Worry grows in Missouri over proposed Medicaid cuts, effects on nursing homes, elderly

July 06--Helen Frye, 84, fell and broke her shoulder last year in her rural Missouri home. After that, she and her sons decided it was time for her to move into a nursing home.

She opted to remain close to home and chose to live at Frene Valley of Hermann. Like a majority of older adults across the country, Medicaid pays for her stay.

The Republican Senate bill targeting health care reform has created fear among some Missouri nursing home providers and patients about what will happen if the proposed cuts to Medicaid become a reality. About 89,000 Missourians 65 and older rely on Medicaid to help pay for their long-term care in nursing homes.

"I'd be homeless if I didn't have it," Frye said. "It pays for most of my nursing home care, and I could not afford to pay for the full cost of my care." Frye's Social Security payments defray only a portion of the cost.

Frye isn't alone. Medicaid pays for 63 percent of all nursing home care in the state, according to data from the Missouri Foundation for Health. Medicaid is the government-run health insurance program for the poor.

Even though the Senate delayed a vote on its health care bill because it lacked the necessary votes, it could be taken up again when the Senate resumes work Monday.

And despite the lack of needed votes, worry remains because cutting Medicaid spending is a theme in both the House and Senate health care bills.

The Senate health care bill would reduce Medicaid spending by $772 billion through 2026 and result in 15 million fewer enrollees in the program, according to the non-partisan Congressional Budget Office analysis.

With less federal funding, states would be forced to either assume more of the costs or scale back services.

Many have speculated that the elderly and disabled, who drive a majority of the spending in the program, would be disproportionately targeted in an effort to reduce spending at the state level.

"Even if you cut kids (off Medicaid), you're not going to save that much. Where we're spending the money is on the disabled and elderly," said Ryan Barker, vice president of health policy at the Missouri Foundation for Health. "That's the choice we want to make? Is to cut folks who are elderly and disabled off of Medicaid?"

Nursing home operators such as Eric Doerhoff of St. Charles-based StoneBridge Senior Living worry they'll be forced to close some facilities if Medicaid is cut.

"It would have a pretty significant impact on us," Doerhoff said of the Senate bill. StoneBridge operates 12 nursing homes in Missouri and two in Arkansas.

About 45 percent of StoneBridge patients rely on Medicaid, he said.

It's a real fear that some of these facilities, especially smaller ones, would close, said Nikki Strong, executive vice president of Missouri Health Care Association, the industry group that represents nursing homes.

"They're the economic engine for rural communities," Strong said of nursing homes. She said Missouri's 550 nursing homes employed about 48,000 individuals.

States are also looking to trim Medicaid spending, another concern for patients and providers.

Missouri Gov. Eric Greitens signed off Friday on the state budget, which reduces Medicaid payments to providers by 1.5 percent.

The U.S. has an aging population that has yet to experience the bulk of the baby boomer generation in need of nursing home care, and when that happens, these cuts will have a "devastating" affect, Strong said.

Medicaid payments don't cover the full cost of the care provided in the nursing homes, Doerhoff said. They fall short by about $17 per resident, per day of the total cost of care.

"The population that we serve, they've typically worked all their life, and they have outlived their financial resources," Doerhoff said. Many have spent all that they have left on health care and use Social Security payments to defray the cost of nursing home care, he said.

Frances Coffi, 62, moved her mother, Grace Hayes, 105, into a nursing home four years ago in Marshall, Mo. She worries about the proposed changes to Medicaid and how that may affect her mother's ability to get care.

"I am scared to death because Medicaid picks up the cost of what her Social Security doesn't pay. I really don't know what I'm going to do if they cut those Medicaid services."

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