Home care gains traction

As Connecticut and New York nursing homes absorb cuts in state funding, legislators in Connecticut are making it easier for some seniors to stay out of homes entirely for health services.

Beginning this month, Connecticut reduced co-payments for seniors in the Connecticut Home Care Program for Elders from 15 percent of services received to just 6 percent ”“ an average savings of $90 monthly. Despite budget cuts, the General Assembly increased funding for the program by nearly $10 million.

The legislative action comes as a lawsuit continues against the state by the Connecticut Association of Healthcare Facilities (CAHF). The group argues the state”™s budgeting process for setting Medicaid payments violates federal law, which requires that payments to state nursing facilities be consistent with efficiency, economy, quality and equality of access to care. The group claims Connecticut bases its Medicaid payments instead on budget considerations that have little bearing on the cost of care incurred by nursing homes.

The association also claims that nursing homes in effect are being forced to subsidize the state in its failure to pay its fair share of costs in caring for elderly citizens.
The East Hartford-based trade group represents 110 for-profit nursing homes in the state. The Berlin-based Connecticut Association of Not-for-profit Providers For the Aging has about 130 nursing homes in its membership ranks.

The New York Association of Homes and Services for the Aging has yet to weigh in on the issue of state Medicaid payments sparked by the Connecticut lawsuit, which has won national attention. Gov. David M. Paterson was left with a stack of spending bills to veto heading into the Fourth of July weekend after the state Senate failed to pass a budget with Medicaid payments remaining a contentious issue.

Other states find themselves in similar straits and have found creative compromises. The Health Care Facilities of Maryland this month began paying taxes equal to an extra 2 percent of their revenue per patient, with the money being used to replenish some of the state”™s Medicaid coffers, while creating a “pay for performance” program that will allow some nursing homes to recoup money if they exceed patient care standards.

Connecticut has allocated about 7 percent of its $18.6 billion budget to nursing homes in the most recent fiscal year, or roughly $1.3 billion, for which the federal government will reimburse about half that amount. The state is cutting payment rates by more than $280 million in the next two fiscal years combined, however, which nursing homes say will imperil their financial footing.

In mid-June, U.S. District Judge Peter Dorsey rejected CAHF”™s request for a preliminary injunction that would have forced the state to ante up more immediately, but Dorsey allowed the overall lawsuit to continue. The group subsequently appealed Dorsey”™s decision on the injection to the U.S. Second Circuit Court of Appeals.

“Whether the rate freeze is so drastic that it affords Medicaid patients unequal access to nursing home care is a fact-intensive inquiry that is not appropriate for a motion to dismiss,” Dorsey ruled.

Heading into July, the state ordered Kindred Healthcare Inc. to keep open its Courtland Gardens Healthcare Center nursing home in Stamford, after the Kentucky-based company decided to pull the plug on the home, saying the state”™s Medicaid payments were too low to operate at a profit.

The state Department of Social Services argued Kindred Healthcare had not been sufficiently proactive to cut costs short of closing the entire facility, which lost $3.9 million last year. Kindred Healthcare had been attempting to find a buyer for the home, which includes a ward for residents with Alzheimer”™s disease.