Nursing staffing shortages have plagued nursing homes for years and only worsened during the pandemic.
The JB Pritzker administration and an influential lobbying group representing for-profit nursing homes have been in negotiations for more than two years over Medicaid rate reform aimed at incentivizing nursing home operators to hire more nursing staff. State Sen. Ann Gillespie, an Arlington Heights Democrat and key negotiator, said significant progress has been made in discussions with the Health Care Council of Illinois, but have come short of finalizing a compromise bill.
Two competing bills to reform the Medicaid rate were filed in January – one supported by the Illinois Department of Healthcare and Family Services and another backed by the Health Care Council of Illinois. Gov. Pritzker’s budget proposal includes $500 million to fund a new Medicaid rate funding formula.
In a letter obtained by Illinois Times, the director of the Illinois Department of Healthcare and Family Services, Theresa Eagleson, addresses HCCI board president Daniel Weiss and board chair Jonathan Aaron and provides a summary of negotiations held last week.
According to the letter, Weiss and Aaron have agreed to several changes to the Medicaid rate which would tie funding to accountability measures, but also call for at least $153 million in additional funding for adapting to the new system.
HCCI’s requests for more money include $41 million for “transitioning” to the new rate system, another $45 million for “a transitional prepayment for hiring for six months,” an add-on annual payment of $34 million, and about $25 million in added funding to the base rate, according to the letter.
“As we’ve said all along, there are many demands on the resources that are available, and we cannot speak to the availability of funds beyond the roughly $500 million included in the governor’s introduced budget,” stated Eagleson in the letter.
A spokesperson for HCCI stated via email on April 1, “We can’t provide confirmation or comment at this time.”
On March 17 HCCI stated: “We continue to negotiate with all parties involved in this important debate and remain confident we can reach an agreement that reinforces our shared values of increasing staffing in skilled nursing facilities and expanding access to quality care while allowing the industry to recover from the devastating impact of the pandemic.”
Long-term care advocates, and labor also have been a part of the discussions and have supported tying any state funding to nursing staffing and quality care of residents.
“A Medicaid system should be going towards ensuring that it pays for staffing, ensuring that it pays for positive outcomes, versus that money going for profits,” said Angela Schnepf, president of Leading¬Age Illinois, a Lisle-based senior care advocate organization.
“If you don’t tie reforms with the increase in Medicaid rate, then the bad actors (will) continue to not staff appropriately.”
For-profit nursing homes make up nearly 79% of long-term care facilities in the state, according to HFS, and their buy-in is seen as important for implementation of any agreement.
Since 2014, the state has increased annual funding by $310 million to help nursing homes support staffing, but regulators concluded it did not help boost staffing levels, according to a September 2021 HFS report.
“Unfortunately, during this time, the care of Medicaid customers has not improved to match the additional funding provided to nursing homes for improved resident care,” stated the report.
Gillespie said the final bill will encourage staffing improvements because “nursing homes have to demonstrate that they are staffed in accordance with the federal benchmark for minimum staffing.” Other funding is also tied to facilities meeting certain standards of quality care.
Eagleson said legislators may want to provide incentives for the industry to support the agreement, but “we will not compromise on care for our seniors in nursing homes and getting real reform in the near future.”
In a December committee hearing HCCI argued the proposed changes may cause nursing homes to close. But, the actual fear for some long-term facilities is the risk of losing revenue, Eagleson said.
“The whole point of this reform is to drive different behavior from some nursing homes,” Eagleson said. “(Some owners) have been making a lot of money and not necessarily providing the care that residents deserve.”
The report stated that 47 of 100 of the worst-staffed nursing homes in the country are located in Illinois, with the consequences of those conditions evident in the high number of COVID-19 deaths in long-term care facilities.
The risk for death was highest for low-income residents in “overcrowded and understaffed” nursing homes, according to the study. Prior to the availability of a vaccine in December 2020, COVID-19 deaths at long-term care facilities made up 46% of all pandemic deaths in the state, according to the Illinois Department of Health. On one day, May 9, 2020, the share of deaths at long-term care facilities was 505 out of 810 total deaths, or 62 percent.
Maria Gardner is a master’s degree student in the Public Affairs Reporting program at University of Illinois Springfield.
This article appears in Fifty years of Doc Helm’s photos.
