State to study Medicaid funding methodology

April 03-- Apr. 3--GOSHEN -- State Sens. James Skoufis and Jen Metzger celebrated the state delaying a proposed change in a Medicaid disbursement funding methodology that could lead to cuts for nursing homes.

Skoufis and Metzger stood outside the Valley View Center for Nursing Care and Rehabilitation in the Town of Goshen on Tuesday, making it a symbol of the potential cuts.

The proposed state budget package unveiled Monday did not include the Medicaid funding formula change. A state Department of Health commissioner-appointed study group, including nursing home administrators, will now examine whether and how to tweak the funding methodology, reporting results by July 1.

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 $246 million statewide.

Orange County-owned Valley View could have immediately lost up $4 million if the funding methodology change was not delayed.

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 New York and they already don't have enough" Medicaid funding.

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 Dan Heim, executive vice president at LeadingAge NY a trade group representing nonprofit and government-owned geriatric-care providers.

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 Laurence LaDue. "It's going to come down to how the state's finances are next budget season."

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