Even though the General Assembly has closed up for the year and its members have gone home, locally hospitals and nursing homes are waiting to see how they will be impacted by the cuts made to the Medicaid program.
"We know there will be cuts. We just don't know where those cuts will be allocated," said Don Harris, Inova Health System, vice president for government relations.
Harris said even though the Assembly has reduced the funding, the actual allocation of those cuts is determined by the governor and won't be known until May or early June. Catherine Weatherby, a spokesperson for the county's Department of Family Services, which assesses whether someone is eligible for Medicaid, also said they will not know the impact of the cuts until the budget takes effect July 1.
Nursing homes, by contrast, already know they will be feeling a pinch when the budget takes effect July 1.
"Before this General Assembly session, nursing homes were losing $12 per day per Medicaid patient. Beginning July with the FY ‘03 budget, they will be losing $18 per day per patient, and if no amendments are made in 2004, it will be $21 per day per patient," said Steve Morrisette, president of the Virginia Health Care Association.
According to the Fairfax County Government's official Web site, the county's Department of Family Services estimated there were 19,500 Medicaid cases, including residents in the cities of Fairfax and Falls Church. The figures do not include the estimated 2,692 children enrolled in the Children's Medicaid Insurance Program. The Web site also does not indicate how many of the estimated cases are senior citizens.
MORRISETTE said both Govs. Jim Gilmore (R) and Mark Warner (D) had proposed an increase in Medicaid reimbursements to nursing homes of $34 million. The increase is based on inflation and actions taken by the General Assembly in past years, which encouraged nursing home administrators to increase wages for Certified Nursing Assistants, along with assurances the funds would be covered by higher Medicaid payments.
Instead, Morrisette said, the House of Delegates proposed eliminating the increase altogether, while the Senate proposed reducing the increase to $22 million. The Senate's version eventually passed the General Assembly.
"We ended up with a $12 million reduction in the increase," Morrisette said. "It did not even keep up with inflation."
As for Inova, Harris said there is a $9 million-per-year cut coming in Medicaid reimbursements. He just does not know if the cuts will be in senior care, children's programs or other services paid for through Medicaid.
"I think the cuts probably will be more for the nursing homes. What it will probably mean is it will be harder for seniors to be admitted to nursing homes, that are on Medicaid," Harris said.
THE REDUCTION in reimbursements to nursing homes could result in a reduction of the number of beds available to Medicaid recipients.
By law, nursing homes cannot turn away or evict a Medicaid recipient. The homes can, however, ask that the state reduce, or decertify, the number of Medicaid beds the facility has available to program recipients.
"You will see nursing homes decertifying Medicaid beds," Morrisette said.
In general, to qualify for Medicaid's nursing-home care, a person must have $2,000 or less in savings and other assets; meet the income requirements, which differ from state to state; and undergo screening to make sure the person meets the state's medical and functional criteria for nursing-home care. The Medicaid program is administered by the state Department of Medical Assistance Programs, while the enrollment of eligible people into the Medicaid program is done by the Virginia Department of Social Services.
Morrisette said the only way for facilities to remain open will be for the nursing homes to raise the fees for residents who pay.
He said it is also hard for facilities to recruit new employees, due to the lack of funding available to increase salaries in an already competitive field.