Medicaid processing backlog a fatal blow for Girard nursing home

July 07--GIRARD -- Donald Barnes is happy with the care that his 81-year-old wife, Hazel, has received at Pleasant Hill Village's unit for people with dementia since the retired bank teller and former businesswoman moved in 10 months ago.

Now she has to leave, but not because of a change in the quality of care at this Macoupin County nursing home in Girard, about 25 miles south of Springfield.

Chronic delays in the state's processing of applications for Medicaid coverage for Hazel Barnes and thousands of other low-income Illinoisans is causing financial stress for many nursing homes and emotional turmoil for families, advocates say.

For Pleasant Hill, a not-for-profit facility associated with the Church of the Brethren, waiting on $2.3 million in Medicaid payments for residents whose applications remain pending -- some as long as two to three years and some involving people who have died during the wait -- has become too much of a burden.

The 98-bed nursing home, a staple in this Macoupin County community of 1,800 people for 113 years, plans to close Sept. 1.

"We just got settled, and she was used to the place," said Girard resident Donald Barnes, 84, Hazel's husband of 64 years. "Now she has to go through it again. I just hope this doesn't have a domino effect on other homes."

With a gubernatorial election looming, there are political arguments over who is at fault for the backlog that has affected long-term care institutions for at least five years.

What's undisputed is the impact on facilities such as Pleasant Hill, where about 60 residents will have to find a new place to live and about 60 nurses, certified nursing aides, dietary workers and other employees will be out of work in less than two months.

The closure won't affect the continued operation of the Pleasant Hill complex's 48 apartments for assisted living and independent living. People living in the apartments don't use Medicaid to cover their care.

The Medicaid funds that Pleasant Hill Village officials say they haven't received because of the Medicaid application processing delays represent 44 percent of the nursing home's annual spending.

The facility, where 60 percent to 70 percent of the residents are Medicaid-eligible or approved for the program, has had to borrow money to make ends meet and forgo capital improvements for years because of the resulting cash-flow difficulties, administrator Maryann Walker said.

There were a lot of tears as patients who found spots in other nursing homes began to move out, she said.

"Nobody wanted to move," she said. "They were forced to. Everyone is pretty devastated, and they have been a little disappointed in the state."

Walker's comments were understated compared with those of Matt Hartman, a lobbyist for the Illinois Health Care Association. The association represents the nursing home industry.

"It's an upheaval to people who need care," he said, describing the backlog as "a screaming problem" that "hurts everybody."

A not-for-profit nursing home in Abingdon, a Knox County community of 3,100 people, closed in March under similar circumstances, Hartman said.

About seven years ago, the state routinely met the 90-day standard for most people applying to Medicaid for coverage of long-term care, he said.

In recent years, the backlog has grown. One reason, Hartman said, is because of an overall increase in Medicaid applications from younger people when Illinois expanded eligibility under the administration of Gov. Pat Quinn as part of the federal Affordable Care Act.

The backlog also grew under Quinn, a Democrat, and Rauner, a Republican, as their administrations presided over moves to centralize the processing of long-term care Medicaid applications in certain parts of the state rather than in local state offices, Hartman said.

The backlog currently totals almost 15,000 long-term care applications that represent $280 million to $320 million in reimbursements to nursing homes and supportive-living centers, according to Matt Werner, a Springfield consultant in a federal court case seeking to clear the backlog.

State Comptroller Susana Mendoza, a Democrat and frequent critic of Rauner, said this summer that the number of pending long-term care Medicaid applications more than 90 days old rose 143 percent between December 2017 and May 2018.

Mendoza said about 55,000 Illinoisans are covered by Medicaid for long-term care, but she can't expedite payments to nursing homes for people whose Medicaid eligibility hasn't been finalized.

"The Rauner administration's continued dysfunction is again threatening the people of the state who, perhaps, need our help the most," Mendoza said in a news release. "For Illinois' aging population, this is a massive health-care and housing crisis, and it again demonstrates an inability by Gov. Rauner to manage basic state functions and critical programs."

Rauner spokeswoman Nicole Wilson said the governor is trying to fix a problem that began before he took office in January 2015.

Wilson said Rauner is "committed to taking every responsible step to improve the processing of long-term care Medicaid applications. These are complex applications, and our teams are working to get them processed. It's important to note that the previous reporting of long-term care applications was based on data that was manually entered. That obviously left room for error and inconsistency.

"Our teams have implemented an automated system to track applications more accurately, get rid of some of the bottlenecks and streamline the process."

Added Meghan Powers, spokeswoman for the Illinois Department of Human Services: "One of the most significant causes of delays is the length of time it takes applicants to provide the state with all the necessary financial documents to determine their eligibility for long-term care services. Caseworkers strive to help applicants provide all documentation required by federal law rather than routinely denying incomplete applications. However, this results in many pending applications. Many cases counted in the backlog numbers are cases without all necessary documentation.

"Last year, we expanded staff working on these cases from 220 employees to 310 employees, and in January the state implemented a significant policy change that made it easier and faster for individuals who have been receiving community Medicaid to add eligibility for long-term care benefits."

Mendoza has criticized the Rauner administration's new Integrated Eligibility System, which processes eligibility for a variety of programs. She has said IES is "plagued by public failures that have stopped or delayed critical services for eligible, needy families."

The Illinois Department of Healthcare and Family Services hasn't yet awarded a contract in the state's quest for a private company to help reduce the Medicaid processing backlog, HFS spokesman John Hoffman said.

The General Assembly passed three bills -- Senate Bill 2385, Senate Bill 2913 and House Bill 4771 -- to streamline the Medicaid application approval process, Hartman said. Wilson wouldn't say whether Rauner will sign the bills, which she said are "under review."

It's unknown whether a federal judge's order for the state to clear the backlog by this past June 28 will speed up processing.

State Sen. Andy Manar, D-Bunker Hill, whose Senate district includes Pleasant Hill Village, faulted Rauner for the impending closure.

"I know this is a pressing issue for all nursing homes in the state," Manar said. "This goes back to managing bureaucracy. The Rauner administration has not done a good job at this."

The governor's reboot of the Medicaid managed-care system is delaying Medicaid payments to nursing homes and adding another twist to the financial situation for nursing homes, Manar said.

State Rep. Avery Bourne, R-Raymond, whose House district includes Pleasant Hill Village, said in an email: "The processing of Medicaid applications has been devastatingly slow for Pleasant Hill Village and other nursing homes. This is unacceptable. We, in the General Assembly, have passed bipartisan legislation to help remedy this process in the future. House Bill 4771 creates a provisional eligibility to keep backlogs like this from happening in the future. I'm calling on the governor to sign the bill."

Back in Girard, Donald Barnes said he was able to secure a spot for his wife at Sunrise Skilled Nursing and Rehabilitation Center in nearby Virden, and a move is planned for next week. He said he wishes he didn't have to move his wife from Pleasant Hill Village, though.

"I haven't seen a bad CNA, and the administration has been excellent," Barnes said.

Hazel Barnes' application for Medicaid coverage to pay for her stay at Pleasant Hill village still hasn't been approved, her husband said.

Donald Barnes, a retired Sears salesman, said he blames elected state officials for the stress that he and his family are going through.

"Most people in office are more wealthy than I've ever been, and they unknowingly turn their backs on other people," he said.

Pleasant Hill Village registered nurse Cathy Vollmer, 33, said seeing residents leave has been hard on her and the rest of the staff.

Dietary aide Dixie Taylor, 63, of Nilwood, has worked at the facility 33 years. Taylor, who is divorced, said she lives with her son, his wife and the couple's three children. The adults all work, and paychecks from all of them are needed for the family to survive financially, she said.

"I'm not old enough to retire," Taylor said, adding that she doesn't know where she will find another job.

Pleasant Hill Village resident Jeanne Manning, 87, a retired school secretary, has lived at the nursing home for 1 1/2 years and said she would rather not move.

"I was very disappointed because I loved it here," she said. "I made a lot of friends."

Like Manning, resident Bob Bouldin, 85, pays privately to receive care at the facility but is losing his home, as well.

Bouldin, a Chicago native and retired Girard teacher, said the closure will upset him.

"The people who suffer the most are the patients," he said. "I don't want to be moved around like a side of beef. I had just gotten settled in here. I was happy with the staff and then the bottom falls out. Will they ever learn to just leave us alone?"

Contact Dean Olsen: [email protected], 788-1543, twitter.com/DeanOlsenSJR.

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