States are seeing in real time what a federal minimum staffing mandate may cost them, as a disagreement between Connecticut and its nursing homes has come to a head.
The state owes its nursing homes $55 million for staffing requirements imposed between March 2023 and this past January when an enhanced version of the directive was discontinued, according to the state Department of Social Services Commissioner Andrea Barton Reeves.
Reeves had reported the financial situation at the legislature’s Appropriations Committee meeting last week, the CT Mirror reported. However, it’s unclear whether the state would be able to recoup even half of the $55 million through federal Medicaid reimbursements, Reeves told the legislature.
At the heart of the dispute is the state Department of Public Health’s interpretation of the 2021 law which boosted staffing standards for facilities. Much like the federal minimum staffing proposal, the state Department stipulated differentiated time requirements for nurses versus lower-paid nursing aides.
The minimum hours per resident per day was raised from 1.9 hours to 3 hours starting in January 2022 – the state originally wanted the minimum requirement increased to 4.1 hours, but that would have cost the state at least $200 million, according to the nonpartisan Office of Fiscal Analysis.
Late into 2022, it was still unclear how much control the state had over the positions that counted in delivering the minimum standard of care. The state Department of Health in November 2022 specified that 0.84 hours of the 3 hours must be provided by registered nurses (RNs) and at least 2.16 hours be certified nursing aides (CNAs). This requirement took effect March 1, 2023.
The 3-hour policy was withdrawn in whole on Jan. 5, according to Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities. It was replaced with a new policy more in alignment with the 2021 Connecticut Public Act and available state appropriations.
“The main difference is returning to the decades-long Connecticut public health policy allowing for a combined licensed staff and nurse aide staff to meet the 2.17 [hours of] direct care in addition to a separate licensed care requirement of 0.83 [hours],” Barrett said in an email to Skilled Nursing News.
There were warnings from industry officials and others that legislators never intended to manage which staff would fulfill the state mandate. Meanwhile, the temporary directive pushed staffing costs beyond the anticipated $1 million price tag anticipated by legislators, according to the CT Mirror.
The state must reimburse nursing homes for the added costs per Connecticut’s existing Medicaid plan with the federal government, Barrett told the CT Mirror. The association ended up suing the public health department in October 2023, alleging an overreaching departure from existing regulations for nursing homes.
Reeves told legislators she would look into filing with the Centers for Medicare & Medicaid Services (CMS) for funding, since federal Medicaid should still reimburse for about half the costs, reports said.
Still, even if CMS confirms it will administer federal aid to the state, Connecticut is on the hook for at least $27.5 million, that is if CMS covers half of the cost.
The state budget is currently projected to close almost $647 million in the black, the CT Mirror report said, but legislators say an agency can’t advance regulations that cost 40 or 50 times more than what was anticipated.
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Centers for Medicare & Medicaid Services, CMS, Connecticut Association of Health Care Facilities, CT Mirror
