Many nursing homes refuse to accept uncovered seniors who don’t have long to live
For more than two years, Kansas has been struggling to eliminate its backlog of Medicaid applications. After the state activated the Kansas Eligibility Enforcement System (which was designed to make application processing more efficient) in June 2015, the backlog exploded. By May 2016, there were almost 11,000 applications in the queue — many of which were pending for 45 days or more. Federal regulations stipulate that determinations of Medicaid eligibility shouldn’t take more than 45 days.
While the backlog has been reduced, there are still 2,000 applications that haven’t been approved more than 45 days after being submitted.
This has had a particularly harmful impact on our seniors, who are disproportionately likely to rely on Medicaid. When patients in need of hospice care are discharged from hospitals, many nursing homes refuse to admit them because they’re still waiting for Medicaid coverage.
According to Morgan Bell, a licensed master social worker at Stormont Vail Hospital, Topeka-area nursing homes are reluctant to accept backlogged patients who will die soon: “That’s been the biggest issue is they don’t want to take on that financial risk because they just haven’t been getting paid.” Cindy Luxem is the president and CEO of the Kansas Health Care Association, and she points out how much of a financial burden the backlog has become: “I can’t even begin to tell you the uncompensated care that our providers have given over the last few years.”
According to an article published by KHI in December 2016, uncompensated care is a perennial issue for nursing home administrators in Kansas.
Crystal Peterson is the owner of Peterson Nursing Home in Osage City, and she told KHI that one patient’s Medicaid application wasn’t approved for six months. The billing specialist for Brookside Retirement Community in Overbrook, Denise Hoback, said her facility cared for a woman for eight months before her coverage was approved. The CEO of Villa St. Francis in Olathe, Rodney Whittington, said the facility at one point had 40 patients with pending Medicaid applications and $1.3 million in outstanding payments.
Bell recommends giving patients “presumptive eligibility” when they aren’t expected to live much longer. This would allow them to be enrolled in KanCare right away instead of waiting for their applications to be approved.
However, Kansas Department for Aging and Disability Services spokeswoman Angela de Rocha says presumptive eligibility is reserved for pregnant women, some people with disabilities and foster children, and points out that an expansion of the designation will require a budget increase from the Legislature.
But what’s the alternative? Should we really be forcing elderly Kansans to fight through the gauntlet of a protracted Medicaid application process and a series of denials at nursing homes when they’re approaching the end of their lives?
KHI notes that “long-term care applications are the most complex type within Medicaid” — something that makes this convoluted and unpredictable process even worse. Regardless of whether the state extends presumptive eligibility to seniors who need hospice care (something we believe it should do, given the circumstances), the backlog is inexcusable. Nursing homes can’t be expected to admit patients without compensation, and dying seniors shouldn’t have to waste precious days and weeks searching for a facility to take care of them.
As Bell puts it, “It’s probably the worst time that most of these people have gone through, and that’s really the last thing they should have to worry about.”
Members of The Capital-Journal’s editorial advisory board are Zach Ahrens, Matt Johnson, Ray Beers Jr., Laura Burton, Garry Cushinberry, Mike Hall, Jessica Lucas, Veronica Padilla and John Stauffer.