Nursing homes: Medicaid cuts will endanger care of seniors

July 27--For 38 years, Mary Boone was elated to help people in need.

She determined cases of disability, TANF and Medicaid for Kentuckians as a part of the state Disability Determination Office. A lot of her clients were filing for members of their family, such as caretakers making sure their loved one could pay for a long-term care facility. Many seemed disappointed to have to ask for assistance, she said.

After her mom was diagnosed with Alzheimer's disease and moved to a full-time care facility, Boone and her family learned firsthand how relieving that assistance could be.

"It was a godsend," Boone said. "She needed in-depth help we just couldn't do at home anymore. When you're talking about family members' lives, Medicaid is crucial."

After a tie-breaking vote Tuesday by Vice President Mike Pence, the House and Senate will be going into conference to determine exactly what the proposed Republican health bill will contain, but policies in the House version and the Congressional Budget Office's latest estimate of $770 billion in Medicaid cuts from the Senate bill has some care companies seeking action.

Signature HealthCARE, which runs two facilities in Owensboro, and nearly 150 locations across the country, has launched a petition campaign to ask Congress "to vote NO on any reduction to Medicaid funding for nursing home residents." The petition currently has over 2,500 signatures online and each Signature facility has its own physical petition.

Boone's sister is now in long-term care at a facility in Owensboro, but she, like other caretakers and much of the nursing home industry, isn't feeling relieved about proposed changes to Medicaid policy.

Kathy Gallin, director of legislative affairs for Signature, said facilities are worried about a legislative situation that has grown far beyond repealing or replacing health insurance policy from the Affordable Care Act.

"From a conservative standpoint, we understand lawmakers are looking for ways to make programs sustainable, but it's always do more with less while being the best care providers on the planet," Gallin said. "Some of the suggested policies would be a huge cut to an already overburdened system. It just seems like Congress isn't listening."

The Medicaid system faces a growing annual shortfall of nearly $8 billion, according to a study from the American Healthcare Association.

Gallin said one of the most troubling situations concerning care facilities is the likelihood that a per capita cap grant policy from the House version of the bill would make its way into the final law.

Medicaid is currently funded by state contributions and a federal contribution based on the overall wealth of a state. Kentucky receives around 71 percent of funding federally while California receives around 50 percent.

Per capita cap grants, similar in approach to block grants which have been proposed by conservatives for Medicaid funding, would set a permanent limit of Medicaid funding for each person enrolled that is only adjusted for inflation and population. Without legislation protecting blind, aged and affirmed populations on Medicaid, states would then have to make Medicaid spending decisions based on the entire pool of applicants.

Dustin Pugel, research and policy associate at the Kentucky Center for Economic Policy, said a per capita grant policy would limit a state's options for which care strategies should be funded.

"A state would have to decide if it will continue paying the same rates at 138 percent of the federal poverty level without the same reimbursement," Pugel said. "If they do, that will mean cuts. The first thing to go will probably be in-home health services, since nursing home funding is mandatory."

Bill Conley, administrator for Signature HealthCARE at Hillcrest in Owensboro, said the residents at his facility have increasingly been older, more infirmed patients as people are able to stay at home longer before needing more intensive care. With Medicaid cuts and a potential flood of people unable to stay at home, Conley said he wasn't sure how facilities could cope.

"There is definitely a fear of the unknown among the industry and our patients," Conley said. "Medicaid has already been underfunded with rural areas being hit the hardest. With huge cuts, I couldn't imagine some facilities staying open."

Long-term care facilities like Hillcrest currently receive 89 cents for every $1 spent on care; a rate expected to decrease with growing shortfalls.

Conley said administrators have already been briefed on what a per capita cap grant would mean for residents in their care. He said they are expecting a 20 percent reduction in funding, or about $600,000 per facility.

Conley, whose grandmother lives at Hillcrest, said it seems impossible to continue caring for residents at the current level after such cuts.

"You can't cut that much cost out and still operate," Conley said. "Buildings would have to close, hundreds of people would have to be laid off and some communities would be without options."

Signature HealthCARE currently employees over 10,000 people across the country. Conley said destabilizing care facilities could have economic and employment effects as well.

After care facilities adjust to Medicaid cuts, the availability of care could look much differently for rural and underserved communities. Nearly one-half of Kentuckians live in rural areas, higher than the national average of 19 percent, according to a 2017 study from the Kaiser Family Foundation. People who live in rural areas are statistically more likely to be covered by Medicaid.

Conley said 67 percent of the residents at Hillcrest are there through Medicaid, mirroring the 67 percent of Kentucky's nursing home residents -- that is, 19,149 people -- who are covered by Medicaid. About 49 percent of Medicaid long-term care spending in Kentucky is for nursing home care.

Conley said he often sees the effects on families weaving through bureaucracy to find aid for their loved ones. He said if a precedent is set to use Medicaid cuts as a way to meet financial outcomes, those effects will be even harder.

"There are daily stresses of care and a lot of personal burden that people deal with while seeking approval for their family," Conley said. "I don't think people understand how painful it can be. We know healthcare is going to change; we just hope they aren't leaning on us for the change."

Boone still visits her sister in the nursing home and greets residents at every chance as she walks through the hallway. She said she never thought her sister would need it but, much like their mom, she doesn't see how people could survive without the help.

Boone said if she and her family hadn't been able to enroll her mom in Medicaid, she would have had to take a leave from work; something she said very few Americans can afford to do. A family member would have had to stay up around the clock to assist her mom due to her dementia and intensive care needs.

"Without Medicaid, I can't fathom what would happen to some people," Boone said. "We would have tried to make it work; we would have found a way. But some people don't have any family. My heart goes out to them."

Jacob Dick, 270-228-2837, jdick@messenger-inquirer.com,Twitter: @jdickjournalism

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