Pa. nursing homes could be hit with wider swings in Medicaid rates starting next month
An industry trade group said the volatility, hitting as nursing homes face stricter staffing regulations on July 1, could jeopardize care at some facilities.
Pennsylvania’s Medicaid regulators last week issued a notice warning nursing homes of unusual swings in their payment rates for the coming year.
Pennsylvania Department of Human Services officials provided no details, but an Inquirer analysis showed that twice as many nursing homes as last year are facing a cut of 5% or more in their daily Medicaid rate.
On the other end, less than half as many as last year could see their rates go up by 5% or more, according to rates published Saturday by the Pennsylvania Department of Human Services.
The volatility comes right as new staffing requirements take effect. Beginning Saturday, the state’s nursing homes must start fulfilling staffing ratios for the first time. For example, the new Department of Health regulations require one nurse aide for every 12 residents during day shifts. Next July, the ratio goes down to 10 residents per nurse aid during day shifts.
The new Medicaid rates causing concern among DHS officials are not final. State lawmakers still have to agree to a budget for fiscal 2024, and federal regulators have to approve the rates.
Meanwhile, industry representatives are worried that some nursing homes might not survive significant cuts.
COVID’s aftermath affecting rates
DHS calculates the rates using a formula required by state law. The General Assembly would have to come up with a fix for the new rates, and Gov. Josh Shapiro would have to approve it.
“There is only so much money allocated to support the care of individuals that cannot otherwise afford it on their own,” said Eric Heisler, a spokesperson for the Pennsylvania Health Care Association, a trade group of long-term care facilities. Increases to some facilities result in decreases to others because the changes must net out to zero, he said, creating winners and losers.
Regulators cite the aftermath of COVID as a big factor in the rate turmoil. A full year of COVID-19 expenses was included in the new calculation, which is based on three years of audited cost reports. The most recent reports included the rates from calendar year 2020 and the fiscal year that ended June 20, 2021, according to the nursing home trade group.
The midpoint for what Medicaid would pay Pennsylvania’s 591 nursing homes that accept Medicaid is $234.77 a day. After lawmakers approve the state budget, DHS will adjust that figure based on the amount of money appropriated for nursing homes.