residential Care Facilities in the United States: 2010.
The CDC's Division of Health Care Statistics and the Long-Term Care Statistics Branch recently released Data Brief #91, Residents Living in Residential Care Facilities in the United States: 2010. The report presents national estimates of RCF residents based on various characteristics, including demographics, Medicaid participation and charges, limitations in activities of daily living, and common chronic conditions. The estimates are derived from the first nationally representative survey of RCFs with four or more beds.
According to the report, in 2010 a vast majority (91%) of the 733,300 residents of RCFs were non-Hispanic white, and 70% were female. Residents aged 85 and over made up 54% of the resident population. Of the remaining residents, 27% were aged 75-84, 9% were aged 65-74, and 11% were under age 65.
At the time the data for the report were collected, residents had lived at their RCFs for an average of 671 days. Out of all the residents, 19% had at least some of their RCF services paid for by Medicaid. Medicaid coverage varied by age group, with 56% of residents under age 65 having Medicaid, compared to 39% of residents aged 65-74, 16% of residents aged 75-84, and just 10% of residents 85 or older.
With respect to services rendered, 38% of residents were assisted with three or more activities of daily living (ADLs), 36% were assisted with one or two ADLs, and 26% did not receive any assistance with ADLs. The most common ADL that RCFs provided assistance with was bathing (72%), followed by dressing (52%), toileting (36%), transferring (25%), and finally eating (22%).
Ninety-four percent of RCF residents had been diagnosed with one or more of the ten most common chronic conditions in the facilities, which included: high blood pressure (57%), Alzheimer's disease or other forms of dementia (42%), heart disease (34%), depression (28%), arthritis (27%), osteoporosis (21%), diabetes (17%), chronic obstructive pulmonary disease and allied conditions (15%), cancer (11%), and stroke (11%). Nearly 75% of the residents had been diagnosed with two or more of these chronic conditions.
Based on the statistics gathered, the report concluded that the RCFs housed a vulnerable population that has a high burden of both functional and cognitive impairment.
More information about the RCF residents data brief, including the brief itself, is available online at http://www.cdc.gov/nchs/nsrcf.htm.
Tuesday, June 28, 2011
U.S. Department of Housing and Urban Development (HUD) in conjunction with NeighborWorks® America has announced the launch of the Emergency Homeowners’ Loan Program (EHLP). The EHLP is designed to provide mortgage payment relief to eligible homeowners experiencing a drop in income of at least 15 percent directly resulting from involuntary unemployment or underemployment due to adverse economic conditions and/or a medical emergency. Under EHLP program guidelines eligible homeowners can qualify for an interest free loan which pays a portion of their monthly mortgage for up to two years, or up to $50,000, whichever comes first. The Dodd-Frank Wall Street Reform and Consumer Protection Act provided $1 billion to HUD to implement the EHLP, and to date, the EHLP operates in 27 states across the country and Puerto Rico. Read the frequently asked questions to learn more about the EHLP.
For more information see http://nw.org/network/foreclosure/nfmcp/EHLPconsumers.asp
Tuesday, May 3, 2011
Based on the just released report "LGBT Older Adults in Long Term Care: Stories from the Field," learn about how applicable law relates to the concerns expressed in dozens of stories contained in the report.
Who: Eric Carlson, Directing Attorney, National Senior Citizens Law Center
Daniel Redman, Del Martin Memorial LGBT Elder Advocacy Initiative, National Lesbian Rights Center
When: May 10, 201
Time: 2 p.m.-3 p.m. EST/11 a.m.-12 noon PST
To register: Click Here
Webinars are free to registrants.
The Webinar is free and part of a monthly Webinar series presented by the
National Senior Citizens Law Center.
Monday, October 25, 2010
REVISITING THE OLMSTEAD RULING: KEEPING MORE OLDER ADULTS OUT OF NURSING HOMES
Presenters: NSCLC Attorneys Eric Carlson & Gene Coffey
Date: Thursday, October 28, 2010 Time : 11:00 AM - 12:00 PM PDT / 2:00 PM - 3:00 PM EDT
Too many people still are forced into nursing homes in spite of the fact that those who need long-term service and supports can better maintain their independence and dignity receiving home and community-based services. The Supreme Court's 1999 Olmstead Ruling has ultimately required states to choose between operating state programs in ways that allow people with disabilities to remain integrated in their communities or face legal challenges. However, in spite of much post-Olmstead progress, there are still challenges to reducing unnecessary institutionalizations.
The National Senior Citizens Law Center has published a new report, "10-Plus Years After the Olmstead Ruling: Progress, Problems, and Opportunities." The report chronicles the advancements made in the availability of community-based service options in the aftermath of the Olmstead decision, and identifies many of the barriers that remain and opportunities for overcoming them. On October 28th, 2010, NSCLC will present a webinar that will provide an overview of the report.
Register now for this free National Senior Citizens Law Center Webinar. Reserve your Webinar seat now at: https://www1.gotomeeting.com/register/729890152 After registering you will receive a confirmation email containing information about joining the Webinar.
Saturday, October 9, 2010
Check out this webinar series sponsored by the American Association on Intellectual and Developmental Disabilities
Series Title: Public Policy & Aging Report on Healthy Aging and the Environment
The American Association on Intellectual and Developmental Disabilities (AAIDD) presents a distinguished panel of guest speakers to bring you a groundbreaking series of webinars on aging, environmental health, and disability. This series, which begins October 12, is sponsored by the John Merck Fund.
The series mirrors the contents of a thematic issue on healthy aging and the environment of the Public Policy & Aging Report of the Gerontological Society of America's http://www.geron.org/ policy institute, the National Academy on an Aging Society http://www.agingsociety.org/agingsociety/ . An electronic version of this publication will be made available for free to all webinar attendees.
To access additional information and register for any of the webinars below, please go to http://aaidd.org/ehi/content_3919.cfm?navID=306 of the AAIDD web site.
Environmental Threats to Healthy Aging with Ted Schettler, Maria Valenti
Tues Oct 12th from 2-3pm Eastern Time
Built Environment with Kathy Sykes, Rodney Harrell, Regina Gray
Tues Oct 19th from 2-3pm Eastern Time
Psychosocial Environment with Danny George, Peter Whitehouse
Tues Oct 26th from 2-3pm Eastern Time
Chemical Environment with Maye Thompson, Marybeth Palmigiano
Tues Nov 2nd from 2-3pm Eastern Time
Food Environment with Michelle Gottlieb, Emma Sirois
Tues Nov 9th from 2-3pm Eastern Time
Tuesday, April 20, 2010
What aspects of the current Title V legislation are effective?
What aspects of Title V are not effective?
What innovations can you suggest?
During the session, stakeholders will have the opportunity to call in with statements (no longer than 3 minutes) to share with attendees. In addition, written comments may be submitted via real-time chat, or emailed to TitleVlisteningsession@dol.gov at any time before or after the session. Stakeholders may submit comments on reauthorization of all other titles of the Older Americans Act to Assistant Secretary Greenlee at:
Registration is now open!Registration is limited and participation is first-come, first-served. We encourage multiple participants from the same organization to register once and view this session from one location. Please note you must first create an account (‘Signup’ link in upper right hand corner) on www.workforce3one.org in order to login and reserve a seat for this event at the link below.
Follow this link to register: http://www.workforce3one.org/view/5001010644815865203/info
Wednesday, March 17, 2010
Call for Papers – Future of Elder Law Practice
William Mitchell Law Review, Vol. 37, Issue I (Fall 2010)
The William Mitchell Law Review is proud to dedicate its first issue of the 2010-11 academic year to Elder Law in its upcoming Volume 37 (Fall 2010). We are currently seeking papers that examine the future of elder law practice. Submissions may either take the form of shorter commentaries or longer law review articles. The deadline for submissions has been set for July 1, 2010.
The William Mitchell Law Review is highly regarded both regionally and nationally. Our Law Review recently ranked twenty-second in citations by judges and ranked fifty-seventh in citations by other law journals, culminating in an overall ranking of seventieth. Over the years, the William Mitchell Law Review has featured the works of various scholars and practitioners such as Congressman Tim Penny, and former Vice President Walter Mondale. The William Mitchell Law Review has also published nationally known legal experts ranging from Philip Bruner, to Supreme Court Justices Sandra Day O’Connor, Byron White, and Harry Blackmun. Now, we would like to invite you to join us to publish in our upcoming volume.
Please direct inquiries to Executive Editor Sanjee Weliwitigoda at firstname.lastname@example.org. Please send submissions to email@example.com or mail them to our Editorial Office. Please note that the Law Review prefers electronic submissions.
March 17, 2010 in Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management, Retirement, Social Security | Permalink | TrackBack (0)
Thursday, January 28, 2010
The National Senior Citizens Law Center has released an issue brief that examines many of the most important issues in Medicaid payment for assisted living, and makes recommendations for policy changes at the federal and state levels. Among other things, the issue brief recommends that Medicaid-certified facilities be required to accept Medicaid from Medicaid-eligible residents, and not be allowed to demand or solicit “supplemental payments” from residents’ family members or friends. The federal government at a minimum should require that Medicaid-certified facilities not discriminate against Medicaid-eligible residents.
The brief is available at NSCLC's website at: http://www.nsclc.org/areas/long-term-care/Assisted%20Living/medicaid-payment-for-assisted-living-current-state-practices-and-recommendations-for-improvement/at_download/attachment.
Tuesday, January 26, 2010
A recent alumnus of William Mitchell, who is working in the home mortgage department of a national bank, describes the following growing problem: “We are speaking with elderly applicants who have old liens recorded on their titles which should not be there. What's sad about the situation is that a lot of applicants are widows or widowers who had their spouse take care of all their property and lien issues, and they have no idea what to do to take these old liens off so the refinancing application can proceed.”
As a first step toward helping this group of people, he suggested that elder law clinics and/or legal services programs that serve elders could develop a checklist to identify folks who might be in similar situations, something along the lines of:
- When was the last date you checked your title? ·
- Are you aware of all liens reported as open on your credit report?
- Are there liens listed as open on your credit report that should be closed?
- Does your title have any liens recorded on it that should not be there?
- Does your title have any liens not recorded on it that should be there? ·
- Does your title have a current lien on there, but that lien's amount has increased/decreased, or has it been bought/superseded by another mortgagee? ·
- Do you have the proper documents necessary to remove/modify/add the proper liens to your title? ·
- Do you know how to modify your title?
What do folks think? Are there clinics or programs doing this kind of work? Is the problem one people are seeing in their regular practice? Are there other resources that can be used to address the issue?
Saturday, January 16, 2010
California news: Assisted living resident newly eligible for SSI can't be charged a rate higher than state SSI rate
/via the Assisted Living Consumers Alliance:
The California Department of Social Services recently confirmed that an assisted living resident cannot be evicted for non-payment when he or she becomes eligible for SSI and accordingly begins paying the lower rate set by state law. This lower rate trumps whatever higher rate may have been set in the resident’s original admission agreement.In California, an assisted living facility is called a “residential care facility for the elderly (RCFE). These facilities are licensed and inspected by the Community Care Licensing Division of the California Department of Social Services. In the letter, addressed to an attorney representing facilities, the state explains that a facility has the right to evict for “[n]onpayment of the rate for basic services.” Cal. Code of Regs tit. 22, § 87224(a)(1) (emphasis added). Another regulatory section defines “basic rate” as “the SSI/SSP established rate, which does not include that amount allocated for the recipient’s personal and incidental needs.” Cal. Code Regs. tit 22, § 87101(b)(1). Another regulation takes the next steps and states: “If the resident is an SSI/SSP recipient, then the basic services shall be provided and/or made available at the basic rate at no additional charge to the resident.” Cal. Code Regs. tit. 22, § 87464(e).Thus, what can an SSI-eligible resident be required to pay? Currently, an SSI-eligible RCFE resident in California receives $1,086 monthly; the facility may charge no more than $961, leaving a personal needs allowance of $125 to be retained by the resident. See Cal. Dep’t of Soc. Servs., Adult and Senior Care Update (Fall 2009), http://ccld.ca.gov/res/pdf/AS1009.pdf. If the resident receives SSI as a supplement to other income, and thus receives an “extra” $20 due to the SSIs program’s any-income disregard, the extra $20 is also retained by the resident, unless the admission agreement specifies that the facility has a right to the extra $20.
This issue highlights an important question for any state’s assisted living program: what are the protections for persons dependent upon SSI and/or Medicaid (in states that allow Medicaid money to be used for assisted living services). Federal nursing facility law establishes that, if a nursing facility is Medicaid-certified, the facility must accept the Medicaid rate when a resident switches from private payment to Medicaid eligibility. See, e.g., 42 U.S.C. § 1396r(c)(4)(A); 42 C.F.R. § 483.12(c)(1). State assisted living regulations should contain similar provisions for both SSI and Medicaid, to assure that low-income residents are treated fairly.