State to study Medicaid funding methodology
Skoufis and Metzger stood outside the
The proposed state budget package unveiled Monday did not include the Medicaid funding formula change. A state
Skoufis and Metzger said they lobbied to have the issue studied, rather than make immediate cuts based on a retroactive Medicaid funding methodology change. The DOH had pegged the combined state Medicaid nursing home rate reductions, and reductions to accompanying federal matching funds, at
The state DOH and the governor's office want to revise methods behind nursing homes' Medicaid reimbursement scoring system, known as their acuity case-mix index. Currently, the state asks nursing homes to score and average the acuity or severity of their residents' health levels at scheduled times. Nursing homes with sicker populations receive higher reimbursements.
Now, the state wants to examine the method by which nursing homes gauge the health of their populations to produce more accurate, consistent data. State officials are concerned over large variations in nursing homes' acuity scores, and facilities reporting significantly sicker populations over the last three years.
"If it's true that there are nursing homes massaging their data" for higher reimbursements "we'd want that addressed," Metzger said. "But nursing homes are struggling in
The state's nursing home administrators need more information and time to examine it and a chance to offer feedback on potentially changing a Medicaid funding methodology in place since 2012, said
Heim said that Medicaid payments, which cover the bulk of nursing homes' caseloads instead of more generous private pay and Medicare reimbursements, don't cover nursing homes' costs and they're not indexed to inflation. So, he added, the state's current formula must be designed to allow nursing homes to get fairer Medicaid reimbursements, which he says are already too low.
Whether Medicaid cuts for nursing homes still occur "is up in the air," said Valley View Administrator
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