State officials say Kansas can't keep up with the rising cost of paying for nursing home care for indigent residents. But a new plan to cut Medicaid costs doesn't sit well with a Lawrence consumer advocacy group.
Sybil Schroyer would rather be home, but she's happy enough at the Sterling Heights nursing home at 1800 W. 27th in Lawrence. She's lived there for nearly four years since breaking her hip.
"I like it here," said the 89-year-old widow. "We have enough activities that keep us busy, I wouldn't want to move."
And she certainly wouldn't want to be forced to move.
But Schroyer, like thousands of other nursing home residents in Kansas whose nursing home bills are partially or fully paid by Medicaid, could be forced to move to a different nursing home under provisions of a plan proposed by the Kansas Department of Social and Rehabilitation Services.
For more than a decade federal rules have guaranteed that Medicaid recipients have a right to choose their nursing home.
Medicaid splits the cost of caring for the indigent between the federal and state governments.
Now, in order to cut its escalating Medicaid expenses, SRS officials would like to be exempted from the "freedom of choice" rule.
The proposal has already drawn intense opposition from a Lawrence group that lobbies on behalf of nursing home residents, as well as at least one major industry group.
"I think that SRS is reacting to a very real and serious concern about how we are going to pay for long-term care," said Margaret Farley, executive director of Kansans for Improvement of Nursing Homes, an advocacy group based in Lawrence. "But I think it's a hysterical reaction to that situation."
According to SRS, Medicaid costs for nursing homes have nearly doubled since 1989, up from $121.3 million to $234.9 million in the proposed 1995 budget. Medicaid nursing home costs increased $27.4 million between 1993 and 1994 and are expected to rise another $22.1 million by and 1995.
To cut those costs, SRS has proposed limiting the number of Medicaid-certified beds in Kansas to about 14,500, which represents slightly more than half of all nursing home beds in the state as of Jan. 1. The state currently has about 370 nursing homes, Farley said, with an occupancy rate of about 90 percent. About half of the beds are occupied by Medicaid-eligible patients.
To further contain its costs, SRS wants several other Medicaid rules waived so that it can allocate the limited number of Medicaid beds based on competitive bids.
Currently, nursing homes are reimbursed for Medicaid care based on a uniform statewide fee schedule.
SRS plans to apply sometime in the next several weeks to the federal Health Care Financing Administration for the Medicaid rule waivers.
"The cost of nursing facilities is out of control," said SRS spokesman Tim Hoyt. "It's taking away from other programs that are needed also. We just can't do it anymore."
Who gets to choose?
SRS needs the "freedom of choice" rule waived because it anticipates that some nursing home residents who start out paying for their services will be forced to move to different nursing homes when they run out of money and become eligible for Medicaid. That's because any one nursing home might not have enough Medicaid beds to serve all the Medicaid-eligible people who want to stay at the nursing home.
With the freedom of choice rule waived, SRS could require Medicaid-eligible nursing home patients to move to nursing homes outside their communities if none in their communities have beds available for Medicaid patients.
"There will be plenty of notice to the resident in the nursing home," Hoyt said. "The bidding is going to be done on a regional basis. There won't be any long moves. And we're just not sure there's going to be a lot of people needing to move. We think most nursing homes are going to be interested in this program."
One pressing concern for state officials is an expected explosion of the state's population of senior citizens over the next several decades as baby boomers get older.
"If this is a financial problem for the state at this point of time, just wait 15 years; wait 10 years," said Robert Epps, the Commissioner of Medical Service for SRS.
"This is an area of the state budget that doubles every four to five years, so it is something that the existing state revenue system cannot sustain for the long haul,"
Epps said his agency's proposal will help ease the dependence on nursing homes for long-term care so that when the population of people over 85 does swell, the state will be prepared. Included in the proposal are more home-based services and group living arrangements, which are less expensive to run than nursing homes.
"We have created over the years a long-term care system for the elderly and disabled that is decidedly institutional-based, and we have very little in the way of community and home-based services that would allow for elderly and disabled persons needing long-term care services to stay at home or stay in their community. We've got a dumb system. It's just that simple."
Linda Redford, director of the National Resource Center on Rural Long-Term Care at the Kansas University Medical Center in Kansas City, Kan., agrees that the state has too many nursing home beds.
"On the other hand, I don't think you can cut nursing home beds and not make sure those community-based options are there," Redford said. "You can't leave people with no options."
Redford also has reservations about the state's plan to allocate Medicaid beds based on bids.
"Anytime you're going in for the low-bid process in relation to care, it's a little scary to me," she said
"The incentive here is for you to reduce your services to the residents," said John Grace, president of Kansas Association of Homes for the Aging, an industry group that represents 140 private non-profit nursing homes.
"It's a degrading and dehumanizing proposal. For the state agency that's supposed to be looking out for the poor and the frail elderly, they've turned their backs on the sick and disabled older people," Grace said.
"They've wandered from their mission and we're asking them to withdraw the proposal, to allow for public discussion and public debate about it because it was developed behind the closed doors of SRS. It's not fair to the citizens of this state to try to ram a proposal through without having more public discussion and dialogue."