Nursing homes: Medicaid cuts will endanger care of seniors
She determined cases of disability, TANF and Medicaid for Kentuckians as a part of the state Disability Determination Office. A lot of her clients were filing for members of their family, such as caretakers making sure their loved one could pay for a long-term care facility. Many seemed disappointed to have to ask for assistance, she said.
After her mom was diagnosed with Alzheimer's disease and moved to a full-time care facility, Boone and her family learned firsthand how relieving that assistance could be.
"It was a godsend," Boone said. "She needed in-depth help we just couldn't do at home anymore. When you're talking about family members' lives, Medicaid is crucial."
After a tie-breaking vote Tuesday by Vice President
Signature HealthCARE, which runs two facilities in
Boone's sister is now in long-term care at a facility in
"From a conservative standpoint, we understand lawmakers are looking for ways to make programs sustainable, but it's always do more with less while being the best care providers on the planet," Gallin said. "Some of the suggested policies would be a huge cut to an already overburdened system. It just seems like
The Medicaid system faces a growing annual shortfall of nearly
Gallin said one of the most troubling situations concerning care facilities is the likelihood that a per capita cap grant policy from the House version of the bill would make its way into the final law.
Medicaid is currently funded by state contributions and a federal contribution based on the overall wealth of a state.
Per capita cap grants, similar in approach to block grants which have been proposed by conservatives for Medicaid funding, would set a permanent limit of Medicaid funding for each person enrolled that is only adjusted for inflation and population. Without legislation protecting blind, aged and affirmed populations on Medicaid, states would then have to make Medicaid spending decisions based on the entire pool of applicants.
"A state would have to decide if it will continue paying the same rates at 138 percent of the federal poverty level without the same reimbursement," Pugel said. "If they do, that will mean cuts. The first thing to go will probably be in-home health services, since nursing home funding is mandatory."
"There is definitely a fear of the unknown among the industry and our patients," Conley said. "Medicaid has already been underfunded with rural areas being hit the hardest. With huge cuts, I couldn't imagine some facilities staying open."
Long-term care facilities like Hillcrest currently receive
Conley said administrators have already been briefed on what a per capita cap grant would mean for residents in their care. He said they are expecting a 20 percent reduction in funding, or about
Conley, whose grandmother lives at Hillcrest, said it seems impossible to continue caring for residents at the current level after such cuts.
"You can't cut that much cost out and still operate," Conley said. "Buildings would have to close, hundreds of people would have to be laid off and some communities would be without options."
Signature HealthCARE currently employees over 10,000 people across the country. Conley said destabilizing care facilities could have economic and employment effects as well.
After care facilities adjust to Medicaid cuts, the availability of care could look much differently for rural and underserved communities. Nearly one-half of Kentuckians live in rural areas, higher than the national average of 19 percent, according to a 2017 study from the
Conley said 67 percent of the residents at Hillcrest are there through Medicaid, mirroring the 67 percent of
Conley said he often sees the effects on families weaving through bureaucracy to find aid for their loved ones. He said if a precedent is set to use Medicaid cuts as a way to meet financial outcomes, those effects will be even harder.
"There are daily stresses of care and a lot of personal burden that people deal with while seeking approval for their family," Conley said. "I don't think people understand how painful it can be. We know healthcare is going to change; we just hope they aren't leaning on us for the change."
Boone still visits her sister in the nursing home and greets residents at every chance as she walks through the hallway. She said she never thought her sister would need it but, much like their mom, she doesn't see how people could survive without the help.
Boone said if she and her family hadn't been able to enroll her mom in Medicaid, she would have had to take a leave from work; something she said very few Americans can afford to do. A family member would have had to stay up around the clock to assist her mom due to her dementia and intensive care needs.
"Without Medicaid, I can't fathom what would happen to some people," Boone said. "We would have tried to make it work; we would have found a way. But some people don't have any family. My heart goes out to them."
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