Service Reimbursement Issues

• Limited capacity in the statewide Medicaid Waiver program
• Family Care offers a solution in five pilot counties
• RCAC assisted living is costly compared to Medicaid Waiver rates

Housing Finance Issues

• Low income housing lenders and investors have little experience with assisted living
• Assisted living industry unfamiliar with financing tools for low income housing
• Limited housing program resources (tax credits, HOME funds, and Section 8 vouchers)
• Incompatibility of service funding programs and housing finance tools

Regulatory Issues

• Confusion among different regulatory categories for assisted living
• Threshold for triggering regulatory requirements

Other Issues Identified by Potential Assisted Living Developers and Operators

• Limited management capacity and expertise available in small operations
• Mismatch between cost to develop/operate and what people can afford, especially in rural areas
• Lack of funding for services to tenants with non-medical needs
• Staffing: turnover and vacancies