When Pennsylvania first licensed assisted-living centers five years ago as an alternative for people to age outside of nursing homes when their health declined, the official acknowledgment was long overdue compared with most states.

Now industry leaders say the state is overdue in living up to its stated goal of helping people with modest resources live in the facilities, which are designed to be more home-like than the nursing homes in which the government subsidizes anyone qualifying financially and medically. Funding might arrive next year under a managed-care system being implemented for long-term care of low-income individuals, but in a curiously vague way the state has yet to spell out if and how that will occur.

It leaves Timothy W. Coughlin, an Erie-based provider and president of the Pennsylvania Assisted Living Association, wondering if his four facilities will need to continue telling longtime residents who eventually deplete their resources that they must transfer to a nursing home.

“We are not funded in any way to provide that charitable care,” he said. “We are hopeful the state will do something to fix the situation. Assisted living providers want something good for folks when the money runs out — we think that’s possible and can be cheaper for the state.”

Budget constraints caused the Rendell administration to back out of plans when assisted-living legislation was passed in 2007 to seek a federal waiver for Medicaid funding. Though assisted living might be only one-half to two-thirds the cost of a nursing home, there were financial concerns about opening up a new category of subsidized care for thousands more beneficiaries.

So it’s been up to everyone to pay their own way — a cost ranging from $3,000 to $5,000 monthly, which people typically must show they’re able to cover for at least three years before being admitted. Providers say absence of the anticipated government support is one of the reasons Pennsylvania doesn’t have the several hundred assisted-living centers that had been anticipated, but only 35.

Many large personal care homes among the 1,200 in that licensing category resemble assisted-living facilities, but they decline to switch their status because they would incur substantially larger licensing fees. Personal care homes don’t have the same option as assisted living, however, to continue caring for someone with a serious medical condition.

State officials specifically ruled out personal care homes as a subsidized, managed-care living option in documents posted this month describing the Community HealthChoices program that starts for some 100,000 older and disabled southwestern Pennsylvanians in January, followed by another 300,000 statewide. The written requirements describe how 11 potential managed-care contractors are to put together networks that include nursing homes, home care providers, hospitals, physicians, therapists, adult day care centers and more.

But on assisted living, the documents are silent.

Jen Burnett, deputy secretary of the state’s Office of Long-Term Living, said the silence doesn’t mean assisted living is excluded from Community HealthChoices. She said managed-care organizations have the latitude to determine if it’s viable for them and their clients. The state is not requiring it in the MCO’s networks, she said, because there are too few assisted-living providers in many parts of the state to offer consumers a good range of choices.

She acknowledged the assisted-living industry has “languished” in terms of reaching its potential in Pennsylvania, which Ms. Burnett said is disappointing in making sure people have good options as their health declines.

“What we’re doing could potentially be a response to it, but we have to wait and see what happens with the managed care organizations,” she said.

Meanwhile, it’s hard for MCOs to say anything for certain because the state has yet to provide specifics about the rate structure for assisted living or the rest of Community HealthChoices, said Ray Prushnok, a senior director for UPMC Health Plan, one of the potential MCOs.

He said assisted living, if possible, would be “an important part of the care continuum” to include. UPMC Senior Communities is the biggest provider of assisted living in the Pittsburgh area, with four sites, so it would be logical for UPMC Health Plan to try to use those facilities for clients in a managed-care system.

Deborah Brodine, president of UPMC Community Provider Services, hopes that will be the case.

Unlike the practice in Mr. Coughlin’s for-profit facilities, she said UPMC keeps assisted-living residents who have exhausted their personal funds by using a benevolent care fund. She believes the government should be helping, however.

UPMC’s assisted-living centers are so well filled that they don’t need to have a financial need to add Medicaid-subsidized individuals, and industry representatives say that’s true generally across the state. The bigger issue, Ms. Brodine said, is ”Philosophically, it’s important to keep people where they want to be.”

Gary Rotstein: grotstein@post-gazette.com

First Published: March 28, 2016, 4:00 a.m.