Medicaid cuts create crisis for seniors

The writer is a former director of the Nebraska Department of Health and Human Services and a former state treasurer. He is president of Rural Health Development, which manages Hillcrest Nursing Home. This opinion first appeared in the Omaha World-Herald.

On any one day, there are approximately 10,000 people in Nebraska nursing facilities, and 6,000 of those residents are on Medicaid. These Medicaid seniors, for the most part, are people in their 80s and 90s, and inflation has outpaced their income. These are the same people who built Nebraska. It has become necessary to educate Nebraska about the way these nursing facilities are being treated by the current Department of Health and Human Services.

Medicaid rates have historically been less than a nursing facility’s cost of providing care; however, this difference has grown dramatically during the last two years. The Medicaid rate paid from July 1, 2017, to June 30, 2018, was 2.65 percent less than the facility’s cost of providing care to Medicaid beneficiaries of two years prior.

Think that’s crazy? The Medicaid rate paid from July 1, 2018, to June 30, 2019, is 7.17 percent less than the facility’s cost of providing care of two years prior. How does a facility survive? First, it must charge its private-pay residents significantly more than their share of the cost increases, and then the facility must use up its savings (if it has any.)

We cannot go to our vendors and say, “we are going to pay you 10 percent less than what we paid you two years ago.” Our employee health insurance has gone up 8 percent to 15 percent per year for the last several years. Food costs and medical supply costs continue to rise. Many facilities have been forced to pay agencies to fill shifts for nursing personnel, and this is very expensive.

So how can HHS officials justify reducing Medicaid rates? They either do not understand or don’t care. The number of Medicaid days paid to nursing facilities over the last several years has steadily decreased. If HHS overestimates the number of days needing to be paid, it can then put a spin on the situation to “justify” the rate reduction.

As president of a small company that manages 20 nursing facilities for small rural communities, I become very upset when we cannot give our nurse aides (many are single moms) modest salary increases because HHS reduces the Medicaid resident rates.

We need Nebraskans to understand and advocate for our seniors. We need the governor to make our seniors a priority. We know many of our state senators are working hard at getting the Medicaid beneficiaries a fair rate. If something is not done soon, more and more facilities will be closing.

When this happens, the area nursing homes will admit only private pay residents, and the Medicaid residents will be forced to move many miles away.