May 24, 2018
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Pay Maine nursing homes in full, but don’t forget real reform for long-term care

Photo illustration by Eric Zelz | BDN
Photo illustration by Eric Zelz | BDN


Lawmakers will confront a difficult reality in the coming weeks: The state has been underpaying its nursing homes for years, and a bill pending before the Legislature’s Health and Human Services Committee would give them a needed raise.

On its own, the issue isn’t one that’s likely to invite partisan division. Few will likely oppose a raise for the state’s 107 nursing homes. They’re paid based on their audited costs from 2005.

In 2011, MaineCare — Maine’s version of Medicaid — paid the homes $29.4 million less than it cost them to care for their residents. To make up the difference, the homes shift the charges to the minority of residents who pay for care from their own assets or whose bills are paid by Medicare.

Cost shifting isn’t fair, and sometimes it isn’t a viable option to help nursing homes stay afloat. That’s why the state needs to fulfill its obligation to the homes that care for Maine’s oldest residents.

MaineCare pays the bills for about two-thirds of Maine’s nursing home residents, and many homes have populations with even greater percentages of MaineCare residents. When that’s the case, nursing homes can’t rely on cost shifting to make up for MaineCare-induced deficits.

That’s the financial reality that caught up with the Atlantic Nursing and Rehabilitation Center in Calais in 2012, forcing the 52-bed facility’s closure and the relocation of its elderly residents to other facilities miles away.

The prospect that other rural nursing homes could shut their doors rightfully inspired lawmakers to act. Now, the legislation pending before the Health and Human Services Committee, LD 1776, takes several needed steps to ensure nursing homes are paid and to, more importantly, ensure Maine’s long-term care system is viable in the future. Lawmakers should approve the bill.

The bill would raise nursing home payment rates by basing them on nursing homes’ audited costs from 2011. Under the bill, the rates would be readjusted every two years to reflect more up-to-date costs.

Importantly, the legislation charges a specially appointed commission with crafting a deliberate plan for long-term care services in Maine that focuses on expanding and improving services that can allow residents to remain in their homes and communities longer.

“If we could reach people earlier with some limited home- and community-based services, we could delay more people going into facilities,” said Brenda Gallant, executive director of Maine’s long-term care ombudsman program.

Nursing homes will always be an important component of long-term care. But services should be available for all those who want to and can remain safely in their homes, be it adult day programming or help from an in-home aide. For taxpayers, those services are substantially cheaper than nursing home care. The federal government has an interest in paying for them through Medicaid.

As it’s currently structured in Maine, however, Medicaid will pick up the bill for virtually unlimited nursing home care while drawing a line on reimbursement for cheaper services that put off or prevent the need for nursing home care.

Maine reduced its number of nursing home beds by about 30 percent in the 1990s and expanded home- and community-based long-term care services. Today, as Maine’s elderly population grows faster than any other age group, the state’s long-term care system needs further review.

Of course, the request for additional funding for nursing homes — $10 million in state money for the approaching fiscal year, which would draw down $16.2 million in federal funds — comes during a year when lawmakers are already trying to fill an $80 million Medicaid-related budget hole. Lawmakers have identified a funding source for the first year of increased payments, meaning the bill has a good chance of sidestepping a protracted budget battle.

Beyond the first year of increased payments, it’s our hope that fair payments for nursing homes are accompanied by a shift in long-term care away from expensive facilities and toward more cost-effective solutions at residents’ homes and in their communities.


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