Wolf, lawmakers need to boost Medicaid rates for long-term care homes | Opinion

February 11, 2019 6:30 am

By Zach Shamberg

When he unveiled his 2019-20 budget proposal last week, Gov. Tom Wolf found that some of his initiatives gained immediate approval, such as his proposal to invest in a trained workforce. And there were items that divided the public, like the renewed plan for a minimum wage hike.

But, for the most part, it seems as if a few truly deserving groups got what they wanted, others received a little less, and now the Legislature goes to work to approve the spending plan before June 30.

There was one constituency, however, that didn’t fare so well: Pennsylvania seniors who currently reside, or who will someday reside, in one of 700 nursing homes across the state.

For the fifth year in a row, the governor proposed flat funding for Medicaid rates in long-term care facilities, such as nursing homes.

That’s five consecutive years without any proposed increase to combat rising health-care costs, rising wages and increased costs for everything from labor to drugs and medical supplies to food and utilities. That doesn’t even include investments needed to meet more stringent regulatory demands from both the state and federal governments.

But that doesn’t mean that health care suffered across the board in this budget proposal. In particular, the governor proposed an increase in funding — 5.6 percent this year, 17.9 percent over the last two years — for inmate medical care.

Yes, you read that right. And the governor did that even as he touted the decline in the prison population. So at the same time the number of inmates in Pennsylvania’s correctional institutions is going down, their costs for health care (and the funding necessary to keep pace with rising costs) are trending up.

In other words, the “cost-inflation” argument makes sense in our prisons, but not in our nursing homes.

Think about this: for each resident, nursing homes provide nursing care and related services, specialized rehabilitative services, medically-related social services, pharmaceutical services, dietary services personalized to the needs of each resident, emergency dental services, and non-emergency medical transportation.

All of these services are provided for an average reimbursement rate of $8.24 per hour (or, $197.76 a day). A stay at the Harrisburg Hilton costs more than that on a legislative session day, and you certainly don’t receive anything close to those services — although the pool is nice.

As the Director of Government Affairs for the Pennsylvania Health Care Association, which represents long-term care providers, I’m constantly inviting lawmakers into long-term care facilities to meet with staff, residents and their family members.

I try to tell our “story” to the legislators, and I always ask two questions to the folks in the facility beforehand: what does it mean to be a resident or a caregiver in a Pennsylvania nursing home today? And what do you need from your government to succeed?

I’m always astounded when I hear the answer to the second question. It’s almost always just one word: “support.”

Pennsylvania has the fourth oldest population in the entire country, and we’re roughly three years away from what many refer to as the “silver tsunami,” or the impending influx of the baby boomers aging into the demographic most in need of long-term care services.

Staying at home is ideal, sure, but it isn’t the solution for everyone. Nursing homes must be an integral part of the health-care continuum, where care is provided around the clock for people with the highest acuity needs.

I was recently asked by a nursing home administrator in southeastern Pennsylvania if state government had simply “given up” on nursing home care. Years without investment in Medicaid funding had forced her to cut back on various programs at her building — many of the perks that had excited her residents in the past were now gone.

It was almost as if we were talking about a school that had done away with its arts or sports programs due to budget cuts. Of course, it’s more than that. Many facilities delay capital improvements or equipment upgrades because of funding shortfalls. I told her that the passage of the state budget was going to be a long process and that we’d now need the legislature to fight for her and others like her around the state.

To put it simply: We can’t just give up on nursing homes and long-term care. They’re too important and too vital for our aging population.

Nursing homes across Pennsylvania are counting on legislators from both parties in both chambers to come together and invest in our seniors with a meaningful funding increase in the 2019-20 budget. Without that critical investment this year, the “silver tsunami” will crash down on the commonwealth — and we won’t be ready for what comes next.

Zach Shamberg is the director of government affairs for the Pennsylvania Health Care Association, an industry trade association. He writes from Harrisburg.

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