TOPEKA — Mitzi McFatrich says there’s a big hole in a bill meant to generate additional Medicaid funding for Kansas nursing homes.
“There’s nothing in here that puts a focus on quality of care. It's a sieve,” said McFatrich, executive director at Kansas Advocates for Better Care, an organization that advocates on behalf of nursing home residents and their families.
If an administrator or corporate executive wanted to use the new money to pad their bottom lines, they could. If they wanted to spend it on new office furniture or computers, they could.
They could spend it on more or better care, but they wouldn’t have to.
“I think that’s outrageous,” McFatrich said, noting that some of the executives who have testified in favor of House Bill 2673 work for chains that have been repeatedly cited for poor care. “Let me remind you that last year, 132 out of the 345 nursing facilities in Kansas were cited for abuse, neglect or exploitation – that’s almost 40 percent of all the nursing facilities in the state. That’s a big deal."
What’s fair?
HB 2673 calls for using a $1,325-per-year tax on licensed nursing home beds to generate about $30 million, which, in turn, would be used to draw down $56 million in additional federal Medicaid funding.
Ninety-nine percent of the $86 million would be returned to the nursing homes – the more Medicaid residents a home has, the more money it would receive.
So far, almost all of the debate in House and Senate budget committees has focused on whether the tax will force nursing homes to raise their private-pay rates, and whether it’s fair to expect private-pay residents to cover the costs of caring for Medicaid residents.
“This shifts the burden from the many to the few, which we believe is bad policy” said Deborah Zehr, executive director at the Kansas Association of Homes and Service for the Aging, which represents almost all of the state’s non-profit nursing homes.
Zehr testified Wednesday before the House Appropriations Committee.
She, too, said the bill includes “opportunities for profit-taking, which, as not-for-profits, concerns us.”
The state’s for-profit facilities support the bill, warning that without it, fewer homes will admit Medicaid residents and many homes – those in small towns, especially – will be forced out of business.
Typically, Medicaid does not pay enough to cover a nursing home’s costs.
Several administrators have said they have no way to make up the 10 percent cut in Medicaid reimbursements that became effective Jan. 1.
“In one of my facilities, I have 60 people who are on Medicaid, six who are private pay,” said Frank Trimboli, who runs Providence Living Center in Topeka. “To make up the 10 percent cut in Medicaid, my private-pay residents would have to pay an additional $100 a day. They can’t do that.”
‘A valid point’
As written, provisions in the bill would "sunset" or expire after four years.
The first year’s proceeds could be used to offset the Medicaid cut, said Cindy Luxem, executive director of the Kansas Health Care Association, which represents most of the state’s for-profit nursing homes.
In the second year, a nine-member panel would advise the Kansas Health Policy Authority how best to distribute the funds in the second, third and fourth years.
The proposed panel’s membership includes a Kansas Advocates for Better Care representative.
“She has a valid point,” Luxem said, referring to McFatrich’s criticism. “But I think the time to get into that is in the second year because right now, the issue before us is one of survival - we’re talking about facilities closing.”
McFatrich said she was pleased that Kansas Advocates for Better Care would have a seat on the panel, if the bill passes, but noted that five of the nine positions are reserved for representatives of the nursing home industry.
“To me, if we’re going to expect the private-pay residents to pay more – because that’s where the nursing facilities are going to get the money for this – then shouldn’t there be some assurances that for their money, they’ll be receiving better quality care?” McFatrich said. “I don’t see those assurances. They’re not in the bill.”
Also on Wednesday, Shannon Jones, executive director at the Statewide Independent Living Council of Kansas, asked the Appropriations Committee to consider committing 20 percent of additional revenue to home and community based services for the frail elderly and people with physical disabilities.
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