COMMUNITY RESIDENTIAL CARE FACILITIES

A "Community Residential Care Facility" (CRCF) falls somewhere along the spectrum between a nursing home and an individual's residence. Under South Carolina law, a CRCF is defined as providing room and board, plus a degree of personal assistance. The extent of the assistance provided can vary greatly from facility to facility. The size and character of CRCFs can also be quite different, with CRCFs ranging from relatively small settings in a converted private residence to very large facilities built especially to serve in this role. CRCFs often market their services under the umbrella of "assisted living." CRCFs provide a valuable alternative for an individual who does not yet require nursing home care, but is also not able to remain at home.

Although most individuals would view admission to a CRCF as some type of institutionalization, the Medicaid Program does not. To Medicaid, a CRCF is the functional equivalent of an individual residing in the community, just as if he/she remained at home. As a result, the Medicaid Program does not cover CRCF charges. A month of CRCF expenses may range from less than $1,000 up to amounts that rival a nursing home -- $3,000 or more. Again, the wide variation in cost is usually dependent upon the size and character of the facility, the degree of assistance available to the resident, and the array of services offered.

Although the Medicaid Program does not cover CRCFs, South Carolina does provide some financial assistance for individuals through its state-funded Optional State Supplementation (OSS) Program. For individuals who have limited financial resources and whose monthly income falls below a prescribed limit, the OSS Program provides a cash assistance payment that is made directly to the CRCF. This payment brings the individual's income up to a level sufficient for him/her to pay the CRCF at an established OSS rate established each year by the South Carolina General Assembly. Because this OSS rate may be significantly lower than a facility's usual rate, not all CRCFs choose to participate in the OSS Program, and those that do participate may set limits on the number of OSS recipients that they will serve.

The OSS Program is administered by the Department of Health and Human Services, which tracks expenditures and controls the number of "slots" that are available. When expenditures appear to be running higher than the funds appropriated to the OSS Program by the General Assembly, a "freeze" may be instituted during which no new participants are admitted. The eligibility determination - including financial qualification - is handled by the Department of Social Services (DSS). Unlike individuals seeking Medicaid coverage for nursing home care, individuals who seek OSS assistance with CRCF expenses are not required to satisfy any Level of Care requirements.

Although Medicaid does not fund the OSS Program, an individual who qualifies for OSS benefits will also automatically be entitled to Medicaid. This aspect of the OSS Program can be quite important, since the Medicaid eligibility that accompanies OSS participation provides the individual with coverage for hospitalizations, physician visits, prescription medications, etc..