Medicaid needs thoughtful reform, not budget cuts and caps … –

Medicaid is our nation’s largest health care plan, serving 65 million Americans and nearly a million Missourians. Importantly, Medicaid is the only public program that provides long-term care for the elderly and disabled. Two-thirds of Medicaid spending supports these vulnerable populations and their caregivers.

Medicaid operates as a federal/state partnership. The federal government sets program requirements, the states administer them, and both pay — but not equally. Congress pays $1.72 for every $1 Missouri spends. To maximize federal outlays, Missouri taxes its health care providers. But, despite higher federal payments, Missouri reimburses many nursing homes at rates below the cost of care. Average 2016 state reimbursement was $155 per patient day compared to $170 average cost. This means that through taxes and under-reimbursement, nursing homes subsidize Missouri Medicaid twice over. This is both unfair and unsustainable. Many nursing homes have reacted by decreasing Medicaid beds. If underpayment persists, some will close.

Missouri is currently engaged in its annual budget balancing exercise that must be completed by May 5. Representing one-third of the state budget, Medicaid is on the cutting block in Jefferson City. Simultaneously, Congress is considering proposals to cap state payments and let the states manage Medicaid’s explosive growth (driven by demographics and rising health care costs). These changes will mean less money for Missouri Medicaid, making a tough situation for nursing homes even tougher.

Recently, I visited Jefferson City and Washington, D.C., to advocate against Missouri cuts and federal changes. As chairwoman for Missouri’s association of nonprofit senior living and health care providers, and a health care professional who has served Missouri’s frail and elderly for more than 40 years, I had to raise my voice. Medicaid is a lifeline for 84,000 Missourians cared for in nursing homes and through home and community services.

A disturbing takeaway from my Capitol visits is that some policymakers are confused about long-term care coverage. I’m not arguing to expand Medicaid. I want our government to honor its current commitment to Medicaid beneficiaries. Medicaid exists for seniors who have exhausted personal resources and need care. While Medicare provides health insurance for seniors (without income limits), Medicare doesn’t cover long-term nursing home or assisted-living care. Long-term care is private pay, and few Americans (less than 5 percent) have private long-term care insurance. Accordingly, Medicaid has become America’s default long-term care program.

Sobering statistics spotlight the long-term care challenge. Today, if you reach age 65, there is a 70 percent likelihood you will need nursing home care for three years on average. The average annual Missouri nursing home costs $63,000 ($92,000 nationally). At such expense, it’s easy to understand why large numbers of people will exhaust resources and default to Medicaid. Will Medicaid be there for Missourians who can’t care for themselves and have no other option?

The largest generation in American history is approaching the age when long-term care is needed. The baby boomers present a monumental fiscal and social challenge. Governments, health care providers, aging service organizations and citizens must work together to save Medicaid for the boomers and beyond. To do so, Medicaid must be elevated to more than a budget exercise. It demands a long-term solution with incremental implementation.

We must care for those in the system while making hard choices and compromises for long-term Medicaid survival. Short-term cuts or fixes only delay and worsen the problem. To balance its budget, Missouri is currently considering payment cuts for already underpaid Medicaid providers and raising the acuity level for Medicaid eligibility (essentially telling seniors to get sicker before getting care and asking providers to care for sicker patients without a reimbursement increase).

Enough of the short-term cuts; let’s debate long-term solutions.

Christine E. Crouch is vice president and senior administrator at Bethesda Southgate/Charless Village.


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