Have “cuts” to federal Medicaid resulted in a nationwide closure of 1,000 skilled nursing facilities (SNFs)? Many are claiming the cuts are to blame, but the cuts have not yet taken place, and the closures started in 2015 under President Obama. Closures have resulted in 62,567 fewer nursing home beds, delays in new admissions, and the displacement of over 28,000 patients.
Medicaid is “…a joint federal and state program that helps cover medical costs for some people with limited income and resources. Each state runs its own program and eligibility requirements and benefits vary by state. Medicaid offers benefits that Medicare does not normally cover, like nursing home care” (emphasis added).
The American Health Care Association and the National Center for Assisted Living (NCAL) reported “chronic government underfunding” as a reason for “a worsening access to skilled care” for seniors, but is federal Medicaid the underfunding source?
No, because the Biden administration expanded Medicaid spending and Congress has not reduced Medicaid funding. The Biden administration increased Medicaid spending in excess of $134.8 billion over 5 years by permitting more “ineligible enrollees” to receive benefits (which Congress is attempting to remove). Jackson Hammond, Senior Policy Analyst at Paragon Health Institute, said the Biden administration enacted two rules allowing “more ineligible enrollees onto Medicaid and for ineligible people to receive Medicaid subsidies for Medicare.”
If government underfunding is the reason, the full blame would fall upon the states because higher federal funding levels were not passed on to SNFs, but 72% of the additional federal money was given to hospitals even after the hospitals had already been paid.
With less beds and placement possibilities available for America’s rapidly aging population, where do seniors go for long-term care?
One option is home health, a Medicare benefit that allows seniors to “age in place” in their own homes. Medicare covers home health care if a person is homebound and requires part-time or intermittent skilled nursing care or therapy services including skilled nursing and home health aide services. It does not cover 24-hour care or personal care unrelated to skilled services.
Are assisted living facilities admitting “skilled level” patients?
NCAL and the Assisted Living State Regulatory Review estimated that 48% of assisted living communities throughout the nation accept Medicaid payments, but only 17% of residents are Medicaid dependent. In addition, 65% of all states have enacted stricter state requirements over the past five years, and facilities accepting Medicaid must comply with added regulations.
Since the 1985 chaptering of California’s RCFE laws, the legislature and the Department of Social Services have relaxed facility acceptance and retention limitations including allowing residents with prohibited health conditions into facilities thus pushing the industry toward a skilled nursing model. However, California’s attempt at allowing facilities to accept Medicaid has failed as the program has not expanded beyond 15 state counties and has experienced financial shortfalls suspending enrollment of new recipients.