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Nursing Home Medicaid Cuts Draw Concern and Criticism

Nursing Home Medicaid Cuts Draw Concern and Criticism

The nursing home Medicaid cuts have been decided by bed occupancy rates.

The Connecticut legislature has passed a law this year that has drawn serious blowback by proposing a series of nursing home Medicaid cuts to homes that don’t have at least a minimum occupancy level of 70 percent. According to state officials, a total of about $6 million will be recovered from these facilities within a year.

While some nursing home Medicaid cuts will definitely restrict the amount of money going to certain homes, lawmakers state that 205 out of the 214 operational facilities in Connecticut will get reimbursement increases for having high occupancy levels and good ratings under federal guidelines according to the Connecticut Mirror. However, for Kimberly Hall South, a nursing home with a federal rating of 4-out-of-5 stars, the nursing home Medicaid cuts will slash over $750,000 from the home’s budget. The decreases started retroactively on July 1 once the law is implemented.

According to a report commissioned by the state from Mercer Human Services Consulting, the trends and predictions on care for older residents up to the year 2040 project a “major increase in demand for and use of home care provided through Medicaid” which justified the nursing home Medicaid cuts. Since the report estimates 6,000 beds will be vacated in the next 21 years, state officials have decided to begin preparations for this shift by slashing Medicaid disbursements for certain nursing homes in favor of home care resources.

Thomas Russo, senior executive director for Genesis Healthcare, which owns five out of the facilities affected by the nursing home Medicaid cuts, says there’s a flaw in the new Medicaid reimbursement calculations, which needlessly punishes facilities. One of Russo’s facilities, Kimberly Hall South, is licensed to hold 180 beds. Over time, however, the facility has removed some beds in order to repurpose areas as private residences and specialty units.

As an example, Russo described how “just four years ago, we took a whole 30 bed unit and transformed it into a very vibrant dialysis clinic here. We’re providing dialysis services for not just residents here in Windsor, but for residents throughout the state of Connecticut.” According to Russo’s testimony, state officials didn’t visit to confirm how many beds were still in use or hey would see that Russo’s facilities had a much higher occupancy percentage that the state assumed from records.

Officials from the Connecticut Office of Policy and Management stated that nursing home facilities will be able to appeal their reimbursement rates under several circumstances, but there were no comments on the failure to ensure occupancy percentages were correct.
The nursing home Medicaid cuts are not being taken quietly, however. Executives and labor leaders from the targetted facilities plan to challenge the state’s decision to preserve their staff and quality assurances. Jesse Martin, vice president of labor union SEIU 1199NE decried the state’s decision saying “The state has been trying to change the way that long-term care is done, and they’re trying to incentivize home care . . . There’s still a vital need for nursing homes in our society.”

Martin met with state legislators, nursing home operators, residents and health care providers in Windsor at Kimberly Hall South on Aug. 22. Kimberly Hall South was one of the facilities notified by the state the previous week of a decrease in its Medicaid reimbursement rates.

The nursing home Medicaid cuts have also been a topic of concern for nursing home residents. One resident, Margaret DeSousa, described her concerns about homes buckling under the financial burden of retroactive cuts. “What happens to me and others in other homes like this?” DeSousa described fears of being shipped to other facilities or being placed in difficult home care situations because “one, we can’t afford it. Two, if our family don’t want us, because they don’t want anything to do with us or they can’t do it, what happens to us?”

These concerns, coupled with the potential for neglect through understaffing or inability to maintain facilities leaves many employees and residents concerned for the safety and reliability of nursing facilities in Connecticut.

For more information about the potential drawbacks of neglect, visit the National Association of Nursing Home Attorneys’ Neglect Page.