Nursing homes may be impacted by a health insurer’s decision to cut benefits for 3,500 low-income seniors in California, with the latest extensions for the program going through Dec. 31.
Health Net has announced a cut to assisted living benefits in the state, and leaders in the post-acute sector believe this may lead to resident placements that don’t match their needs, including nursing homes and hospitals. A lot of residents receiving these benefits have dementia or similarly high care needs.
The benefit currently pays for 24-hour services in board-and-care homes, memory care facilities and similar residences. It’s part of the state’s Medicaid overhaul designed to cut down on repeat emergency room visits and expensive hospital stays.
Health Net argued the program brought people from home to assisted living, instead of moving people out of the nursing home and into lower cost settings and has not led to better care for those on the program.
Pauline Shatara, deputy director of California Advocates for Nursing Home Reform, told CalMatters the fallout from the decision is “going to be a disaster.”
New enrollees could have a hard time getting approved for costly long-term care, while others are trying to figure out whether services might stop after Oct. 7 when some provider contracts expire though benefits are supposed to continue through the end of the year.
Either way, families are facing uncertainty. And on the nursing home end, operators are still limiting admissions and reducing services due to reimbursement inadequacy with Medicare Advantage, according to a survey conducted by Skilled Nursing News in June.
Between 2019 and 2024, the number of licensed SNF beds declined modestly, while operating capacity declined by 5%, according to a study published in the National Library of Medicine earlier this year.
Nursing home capacity for new admissions varies wildly based on geographic location, and actual capacity declines were larger when researchers factored in staffing shortages during this time.
Health Net in a statement said members will continue to receive care until their authorization periods end, and then they’ll be moved to nursing homes, in-home care or other programs in the state.
“We are working closely with members, providers and care management teams to develop individualized transition plans based on each member’s clinical needs and eligibility for other available programs and services,” Health Net said in its statement.
The state Department of Health Services will work with Health Net to ensure member protections and continuity of care.
Companies featured in this article:
California Advocates for Nursing Home Reform, CalMatters, Health Net, National Library of Medicine
