Medicaid Assistive Care Services (ACS)

SERVICE DESCRIPTION

Assistive Care Service (ACS) is a Medicaid-based, state plan that provides care to eligible recipients who require an integrated set of services on a 24-hour-per-day basis.

ACS recipients must demonstrate functional deterioration that makes it medically necessary for them to live in a supportive setting and received integrated services, whether scheduled or unscheduled. ACS includes four service components:

• Assistance with activities of daily living (ADLs) such as bathing, walking, toileting, etc.;
• Assistance with instrumental activities of daily living such as shopping or making a telephone call;
• Assistance with self-administered medications; and
• Health support (observing the recipient’s state of health and well-being on a daily basis and reporting changes to the health care provider as appropriate)

FUNCTIONAL ELIGIBILITY

To receive ACS an individual must meet the following requirements:

• Be at least 18 years of age;
• Medicaid-eligible;
• Assessed by a physician or other health care practitioner as needing at least two of the four ACS components; and
• Residing in an ACS-enrolled assisted living facility (ALF) or adult family care home (AFCH).

The following are NOT eligible for ACS:

• Residents of institutions such as nursing facilities, state mental hospitals, institutions of mental disease, or intermediate care facilities for the developmentally disabled; and
• Participants in any Medicaid managed care program in which the capitated payment is designed to cover all Medicaid long-term care services.

FINANCIAL ELIGIBILITY

An individual must be:

• Eligible for Medicaid based on participation in the Supplemental Security Income (SSI) Program, or
• Eligible for Medicaid through the MEDS-AD Program, which entitles certain aged or disabled individuals to receive ongoing Medicaid coverage if their income and resources are within the specified limits. Currently the asset limit is $5,000 for an individual. The income limit changes from year to year and is currently $702 per month plus a $20 disregard, for a total of $722 per month.

REIMBURSEMENT

ACS (Medicaid) is billed at a daily rate for days the recipient receives services in the facility. The provider must maintain service plans and daily service documentation on each ACS recipient. In addition, the provider must ensure that a new health assessment is completed on an annual basis and whenever there is a significant change in the recipient's condition.

As of January 2004, the daily rate for ACS is $9.28 per day, for a total of $278.40 for a 30-day month. Together with the resident’s payment for room and board (from his or her personal income and possibly the Optional State Supplementation program), the reimbursement to the facility would be at least $866.80 for a 30-day month.

Note: ACS recipients are entitled to a personal needs allowance of $54 per month.

A licensed ALF or AFCH must be enrolled with Medicaid as an ACS provider. Facilities seeking additional information regarding the ACS program should contact the Medicaid Area Office in the appropriate Planning and Service Area (PSA).