State must budget more for long-term care

The release of Gov. Jay Inslee’s proposed two-year budget brought some grim news for many of our state’s most-vulnerable residents lost in the budgetary shuffle.

While budget components for education, transportation and the climate each warranted their own days, full of a “Roll Out The Barrel” hullabaloo, the long-term care budget was lumped in with funding for prison inmates, invasive weed removal, raw milk inspection and all other budget aspects too unglamorous to celebrate.

The good news was funding of a contract for home care workers, along with a proposed modest increase in Medicaid rates for assisted living facility care — the only long-term care setting to receive two rate reductions in the past five years. As those Medicaid payments are presently as low as $46.51 a day for 24/7 care, meals, and housing, they are easily dwarfed by the estimated daily expenditure of $79.02 for medium security prison inmates.

Nursing home care continues to fare poorly. A March 2013 state study acknowledged it only paid around 86 percent of the costs incurred by its roughly 10,000 Medicaid clients receiving skilled nursing care. The same study noted Washington’s patient care needs exceeded that of other states studied, including California and Oregon. Thus, our patients are especially frail; over 59 perecent need assistance with four or more activities of daily living. Yet their funding pales compared to, say, Oregon, which has a daily Medicaid rate more than $58 higher.

For years Washington has ignored care costs through various gimmicks, including keeping 2007 as the cost reimbursement year. The effects are plain to see: A 73-bed facility in Lakewood in Pierce County forced to close due to poor reimbursement had a Medicaid payment $52,744.12 short of its costs (including a union contract) in September alone.

The state study blithely suggested Medicaid payment shortfalls “possibly require facilities to increase rates for private pay residents.” Apart from its obvious inequity, this suggestion suffers from economic unreality: Over 60 percent of nursing home patients are on Medicaid, with perhaps another tenth on Medicare; there are not many private-paying patients. Of the 73 beds at the closing Lakewood facility as many as 56 were occupied by Medicaid patients last year. Displaced patients, most too infirm to manage their own affairs, spent the Christmas season hoping for new homes.

Gov. Inslee’s budget would use 2013 as the cost year (through 2017). That sounds like a real improvement. But such a “rebase,” in a system artfully designed to avoid paying costs, actually results in a decrease for many facilities that cut to the bone and triaged their way to 2013. Further, the 2015 obligation, under the Affordable Care Act, to provide health insurance to workers of almost every nursing home will not be reflected whatsoever in an ACA-celebrating state’s “reimbursement” of Medicaid cost.

The proposed budget deepens the mystery of what has happened to revenue derived from a “safety net assessment” nursing homes pay to support sustainable Medicaid rates. Is it invested in some new state initiative? Compounding the mystery, the budget garnishes another $8.2 million from patients for investigations — the state again trying to enforce quality instead of funding it.

Legislators must build upon what Gov. Inslee has proposed lest more misery be created through facility closures and the displacement of vulnerable Washingtonians and their caregivers.

Brendan Williams is an Olympia attorney and long-term care advocate and was a former 22nd District state representative from 2005-11.