EDITORIAL: Hochul's Medicaid boost for nursing homes is welcome – but is it enough? [The Buffalo News, N.Y.]

Feb. 4—When New York's nursing homes are no longer able to accept residents in need of skilled care, where will these mostly elderly people find respite? Will they have to resort to expensive short-term stays in hospitals, forcing patients who truly need hospital-level care to wait longer for beds? Will they have to be sent to other states, separated from their families and communities? How many of New York's long-term care facilities will shut down in 2023?

These are the dire questions being asked by nursing home operators across New York, as they contemplate the survival of their facilities. It should come as no surprise that the pandemic has left one of the state's most vital safety nets reeling, with no solutions in sight.

The reason: a perfect storm composed of workforce shortages, inflation, Covid-19 revenue loss and — most devastating of all — Medicaid reimbursement rates that haven't been updated in 15 years.

New York is not a young state. With one in six residents over 65, there are now more older adults in New York State than the entire population of 21 states, and many of these seniors, after years of hard work and unfailing contributions to the economies of their communities, have physical frailties that necessitate skilled care. They should receive this care. It's up to Albany — working with the industry — to find a way to provide it — reliably and affordably — for those who need it.

In her 2024 budget proposal, Gov. Kathy Hochul asked for an increase of 5% in Medicaid reimbursements to hospitals, nursing homes and assisted living providers. That's not enough, say New York's providers, who assert that 20% is the minimum needed to help the industry survive.

In fairness, Hochul's proposal is the best the industry has seen from Albany in years. In 2020, then-Gov. Andrew Cuomo made cuts — which were later restored — in the reimbursement rate. The question state legislators must answer is whether it is enough.

Many watchdog groups repeatedly state that New York's per capita spending on Medicaid is the highest in the country, more than double the national average. Given the state's population and demographics, these facts do not surprise; nor do they offer solutions. Also, Medicaid is a huge public health insurance provider that funds a wide range of state programs. To some observers, the lack of attention to nursing home reimbursement rates suggests there are better ways to more equitably fund Medicaid's many offerings.

Significantly, the long-term care crisis does not seem to pit New York Democrats against Republicans, as a sampling of statements from Assembly Republicans demonstrates:

Assemblyman Josh Jensen, R-Rochester: "Long-term care is in jeopardy."

Assemblyman Matt Simpson, R-Horicon: "It's a ticking time bomb."

Assemblyman Scott Gray, R-Watertown: "There's no question" the rates are overdue for an adjustment.

It's not a problem where partisan politics should intrude. Some lawmakers are exploring ways in which "aging in place" services can be offered to those who need it at home, through Medicaid, though nursing home providers assert that these are exactly the programs that have reduced their shares.

Bob Kramer, cofounder and strategic adviser for the National Investment Center for Seniors Housing & Care, suggests that a potential solution is to create a new Medicare benefit, a "Part E," that would cover most or all of older Americans' long-term care costs. In Washington state, a mandated public long-term care insurance program is funded through payroll deductions.

These are interesting ideas, but may be better for the long term than in the current crisis.

In the end, there's no choice here. As long as 75% of New York's long-term care patients rely on Medicaid, a way to properly fund Medicaid — or find a substitute for that funding — must be identified.

After the horrors of the Covid era, New York's nursing home residents have suffered enough. They deserve creative solutions from their state and from their providers.

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