Home Care Providers See SNF Medicaid Imbalance

Louisiana nursing homes are getting most of the state’s Medicaid dollars over home care providers, according to a recent story on Business Report.

But that’s not for lack of demand for home care services. The state currently has a backlog of around 31,000 Medicaid applicants for home-based care.

“Across the country, we have had this issue of an imbalance, with dollars going to nursing home care versus care at home,” Warren Hebert, chief executive officer of the Homecare Association of Louisiana, told Business Report. “In Louisiana, we had begun to move toward a more balanced system, but that essentially turned back in the opposite direction a few years ago.”

A Louisiana Legislative Auditor’s Office report cited by Business Report showed payments to the nearly 260 private Medicaid nursing facilities grew 54% between 2006 and 2016. Overall, skilled nursing facilities (SNFs) in Louisiana received $8.7 billion in Medicaid dollars. Occupancy rates climbed by less than 1% during that period, however.

The data mirrors health care spending trends recorded elsewhere in the country. The latest “State Scorecard” report from AARP, the SCAN Foundation and Commonwealth Fund found that, overall, most Medicaid long-term services and supports (LTSS) funding for seniors and adults with physical disabilities went to nursing homes.

Though the data varied widely depending on region, just 10 states spent more on home- and community-based services than on nursing homes, the report found. Louisiana, which ranked near the bottom of the pile for several categories, was also one of the states that showed the most improvement in the percentage of new LTSS users who first received home- and community-based services.

Some nursing home providers have defended the imbalance in funding, however. Mark Berger, executive director of the Louisiana Nursing Home Association, said the increases in Medicaid funding were necessary because of the overall rising cost of care.

“Certainly, as with all professions, the costs to do business for nursing facilities have increased over the past 10 years,” Berger told Business Report in a statement. “However, the nursing facility program has grown at a slower pace than the total Medicaid program for the same time frame.”

Solving the problem

Louisiana is taking some steps toward trimming the state’s home-based care backlog. Michelle Alletto, the Louisiana Department of Health’s deputy secretary, has vowed to more effectively clamp down on nursing homes for inaccurate Medicaid cost reporting. Another plan is to hold audits more frequently.

Additionally, state legislators have singled out home health care as an area needing improvement. Last year, the Louisiana House of Representatives supported legislation aimed at fostering special arrangements between state Medicaid programs and managed care plans, where managed care plans would get capitated payments for home-based services.

Such arrangements could improve the quality of long-term services and supports and possibly boost quality for all long-term services at the same time, Louisiana AARP Director of Advocacy Andrew Muhl told Business Report.

Written by Tim Regan