Articles Posted in Medicaid and Nursing Homes

the american rescue plan nursing homes

Justice in Aging: How The American Rescue Plan Helps Older Adults

More than 45% of Americans over 65 have trouble meeting their basic needs. As a new administration works to provide COVID-19 relief to older adults, many of who are reliant on Medicaid funding for their health care, including long-term care, a fifth COVID-19 relief package, the American Rescue Plan (H.R. 1319), was signed into law totaling $1.9 trillion on Mar. 11, 2021.

The law is expected to significantly improve health care access and increase economic security for older adults due to the pandemic. Medicaid is the funder for most long-term care in the United States, whether at home or in an institution. An analysis provided by Justice in Aging, an organization committed to fighting senior poverty through the law, outlines the significant provisions impacting older adults, including Illinois nursing home residents and long-term care patients.

dehydration in nursing homes

March is National Nutrition Month – Nursing Home Negligence Can Lead to Malnutrition and Dehydration

In long-term care and post-acute care settings, malnutrition is often a result of ongoing neglect by caretakers who do not offer enough food or do not monitor proper nutrient consumption either by the mouth or a feeding device. And although delivering nutritious food, adequate amounts of water, and quality care to these individuals seems like basic necessities all facilities should provide, a staggering 85% of elderly living in nursing home-type environments suffer from malnutrition.

According to the Academy of Nutrition and Dietetics:

inspecting illinois nursing homes

Nursing Homes Cited for Mistreatment Are Flagged with Special Icon on Government Website

In 2019, the Centers for Medicare and Medicaid Service’s (CMS) Five-Star Quality Rating System via The Nursing Home Compare website added a new tool to help better identify elder-care facilities with extreme and troublesome care failures. When visiting the site, the most troubled homes, many with only a one-star rating, also display a red circle with a white hand inside. The stop-sign-like icon can be used as a way to warn families of long-term care facilities currently in non-compliance and those with a documented struggle to meet Federal and state quality care measures.

These facilities meet the following criteria:

medicaid nursing home patients

Hole torn in a dollar bill with medicaid text

Nursing Home Residents on Medicaid Suffer Most 

Most whose financial situation would be characterized as low income and need to remain in a nursing home for longer than expected, Medicaid will quickly become the primary payer for their long-term care. Designed as a public assistance program for individuals with limited financial support, Medicaid funds a person’s physician visits, hospital, and long-term care, drugs, medical equipment and transportation, and other medical services.

retirement home

Nursing Homes With “No Harm” Deficiencies Are Not Being Held Accountable

Nationwide, a majority of nursing homes voluntarily participate in the Medicare and Medicaid programs. Because of this partnership, facilities must adhere to minimum standards of care established by the federal Nursing Home Reform Law. Those who do not comply, should receive health violations leading to various penalties including fines or in some of the most severe cases, a group’s Medicare or Medicaid certification will be suspended or revoked by the Centers for Medicare & Medicaid Services (CMS), a part of the Department of Health and Human Services (HHS).

CMS data indicates that about 95 percent of these health violations are cited as causing “no harm” to residents. In a May 2019 newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition (LTCCC) several examples of these “no harm” deficiencies, taken from Statements of Deficiencies (SoDs) on Nursing Home Compare, were discussed. Surveyors classified all of the shortcomings listed below as “no harm,” meaning that they determined that residents were neither hurt nor put into immediate jeopardy for their health or well-being.

healthcare fraud

Miami-Dade Nursing Home Owner Convicted in Largest U.S. Healthcare Fraud Scheme

Just last week, a 12-person jury deliberated for four days before finding Philip Esformes, a 50-year-old entrepreneur and owner of a network of 16 nursing homes and assisted living facilities in Florida, guilty on 20 out of 26 charges related to healthcare fraud. This is believed to be the largest fraud scheme ever charged by the U.S. Justice Department and a reflection of the business owner’s greed through receiving kickbacks, money laundering and conspiracy to commit federal program bribery totaling $37 million. In an April 5th, 2019 public statement, prosecutors called him a “despicable,” “vampire” who was fueled by “unbounded greed.”

“Esformes exploited and victimized patients by providing inadequate medical care and poor conditions in his nursing homes. We will continue the fight against such parasites.”

Our state has already had its hand slapped over delayed Medicaid payments and history has just repeated itself. Earlier this month, a judge ruled that Illinois was responsible for delinquent Medicaid application approvals and is allowing seniors who faced delays to sue the state. Seniors who applied for Medicaid after February 1, 2015, who were eligible for the program according to state requirements, and whose care was denied or hindered as a result of a delayed final eligibility determination can pursue action. According to the Centers for Medicare & Medicaid Services (CMS), states have 45 days to process and respond to a Medicaid application. Illinois has 90 days to process Medicaid applications that involve a disability. Many seniors have reported facing delays far greater than 45 days, even after submitting all necessary paperwork.

As a result of delayed approvals, nursing homes have had to discharge current residents and turn away potential residents. Seniors have also reported not being able to receive the care they need, missing out on crucial healthcare, drugs, and services.

Illinois: A Repeat Medicaid Offender

Reducing Medicaid fraud and waste has been a talking point among many administrations, but with recent reports that 10% of Medicaid payments last year contained an error, several government offices are ready to take action. A meeting between the House Oversight Committee’s Subcommittee on Government Operations and the Subcommittee on Intergovernmental Affairs was planned for this past Wednesday and then cancelled. It was expected that lawmakers from both sides of the table would offer suggestions for reducing waste within the program.  No future meeting date has been announced.

Medicaid Recipients Fearful of Losing Benefits

It’s estimated that fraud and erroneous payments in all public assistance programs cost federal and state governments nearly $140 billion in 2015. Medicaid is considered particularly vulnerable to fraud because there are so many parties involved in the administration of the program. Each state is tasked with day-to-day management of Medicaid, but there are also managed care companies and companies they subcontract with to offer plans. It’s hard for states to police all of the groups involved, making Medicaid a relatively easy area for things to slip between the cracks.

A major nursing home chain with locations in Aurora, Rockford, and Dixon, Illinois is in the middle of a $60 million lawsuit brought by the U.S. government. The lawsuit alleges that Meridian Senior Living Group (some former Meridian facilities are now owned by Affinity Living Group) submitted at least that amount in false billings to North Carolina’s Medicaid program for services provided in their facilities’ Special Care Units. These units are intended to treat specialized conditions within long term care facilities and nursing homes. The lawsuit names 45 separate Meridian facilities in North Carolina, Meridian’s owner, and their management and billing departments. As a combined entity, Meridian and Affinity operate the most adult care facilities in the state of North Carolina and are one of the top 10 largest adult living networks in the country.

Scam: Too Few Staff for High Billable Care Hours

Information about the scheme was brought forward by a whistleblower who was aware that the submitted claims to Medicaid were purposely overstated to reflect more frequent and extended periods of care than were actually provided. Among other allegations, the whistleblower alleges that the number of staff to the number of residents could never provide for the amount of 1:1 care for which Meridian Senior Living facilities billed. The facilities are accused of charging Medicaid for 1.5 – 1.75 more hours on average than a staff member actually spent with a resident. The lawsuit also alleges that Meridian would bill the maximum allowed per month, regardless of the release date or the date on which a resident was given a diagnosis, a requirement for allowing certain charges to be submitted and reimbursed by Medicaid.

As congress continues working on the American Health Care Act (AHCA), the bill that will repeal and replace the Affordable Care Act (Obamacare), one of the main issues at hand is a cap on federal contributions to state Medicare & Medicaid budgets. A cut or cap on Medicaid would be tragic for millions of Americans who rely on it to receive long term care.

The National Consumer Voice, an elder advocacy group, cites many reasons why capping medicaid spending would be detrimental. Most notably, the group points out that Medicaid is the only way most elderly Americans can afford a nursing home or long term care. With the average annual cost of nursing home services nearing $84,000, many of America’s elderly can simply not pay for their own care. Medicare covers medically required care in a skilled nursing facility, but the majority of Americans only require custodial care, which includes tasks such as bathing, getting dressed and learning to take medications.

National Consumer Voice also notes that Medicaid helps the elderly stay in their own homes by allowing them access to home health providers that can assist with custodial care.

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