Cuts in Medicaid a threat to elderly
Entitlement for most of 1.4 million people in nursing homes in peril
ORANGE, Va.— Alice Jacobs, 90, once owned a factory and horses. She raised four children and buried two husbands.
But years in an assisted living center drained her savings, and she relies on Medicaid to pay for her care at Dogwood Village, a nonprofit, county-owned nursing home here.
“You think you’ve got enough money to last all your life, and here I am,” Jacobs said.
Medicaid pays for most of the 1.4 million elderly people in nursing homes, like Jacobs. It covers 20 all Americans and 40 percent of poor adults.
On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid, part of the effort to repeal the Affordable Care Act.
Conservatives hope to roll back what they see as an expanding and costly health care entitlement.
Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.
“The states are going to make it harder to qualify medical ly forhome care ,” said Toby S. Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”
States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare does. Contributing factors
A combination of longer life span sand spiraling healthcare costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation.
Even if Congress does not repeal the Affordable Care Act, Medicaid will remain a target for cuts, experts say.
“The Medicaid pieces of the House bill could be incorporated into other pieces of legislation that are moving this year,” said Edwin Park, a vice president at the Center on Budget and Policy Priorities, a Washington nonprofit that focuses on how government budgets affect low-income people. “Certainly, nursing homes would be part of those cuts, not only in reimbursement rates but in reductions in eligibility for nursing home care.”
The House healthcare bill targets nursing home coverage directly by requiring every state to count home equity above $560,000 in determining Medicaid eligibility.
That would make eligibility rules tougher in 10 states — mostly ones with expensive real estate markets, including California, Massachusetts and New York — as well as in the District of Columbia, according to an analysis by the Center for Budget and Policy Priorities. Quality of care questions
Dogwood Village receives about half of its $13 million annual operating costs from Medicaid, with rates from $168 to $170 a day. Some residents who come to the nursing home after a hospital stay are initially covered by Medicare, but if they stay longer than 100 days, that benefit ends, and those without savings move to Medicaid.
Major Medicaid cuts would compel Dogwood Village to slash staff, supplies and amenities — changes that would affect the quality of care for all residents.
Some residents do not know they are on government insurance; administrators often complete the paperwork to start Medicaid once other insurance expires.
Others are embarrassed they are dependent on a program that carries stigma.
They should not be, said Jennifer Harper, assistant director of nursing. Relying on Medicaid for nursing home care has become the new normal.
“These folks have worked their whole lives … and paid into the system,” she said.
But with changes looming, she said, “It may be a system that fails them.”