Medi-Cal Regulations Disregard Cost, Necessity of Nursing Home Care
Medi-Cal sends many seniors to nursing homes although they do not require the full-time, skilled care offered at such facilities and could receive care elsewhere for "a fraction of the more than $43,000 [per person] per year the government pays to reimburse nursing homes," the San Francisco Chronicle reports. According to the Little Hoover Commission, one-third of California nursing home patients -- about 20,000 residents -- could be moved to facilities that help residents with tasks such as bathing, grooming, toiletry and eating but do not offer extensive medical care. The Health and Human Services Agency issued a report five years ago that stated, "Long-term care in California traditionally has been biased toward institutional care using a medical model, largely in response to the public reimbursement available for institutional care. This tendency can result in care that is both more restrictive and more expensive than necessary."
Alternative facilities, including board-and-care homes and assisted-living apartments, cost between $18,000 and $30,000 annually per resident for care, the Chronicle reports. More than 20 years ago, the federal government said that states could apply for waivers to use Medicaid funds for less costly long-term care options; 30 states have established pilot programs to test alternative care programs. According to a California HealthCare Foundation report, when states expand coverage to nursing home alternatives, they save money and are able to increase the number of beneficiaries they cover. According to the Chronicle, state officials recently approved a pilot program to test alternative care options among 500 to 1,000 people. Results of the program are not expected for three to five years.
The criteria for long-term care options that HHSA is considering are "so wildly inappropriate that [new regulations] will bar more than 90% of board-and-care homes from participating," the Chronicle reports. For example, to qualify for Medi-Cal reimbursement, a room would have to be private, have its own bathroom and be equipped with a kitchenette -- "conditions that are far more luxurious than even private paying residents typically can afford," according to the Chronicle. Stan Rosenstein, deputy director of Medical Care Services for the Department of Health Services, said that the criteria are only proposals submitted by a private contractor and that the state may revise them (Haddock, San Francisco Chronicle, 8/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.