Guest Columnist

Funding for skilled nursing needs to be a priority

Stethoscopes hang in the hallway of a Cedar Rapids clinic on May 10, 2017. (Rebecca F. Miller/The Gazette)
Stethoscopes hang in the hallway of a Cedar Rapids clinic on May 10, 2017. (Rebecca F. Miller/The Gazette)

Virtually every Iowan will be touched by the need for long-term care at some point in their lifetime. As we or a loved one ages or faces complex medical challenges, the necessity of access to an effective long-term care system affects us all. Iowa skilled nursing facilities provided more than 8.5 million days of care for Iowans last year, despite extraordinary financial challenges facing the sector related to Medicaid funding shortfalls.

Continued access to long-term care is increasingly important. Iowans are living longer. In fact, Iowans are living an average of 80 years, which is higher than the national average. The gift of more time with our loved ones compels us all to ensure that we maintain a system of care to support our fellow citizens when they need care, and where they need it.

One in every two residents of a skilled nursing facility in Iowa is on Medicaid. As the Legislature gavels into session in 2019, skilled nursing facility Medicaid funding faces a state funding shortfall of $54.9 million. Think that doesn’t apply to you? Not so fast.

The increasing life expectancy of Iowans means most nursing facility patients on Medicaid enter the program later in life after outliving their savings. Today, Medicaid is not fully covering the cost of skilled nursing care of an Iowan on Medicaid. Medicaid payment for care falls short $16,000 per patient, per year.

This shortfall affects patients who are paying their own way, often in the form of higher daily rates. The remaining loss is borne by the facility, a trend that has turned the skilled nursing facility sector upside down financially in recent years. The Iowa Health Care Association projects that without addressing the shortfall, skilled nursing facilities in Iowa can expect to be reimbursed at 2012 levels for patient care. It’s a trend that’s not at all sustainable.

An increase in nursing facility Medicaid rates in 2019 is critical to ensuring Iowans continue to have access to the long-term care they need. Forestalling the full funding of nursing facility Medicaid offers an alternative future Iowans don’t want. A glance around the neighborhood is instructive. In five nearby states facing their own Medicaid funding shortfalls, nearly 100 nursing facilities closed or went bankrupt just last year. Seventeen nursing facilities in South Dakota entered state receivership, and three more closed. Twenty-one nursing facilities in Nebraska went bankrupt and three closed. The state of Kansas was forced to take over 21 struggling nursing facilities. In Wisconsin, where sixteen nursing facilities have closed since 2015, 33 more facilities entered receivership last year.

We can do better in Iowa for some of our most vulnerable citizens, and we must do it now. Medicaid funding for skilled nursing facility care must be a priority this legislative session. We look forward to the very necessary discussion with the Legislature and the governor on a topic that touches the lives of every Iowan.

• Brent Willett is president and CEO of the Iowa Health Care Association.

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