While regulations overseeing AL vary from state to state, currently they all share a focus on ways to make AL more affordable and accessible for its residents. One new report from the Virginia Joint Commission on Health Care offers some guidance to the legislators there about how to address this challenge. Among the findings:

• The state’s Auxiliary Grant (AG) rate, which has stayed relatively flat for the last 13 years, isn’t sufficient to cover the cost of AL in Virginia. This has resulted in limited access. (The AG is an income supplement for people who receive Social Security Income and certain other individuals who have  various disabilities and care needs.)
• Leveraging Medicaid payments to cover AL services would require significant change Medicaid can pay for services to eligible individuals who live in an AL facility, but it can’t pay for room and board. AL facilities would have to meet federal criteria as a home and community-based setting for residents to be eligible for Medicaid-funded long term supports and services.
• Other community settings, such as adult foster care, could help meet the needs of patients with lower functional needs.
• Increased personal funds can improve the quality of services for current AG recipients. The authors noted that AL facility closures also can negatively impact other facilities that accept AG recipients. At the same time, over 43 percent of AL providers in the state reported accepting an AG recipient who initially entered the facility as private pay, limiting bed availability even further.

The report suggested several policy options including:

• Increase the base AG rate to $2,500 per month.
• Provide a one-time, lump-sum payment to AL facilities that serve a new AG resident, above the number of AG residents that they currently service.
• Expand the list of eligible living arrangements for the AG program to allow AG recipients to remain in the community and coordinate their own care as needed.
• Increase the personal needs allowance and include language tying the personal needs allowance to federal cost of living adjustments for the Social Security program.

The report authors noted that there is a growing need for affordable community-based living for older adults, and AL is an appropriate setting for many. They further observed that while AL is often less expensive than a nursing facility, “many adults have difficulty accessing AL due to the cost.” Read the full report at: jchc.virginia.gov/documents/ALF%20Affordability%20Commission%20Draft.pdf.​