Nursing homes in Wisconsin are blaming the state’s low Medicaid reimbursements for a wave of nursing home closures and persistent financial struggles, Wisconsin Public Radio reported earlier this month.

Nursing home advocates are asking lawmakers in the state to invest $83.5 million in the next two-year budget as a result, the media organization reported. The state has seen 27 skilled nursing facilities shut down since 2016, including eight facilities whose closures have been announced this year, Wisconsin Health Care Association president and CEO John Vander Meer told Wisconsin Public Radio.

The Wisconsin Health Care Association is the state affiliate of the American Health Care Association (AHCA), a trade group that represents for-profit nursing homes.

The Badger State had the second-highest losses for Medicaid reimbursement, at least out of the 28 states that participated in a 2018 report compiled for AHCA, Vander Meer told the outlet. For every Medicaid resident served, SNFs lose more than $70 per day, he said. The estimates of losses by facilities are based on cost reports audited by the Wisconsin Department of Health Services, he added.

AHCA found that based on the projected cost of care in 2017, Wisconsin facilities lost $63.71 per day to care for Medicaid-eligible residents, though it said actual losses were likely higher, according to Wisconsin Public radio.

LeadingAge Wisconsin, which represents non-profit senior living and care providers in the state, reported an average loss of $78.58 per day per Medicaid resident from 2017 to 2018, Wisconsin Public Radio reported.

Workforce challenges are also plaguing nursing facilities in the state, nursing home executives told the outlet. A report released by health care trade groups that included Wisconsin Health Care Association, the Wisconsin Assisted Living Association, and LeadingAge Wisconsin found almost 20% of caregiver positions in the state go unfilled.

Low reimbursement rates factor into that shortage as well, the report indicated, as providers don’t have the budget to increase wages in a competitive market with low unemployment.

“Sometimes we lose people because they’ll go to a convenience store or make money in that fashion rather than a dedicated nursing job,” Bayfield County supervisor Jeff Silbert told Wisconsin Public Radio. “If we were able to get full Medicaid reimbursement for what it actually costs, we could pay staff more and it would be a better situation all the way around.”

The Wisconsin Department of Health Services indicated in its two-year budget request that it expects revenue from nursing home expenditures will drop from $44.1 million in fiscal 2018 to $29.4 million in fiscal 2021, because of declining patient days and county nursing home closures, Wisconsin Public Radio reported.