Medicaid Cutbacks Threaten Nursing Home Residents in Texas
Recently Cariloop has been working to help a significant number of families looking for a new home for loved ones who are currently living in a skilled nursing facility. If you or someone you know are supporting a loved one in a nursing home or anticipate a loved one needing skilled nursing facility services, please take note of this important information.
Changes taking place in the Texas Medicaid program with a goal of reducing skilled nursing costs have the potential to affect thousands of nursing home residents in the near future.
In an effort to reduce costs, “states are trying to ‘force’ borderline folks… into lower cost care environments by not granting medical necessity which is required to be approved for nursing home Medicaid,” one former nursing home administrator told Cariloop.
In other words, thousands of people may be forced to look elsewhere for care due to Texas Medicaid transitioning nursing home residents to the STAR+PLUS program which will make eligibility for Medicaid in nursing homes harder to meet.
According to the Texas Health and Human Services Commission’s website, individuals with traditional Medicaid coverage living in nursing homes will be moved to the STAR+PLUS program beginning March 1, 2015.
The problem that transitioning to the STAR+PLUS program poses for nursing home residents is STAR+PLUS’s goal to reduce long-term care and nursing facility care costs. The Texas Health and Human Services Commission predicts that expanding the STAR+PLUS program will result in a 15 percent reduction in long-term care and nursing facility costs. Proven to be included in those reductions is patient eligibility for Medicaid coverage in skilled nursing facilities.
Reductions in patient eligibility will only add to the burden that nursing homes have had to bear in light of changes to Medicaid. In 2011, the Texas Medicaid program was forced to cope with $58 million in funding reductions according to the Texas Health Care Association.
An article published by The Houston Chronicle in March of 2011 pointed out just how costly the impact of budget cuts to Medicaid in 2011 had the potential to be. The Chronicle estimated some 60,000 nursing home residents would lose care and 80 percent of the state’s 1,000 plus nursing homes would be threatened by the cuts.
The new cost reduction initiatives included in the implementation of STAR+PLUS may result in a similar fate for nursing homes and their residents. A survey conducted by the Texas Health Care Association regarding the impact the funding squeeze is having on nursing facilities found that 82 percent of facilities may have to defer expansions and renovations to help accommodate more patients, 31 percent may be required to lay off the key front line staff responsible for 80 percent of direct patient care, and 18 percent of nursing homes said they may even be forced to consider closing their facility.
What does this mean for you?
With STAR+PLUS’s plans to reduce nursing home costs, thousands of nursing home residents run the risk of being denied skilled nursing facility eligibility over the next two years. This means your loved one may need to search for a new home in the near future.
Residential care homes offer similar services to those received in nursing homes, but in a smaller home-like setting. The switch to STAR+PLUS for Medicaid dependents offers a prime opportunity for residential care homes to take in residents who have been displaced from skilled nursing facilities.
“STAR+PLUS’s focus is to keep people out of nursing homes,” Teresa Scoggins, owner of Promiseland Assisted Living and President of Texas Organization of Residential Care Homes, said. “STAR+PLUS seeks to find people that really don’t need skilled nursing care, but need supervision—and that’s what assisted living is for. It’s a much better living environment than what a nursing home is for someone who really doesn’t need skilled nursing care.”
Residential care homes that accept individuals relying on Medicaid through the waiver program are able to provide quality care for seniors in a more cost-effective way. This allows people to receive the appropriate care they need outside of an institutional skilled nursing setting.
“The Star Plus program is a much better program than we’ve had in the past,” Scoggins said. “The reimbursement rates are higher and so it allows people who are in nursing homes for financial reasons rather than skilled nursing needs to move into residential care homes or assisted living homes.”
Cariloop believes residential care homes could be an answer for many of those affected by the changes in Medicaid, and our matchmaking process will help you find a home that fits your specific needs. Please don’t hesitate to contact us if you or a loved one is feeling the effects of the latest changes to Medicaid.