En español | Two decisions by the Florida legislature to slash nearly $188 million from Medicaid nursing home funding and to reduce minimum staffing standards for direct care mean tens of thousands of vulnerable nursing home residents will receive less assistance.
See also: Will Medicaid pay nursing home costs?
The staffing changes surfaced on a take-it-or-leave-it basis the night before the legislative session ended earlier this year.
The cut in nursing home funding reduced anticipated spending by 6.5 percent for the year that began July 1 — a level less than was spent the previous year. Legislation also reduced the minimum amount of time a nursing home resident must receive one-on-one care. The change shaves 18 minutes off the required direct daily skilled nursing care, cutting the minimum to 3 hours 36 minutes.
The legislature also voted to force almost all Medicaid beneficiaries in Florida to be covered by managed care plans.
In another blow, the Joint Legislative Budget Commission rejected a $35.7 million, five-year federal grant designed to help move Medicaid-eligible nursing home residents to assisted living or home care facilities, which cost less than half as much, because the money was part of the federal Affordable Care Act.
The combined impact is that nursing home facilities are likely to reduce staffing levels as a result of the cuts, which means the quality of care received by both Medicaid and private-pay residents could diminish, said Jack McRay, AARP Florida advocacy manager.
"They're going to reduce their staffing, and they're going to continue to charge the private-pay patients the same amount of money," McRay predicted.
"Florida and the nursing-home industry must keep the 'nursing' in nursing homes," he said. "By relaxing state standards for nursing care, the state of Florida has opened a door that could put tens of thousands of very frail, vulnerable Floridians at risk."
Medicaid covers about 41,000 of the 72,000 nursing home residents in Florida.
Emmett Reed, executive director of the Florida Health Care Association, which represents long-term care facilities, said, "Nobody is happy with the budget cuts made by the legislature to nursing home care. We would have preferred legislators maintain the funding and mandated staffing requirements, and, in fact, nursing home employees from across the state were very vocal … advocating for adequate Medicaid funding.
“Good care costs good money; yet the gap between the cost of care and the reimbursement for that care has been growing wider every year," Reed said. He said that nearly 70 percent of the expense of nursing home care comes from personnel costs, and the cuts will mean the "facilities' ability to do their jobs well have become even more challenging."
State Rep. Mark Pafford, a West Palm Beach Democrat, said, "There were some of us who wanted to protect against things like that, but when you have the power like [Republican legislative leaders] do, you can sneak things through."
Democratic legislators and the Florida Medical Association have urged the federal government to reject the move to place all Medicaid beneficiaries into managed care programs. Long-term care recipients will be the first switched to managed care, in July 2012. The federal government has not indicated when it may rule on the lawmakers' request.
Floridians "are not going to be real happy about having a clerk in Nebraska making decisions about long-term care in Florida," said McRay, who noted that the reduction in staff standards would have a ripple effect on the treatment of private-pay residents because nursing homes will try to conform to one set of guidelines. He added that AARP Florida will fight for changes that will benefit nursing home residents and will urge residents and family members to report all incidents of mistreatment and neglect to their legislators.
Also of interest: Moving out of the nursing home. >>
John Van Gieson is a freelance writer living in Tallahassee, Fla.