LTC Bullet: Perils of Medicaid Wednesday February 3, 1999 Seattle-- A reporter from a prestigious financial planning publication contacted the Center for Long-Term Care Financing yesterday. She asked us to provide evidence that Medicaid nursing home care can be risky for consumers. Some Medicaid planning attorneys had told her that clients they artificially impoverish to qualify for the welfare program do not experience access and quality problems. We thought our readers would appreciate seeing the same evidence of potential Medicaid-related deficiencies gleaned from the gerontological literature that we provided to the reporter. That information follows. If you need complete bibliographical references for any of the quotations cited, the information is available in "The Perils of Medicaid: A New Perspective on Public and Private Long-Term Care Financing," Center for Long-Term Care Financing, Seattle, Washington, 1997, 100+ pages, $23.95 (hard copy), $13.95 (disk) which may be ordered by contacting info@centerltc.com or by calling (206) 447-1340.
ACCESS PROBLEMS "...those most likely to have to wait for nursing home placement are those...financed by Medicaid." (GAO, 1988, p. 22) "...there is a shortage of beds in many nursing home care markets and, under such circumstances, only private patients will have a free choice among nursing homes.... Thus, if beds are occupied in the more desirable homes, Medicaid patients could be forced to choose a home that they would not otherwise have chosen. Private patients, since homes are competing for their business, will tend to have an unconstrained choice among homes." (Nyman, June 1989, p. 210) "Private-pay patients can usually find a nursing home
bed quickly. Waiting lists for Medicaid patients (especially
heavy-care patients), can stretch for several months, even a year
or more. The only opening for a Medicaid patient may be in a
facility that is not convenient to visitors, or "There is strong evidence that Medicaid eligibles face substantially lower access to nursing home services than private payers.... It is not known whether lengthy waits to enter nursing homes threaten the health and well-being of Medicaid eligibles. In any event, many are likely to be forced into care arrangements that are more expensive. Studies suggest that patients receiving long-term care in hospitals while waiting for admission to nursing homes are disproportionately Medicaid eligible." (Reschovsky, 1996, p. 16) "Because the Medicaid approved rate of payment is lower than what the nursing home charges private pay patients, many nursing homes are reluctant to accept Medicaid patients.... Nursing homes are not supposed to discriminate against patients who go on Medicaid. However, some states do allow Medicaid patients to be assigned to a separate wing of the nursing home, or to be discharged to another nursing home if no Medicaid bed is available. If you have to receive acute care in a hospital, the nursing home will keep your Medicaid bed for you for a limited time. If this period expires, the nursing home may not readmit you." (USHC, March 1997, p. 53)
QUALITY PROBLEMS "One reason for poor quality is inadequate and poorly targeted reimbursements by Medicaid/Medicare, which forces some nursing home operators to 'cut corners' on care." (U.S. Congress, 1986, p. vi) "Dissatisfaction with the current medicaid program is high. Not only does the demeaning means test often imply hardship for patients and their spouses, but low reimbursement rates mean that nursing homes frequently resist taking medicaid patients or provide poor care." (Rivlin and Wiener, 1988, p. 203) "One way to interpret the current market outcomes in the nursing home sector is to say that, despite protest to the contrary, state Medicaid programs are acting effectively to buy the services they wish to purchase for Medicaid patients--a limited amount of relatively low-cost care of uncertain quality." (Bishop, 1988, p. 352) "States' efforts to limit the number of beds to control Medicaid costs provide a protective environment for most nursing homes. Operators can have little or no fear that their occupancy will fall or that a new home will try to enter their market even if the quality of care provided is somewhat deficient." (Scanlon, 1988, p. 12) "Facilities can attract as many Medicaid patients as needed
without addressing quality, because Medicaid patients are most
concerned with simply finding a bed. Accordingly, higher-quality "...the proportion of Medicaid recipients is indeed associated
with lower levels of RN staffing and a higher proportion of residents
not toileted ...higher proportions of Medicaid were found EVEN THE MOST RECENT PAST PRESIDENT OF THE NATIONAL ACADEMY OF ELDER LAW ATTORNEYS ACKNOWLEDGES THE PERILS OF MEDICAID: "The escalating cost of the Medicaid program at both the
federal and state levels has caused a significant 'tightening'
of the program, both through legislative change and cutbacks in
coverage. These changes have been heavily focused on the category
of aged persons who need long-term institutional care. At the
federal level this is reflected in the passage of the Medicaid
portions of the Omnibus Budget Reconciliation Act of 1993 (OBRA
93). At the state level, there has been proactive elimination
of Medicaid coverage. Typical items eliminated from Medicaid
nursing home programs in such cutback programs have been eyeglasses,
dentures, hearing aids, and
ACCORDING TO CENTER PRESIDENT STEPHEN MOSES: "Medicaid definitely has its problems. No matter how
hard they try, the nursing homes cannot guarantee access to quality
care when Medicaid pays too little and regulates too much. The
only way America can preserve and improve publicly financed long-term
care is to target it narrowly toward the genuinely needy while
providing ever stronger incentives for everyone else to purchase
private long-term care insurance." |