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Need for Adequate Medicaid Reimbursement to Provide Skilled Nursing Care Outlined

Armen Hareyan's picture

Medicaid and skilled nursing facilities

In a hearing held by the House Health and Human Services Sub-committee, representatives of Ohio's skilled nursing facilities outlined the critical need to provide adequate reimbursement in the state's proposed budget to enable them to continue giving quality care to those patients.

Despite demographic projections showing that Ohio's over 65 population will increase 50% in just the next 20 years - including a 28% increase in severely disabled elderly - the proposed two-year state budget calls for no increase in Medicaid reimbursement to provide patient care in skilled nursing facilities.

Ms. Jill Herron, administrator of the family-owned Welcome Nursing Home in Oberlin, noted that her grandparents founded the facility sixty-two years ago under the motto "People Helping People" and described the difficulty of being able to pay the staff that provides patient care due to the reduction in Medicaid reimbursement. "Staying competitive with wages and benefits is important to continue attracting quality staff to long-term care," Ms. Herron explained, noting that 75% of the facility's annual budget is devoted to employee wages and benefits. "However, we have basically been flat funded since 2003 despite increases in costs, and we are beginning to lose staff as they look for more competitive job opportunities."

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"Our patients are among Ohio's most vulnerable citizens ... and they need staff to keep them safe, to provide their care and to keep them company," said Ms. Robin Hillier, a co-owner of Miami Shores of Moraine. The facility has 129 certified beds, including a special 33-bed pulmonary unit that provides intensive rehabilitation services or intravenous therapy and takes care of patients who are on ventilators or receive tracheotomy care. Ms. Hillier told sub-committee members that Medicaid reimbursement rates for Miami Shores have decreased by 3.5% over the past four years while Ohio's inflation rate has increased by more than 10%. "Our staffing crisis is a direct result of our wages no longer being competitive in the marketplace," Ms. Hillier said. "78% of the people we care for are Medicaid recipients; therefore we are tightly constrained by the Medicaid rate."

Sister Pauline Ross, Administrator of Mother Angeline McCrory Manor in Columbus, summarized the problem succinctly: "We lose funds every day because Medicaid does not pay for the cost of providing care for the residents we serve in the manner which they deserve." She also identified an additional problem in the state Medicaid reimbursement structure, explaining that the reimbursement system " ... provides no incentive for the construction of a new building or renovations to meet changing resident care needs and demands."

Humility of Mary Health Partners, located in the Youngstown area, is responsible for operating facilities spanning the full spectrum in the healthcare continuum-of-care, including critical skilled nursing care. Executive Director Warren Harris urged sub-committee members to correct a particularly damaging aspect of the Medicaid reimbursement calculations that classify Youngstown-area skilled nursing facilities as "rural", and therefore having lower reimbursement rates than other metropolitan areas in the state. Mr. Harris said, "Quite simply, the reimbursement formula does not reflect the realities of the costs of our area due to the misclassification of our region. As a result of Medicaid reimbursement methodology changes, quality service (to patients) is even more threatened. It is vital that senior service providers be given the proper resources to provide our frail elderly and disabled citizens the right care, at the right time, at the right place."

The Skilled Nursing Care Coalition is asking legislators to restore the Medicaid budget appropriation to the level that was approved in the prior biennial budget along with a modest 1% increase, yielding a 3% increase in reimbursement rates. The Coalition also has expressed its support for adequate funding of the entire continuum-of-care, including expanding PASSPORT funding to enable more people to stay at home longer before needing to move into a skilled nursing facility.