The Washington Post wrote a story this month called “Assisted-living homes are turning down Medicaid and kicking out seniors.” Unfortunately, the story didn’t show the whole picture of what assisted living providers have to deal with.
The story says that Medicaid pays for some kind of long-term care for 4.4 million Americans. Medicaid is a state and federal program that helps low-income people get health care and long-term care services.
But paying back providers, like skilled nursing homes and residential settings like assisted living, has been a problem for a long time. As a result, fewer and fewer providers will take Medicaid residents.
A 2021 Genworth Cost of Care survey found that long-term care costs $4,500 per month in an assisted living community, $9,034 in a nursing home, and $19,656 for around-the-clock care in a home health setting.
These prices will vary based on the local market. Since then, prices have only gone up due to a lack of workers, which drives up the cost of labor, general price inflation, and price increases for healthcare services and supplies. Providers haven’t been paid enough to keep up, and while the amounts vary by state, the national average is about $3,000, which is much less than the cost of care.
It’s important to remember that assisted living helps Medicaid money last longer. Medicaid is the biggest payer for long-term care services in the U.S., and if assisted living wasn’t a choice, it’s thought that as many as 61% of senior citizens would have to go to much more expensive skilled nursing facilities, which would cost $43.4 billion.
This extra cost would ruin the budgets for both state and federal Medicaid programs. If state lawmakers were serious about giving their older residents access to assisted living services, they would raise reimbursements to cover the real cost of care.
Legislators in New Jersey are thinking about passing a bill that would raise the daily Medicaid rates for assisted living programs and housing.
This would help low- and middle-income seniors live on their own longer and give their caregivers a better wage. The bill would raise payments to assisted living homes and programs. New Jersey’s rates have been lower than those in other states for a long time and haven’t gone up in 10 years.
One person who supported the bill said, “There’s a reason why there aren’t more places in New Jersey for low-income, old people. The main one is the rate at which Medicaid pays out. As the state keeps trying to move people out of institutions and into their own homes and communities, the housing problem will only get worse if Medicaid rates aren’t raised in a serious way.
States will have to do the same thing because of an older population and the need for long-term care and assisted living services in the future. We hope that other states, like Wisconsin, will think about doing the same.
The Washington Post story says that “evicting” residents is “becoming more common.” This is a worst-case situation that comes from a Medicaid system that doesn’t pay enough to cover the real cost of care and services given to people.
In Wisconsin, as in most states, the Medicaid long-term care program, Family Care, gives contracts to managed care organizations, which are like HMOs. These organizations then negotiate with providers to give eligible seniors and people with disabilities the real care they need. MCOs get a payment called a capitation from the state to help them control costs, use, and quality.
Most providers will tell you that there isn’t much or any negotiating. They either take the Medicaid rate that the MCO gives them or the MCO moves the people they serve to another place.
When an MCO and an assisted living community can’t agree on a reimbursement rate, the facility works with the state long-term care advocate, the state health department, the resident, and the resident’s family to find another place for the resident to live.
A person is not “kicked out” of an assisted living community. Instead, safeguards are in place to make the process of moving easier.
Far from being “the wild west” as the story says, deciding to end a contract with an MCO and telling residents is a well-organized process.
And let’s be clear: this is the last option for communities that have been waiting to make a decision in the hopes that policymakers will raise rates to cover the cost of the care and services they give to residents every day. It’s not something you should decide on the spot, and it’s not what any assisted living community wants to happen.
This is a complicated topic that needs to be covered in a thorough and fair way. Picking on senior living communities misses the bigger point that more older people won’t be able to get assisted living without more fair payment.