Florida Nursing Home Payment Reimbursement Changes

LeadingAge’s Erwin Bodo, the group’s Medicaid reimbursement specialist, takes issue with Tallahassee’s proposed legislative changes to the way Florida nursing homes get paid for resident care by Medicaid. The proposed change would shift at least $100 million toward larger corporate owned facilities and away from smaller nursing home groups.

Larger chains, such as HCR Manor Care and Consulate, stand to increase their Medicaid revenues by the millions while smaller ‘Mom and Pop’ nursing homes will lose revenues. River Garden Hebrew Home administrator and CEO Martin Goetz told POLITICO Florida on Thursday that the changes take Florida backward and place profits above people. The smaller facility administrator told news sources that the decrease in Medicaid revenues will result in a deterioration in resident care. As we have discussed in other posts on this site, decreased funding results in understaffing and systemic nursing home neglect.

"Floridians and the state Legislature will not tolerate a return to the old days; the oldest and frailest among our people deserve better," said Goetz, a member of LeadingAge Florida, an association that represents smaller community-driven nursing homes.

The Legislature last year directed the state Agency For Health Care Administration to scrap the current cost-based payment methodology and replace it instead with with a prospective payment system that is budget neutral. It must submit its report to the Legislature by Jan. 1.

AHCA shared two simulations on Thursday. Both scenarios include components for direct care, indirect care and operating component.

In all, the state is projected to spend $4.4 billion in long-term care Medicaid costs this year, about $3.9 billion of which is paid to Medicaid prepaid health plans. Florida has a requirement that most Medicaid beneficiaries - including the elderly and those in need of nursing home care - enroll in managed care.

Goetz is troubled not only by the proposed money shift in the simulations but that there's no requirement the nursing homes spend the money on direct patient care. The current payment system, based on costs reports, reimburses nursing homes that spend money on the furtherance of patient care.

Goetz, whose nursing home has received eight "Gold Seal Awards" reserved for Florida's top nursing homes, has vowed to fight the proposal in the Legislature.