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California nursing homes dodged the 10 percent rate cut hitting doctors and most other Medi-Cal providers approved by the Senate on Friday, angering advocates who hoped to see funding aligned to reward top-notch care.
Nursing homes carved out a deal carried by Assemblyman Bob Blumenfield, D-Van Nuys, that requires them to take a 7.6 percent cut this fiscal year. But those funds – an estimated $400 million – will be given back to them [PDF] by the end of 2012.
The 10 percent rate cut has been proposed this year and in years past for a number of Medi-Cal providers, including hospitals, which are taking a case to the Supreme Court, and doctors, who recently made a high-profile lobbying trip to Washington, D.C., seeking to thwart the cut.
Despite the relative ease with which nursing homes avoided the sharp edge of the budget ax, the trade association representing nursing homes said it still is bracing for possible Medicare cuts to nursing homes or payment delays if the budget is late.
Nancy Reagan, general counsel for the California Association of Health Facilities, said the temporary cuts could mean that a 99-bed nursing home would go without $600,000 before the money is refunded.
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“I don’t see it as a victory,” said Darryl Nixon, director of reimbursement and data systems for the association. “But I see it as recognition of the importance of 24-hour care.”
Advocates for nursing home improvements and home-based care, though, see the funding reimbursement as a defeat.
The budget trailer bill extends by a year a controversial 2004 nursing home funding law known as AB 1629. California Watch reported that even though the bill gave nursing homes an additional $880 million from 2004 to 2008, more than 230 homes either cut staffing or worker pay.
The Schwarzenegger administration responded to the article with a call for quality and accountability reforms. Those include stepped-up fines and inspections to detect understaffing, which are under way.
However, the changes ratified by both legislative branches in recent days delay for a year other reforms, including setting aside 1 percent of nursing home funding that would be sent back in large part to the best-performing facilities.
“There’s no sign that anything is getting any better or that there’s any kind of accountability,” said Michael Connors, an advocate with California Advocates for Nursing Home Reform. “Yet nursing home operators win the lottery again.”
The latest federal government report on U.S. nursing home performance finds “weak” changes in performance for the Golden State.
That report shows that California performs “better than average” in only five categories and “worse” in 14, including pressure sores on short-term-stay patients. California’s rate of long-stay residents who are physically restrained is 8.4 percent, more than double the national average.
Deborah Doctor, a legislative advocate for Disability Rights California, said she was amazed that nursing homes were virtually spared from budget trauma even though home-based care options for the elderly and disabled have been hobbled by cuts.
Adult day health care centers are closing throughout the state and stand to see at least half of their funds cut, she said, and case management for seniors who require assistance has seen little funding improvement in decades.
"I was so shocked," Doctor said of the nursing home budget solution. "I didn’t think I could be shocked anymore after all the years of doing this."
The nursing home budget cut temporarily shaves funding from Medi-Cal, a program for the needy. Of California's approximately 1,100 nursing homes, about 645 get half or more of their funding from Medi-Cal, state data shows.
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