CBC Members Express Urgent Need to Pass Extension of Emergency Medicaid Relief

 

CBC Members Express Urgent Need to Pass Extension of Emergency Medicaid Relief

Concern Expressed About New Study Suggesting African-American Seniors More Likely to Face Problems Accessing Quality Nursing Home Care as State Budget Crisis, Recession Continue

 

Washington, DC – With states facing an unprecedented ch allenge meeting their obligation to adequately support Medicaid-financed care for America’s frail, elderly and disabled – and now compounded by Congress’s failure to pass a critical extension of Medicaid (FMAP) relief to states – a new non-partisan health policy study suggests that deteriorating Medicaid rate levels across the nation disproportionately impact the ability of African-Americans to sustain ongoing access to quality nursing home care. 

 

Commenting on the research, Rep resentative Edolphus “Ed” Towns, (NY-10, D-NY) warned: “Besides stressing why it is essential to pass emergency Medicaid relief, it is important to express the urgent need to head off any systemic trend towards a two-tiered system of nursing facilities -- whereby the lowest performing facilities provide care to the poorest and most vulnerable populations in rural and inner-city America. That would be an intolerable development, and discussion and action are warranted to ensure equal access to care for every American.”

 

The research findings, outlined at a Capitol Hill briefing, are published in the new edition of Care Context, an Alliance for Quality Nursing Home Care policy discussion series created with analytic support from Avalere Health, a non-partisan healthcare advisory firm. The new study, entitled “Medicaid Support for Nursing Facility Care: At a Crossroads,” details the fact forty percent of all minority skilled nursing facility residents live in facilities with large Medicaid populations. Further, the study illustrates geographical strains, and facilities classified as lower-tier, based on resources and Medicaid resident population, are more prevalent in the south and east (See Map): Louisiana, Mississippi and Georgia have the highest percentage of resource-poor facilities (>36.63%). States with the second highest percentage of resource-poor facilities (12.03% -- 23.18%) include Texas, Arkansas, Illinois, Kentucky, Tennessee, North Carolina, South Carolina, West Virginia, Pennsylvania, New Jersey, New York, Massachusetts and New Hampshire. 

 

Ellen Lukens, a Director at Avalere Health, and lead author of the analysis (http://www.aqnhc.org) pointed out that while patient acuity is rising and skilled nursing facility payment rates are falling relative to the cost of care, research increasingly points to the important relationship between Medicaid rate levels and quality. “Where rates are relatively high, many nursing homes perform better on key outcome measures, such as hospitalization rates,” she said. “Medicaid rates have implications for residents’ care, particularly in those facilities with high Medicaid concentrations where there is limited opportunity to cross-subsidize with funding from other payers – such as Medicare or private payments. Where there is limited ability to cross-subsidize due to a high concentration of Medicaid residents, facilities may perform more poorly on quality metrics,” she explained. 

 

Prominent Harvard University health care researcher David Grabowski has observed that “quality of nursing home care may suffer if budget shortfalls force state legislatures to freeze or reduce nursing home rates” and the new Care Context points out that “facilities with fewer resources may be driven out of business, which will disproportionately affect non-white residents living in poor communities.”

 

According to the study, facilities classified as lower-tier based on resources and Medicaid resident population are more prevalent in the south and east:

Percentage of Facilities Classified as Resource-Poor, by State, 2000

Source: Vincent Mor, et al. Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care. Milbank Quarterly 82(2). 2004. 

In addition to the facts surrounding equal access to quality eldercare, the Care Context policy document prompts additional questions for policymakers to consider:

 

  • Given compelling evidence that Medicaid rates have a direct impact on staffing levels and quality outcomes, to what extent should a federal standard exist mandating appropriate levels of Medicaid funding to support the actual cost of providing quality care? 
  • What initiatives should be undertaken to coordinate payments and care for beneficiaries dually eligible for Medicare and Medicaid? Should policymakers consider the benefits and limitations of a single, Federal funding stream for these beneficiaries?
  • Do policymakers envision a continuing role for institutions in serving individuals with long-term care needs?  If so, what is the most appropriate role and how can the service setting be adequately funded to ensure the well-being of our country’s most vulnerable citizens?  

 

 

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