[Jeff’s comment: This story
was written by Jordan Rau for Kaiser
Health News. I thought it was important enough to republish on this blog.
It is republished with permission of Kaiser Health News]
In The End, Even The Middle Class Would Feel GOP Squeeze On
Nursing Home Care
By Jordan
Rau Kaiser Health News, June 26, 2017
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 facility drained her savings,
and now 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 about two-thirds of the 1.4 million elderly
people in nursing homes, like Jacobs. It covers 20 percent of 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. But little has been said
about what would happen to older Americans in nursing homes if these cuts took
effect.
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 medically
for needing nursing home care,” predicted Toby 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 already does.
The 150 residents of Dogwood Village include former teachers,
farmers, doctors, lawyers, homemakers and health aides — a cross section of
this rural county a half-hour northeast of Charlottesville. Many entered old
age solidly middle-class but turned to Medicaid, once thought of as a
government program exclusively for the poor, after exhausting their insurance
and assets.
A combination of longer life spans and spiraling health care
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. (KHN is an editorially
independent project of the foundation.)
“People are simply outliving their relatives and their
resources, and fortunately, Medicaid has been there,” said Mark Parkinson,
president of the American Health Care Association, a national nursing home
industry group.
With more than 70 million people enrolled in Medicaid at an
annual cost of more than $500 billion, the program certainly faces
long-term financial challenges. Federal Medicaid spending is projected to grow
by 6 percent a year on average, rising to $650 billion in 2027 from $389
billion this year, according to the Congressional Budget Office.
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.”
While most Medicaid enrollees are children, pregnant women
and non-elderly adults, long-term services such as nursing homes account for 42
percent of all Medicaid spending — even though only 6 percent of Medicaid
enrollees use them.
“Moms and kids aren’t
where the money is,” said Damon Terzaghi, a senior director at the National
Association of States United for Aging and Disabilities, a group that
represents state agencies that manage programs for these populations or
advocate for them. “If you’re going to cut that much money out, it’s going to
be coming from older people and people with disabilities.”
The House health care 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.
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 facility 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.
“You have patients who have spent their life savings, and
they come here,” said Kristen Smith, the admissions coordinator. Smith said
patients now were older and sicker than they used to be, frequently arriving
directly from a hospital.
“It used to be hips and knee” surgeries, she said. “And now a
lot of those patients are going home. What we’re seeing is more complex, sicker
patients.”
With cinder-block walls brightened by pictures of horses that
evoke this equestrian county, the nursing home offers crafts, bingo and other
activities.
Mary Ann Mohrmann is 85, the average age of Dogwood Village
residents. An elementary school teacher for 25 years, she has
Charcot-Marie-Tooth disease, a neurological disorder that has weakened her
legs, feet and thumbs and compromised her fine motor skills.
Two of her children have it, too, she said. None of them can
take care of her at home. “I’ve been here years,” she said. “I don’t know how
many.”
Medicaid helps pay for care for people with disabilities,
like Nancy Huffstickler, 64, who has been here four years and regards herself
as “a medical disaster.”
She listed her ailments: spinal cancer in remission, restless
legs syndrome, high blood pressure and multiple ulcers. She has had spinal
reconstructive surgery and a hip replacement. She is undergoing physical
therapy with the hope that, one day, she will be able to leave her wheelchair
and use a walker.
Huffstickler is fearful of Republicans’ health care changes.
“It may save the federal government money, but what about us?” she asked.
Major Medicaid cuts would compel the facility to cut staff,
supplies and amenities — changes that would affect the quality of care for all
residents, not just those on Medicaid.
If that does not save enough money, the facility might have
to reduce the number of Medicaid residents, said Vernon Baker, who resigned as
administrator in April. “It’s not like our toilet paper or paper towels are
like the Ritz-Carlton’s,” he said.
Some residents do not even know they are on government
insurance; administrators often complete the paperwork to start Medicaid once
other insurance expires. Others are embarrassed that they are dependent on a
program that still carries stigma.
They should not be, said Jennifer Harper, the assistant
director of nursing. Relying on Medicaid for nursing home care has become the
new normal.
“These folks have worked their whole lives, some with pretty
strenuous jobs, and paid into the system,” she said. But with changes looming,
she said, “it may be a system that fails them.”
Kaiser Health
News, a nonprofit health newsroom whose stories appear in news outlets
nationwide, is an editorially independent part of the Kaiser Family Foundation.
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