KNOXVILLE — For about two years the Knox County Nursing Home’s payment from the state for Medicaid patients has been delayed anywhere from six months to as long two years, according to county officials.

Nursing Home Administrator Rachel Secrist said after the state consolidated 65 counties’ Medicaid caseworkers into one office in Macon County two years ago, residents who wish to sign up for Medicaid to receive nursing home services can take several months to set up. While they wait for the resident to be approved the nursing home isn’t reimbursed for the services it provides during that time.

A resident that comes in that needs to apply for Medicaid, it can take anywhere from six to nine months generally on a case-by-case basis, and that’s to get approved for Medicaid,” Secrist said. “And then it may take another month or two to get that payment.”

Other factors can drag the process out even longer.

“If there’s something difficult about their case then it may take even longer, if it could go to Springfield to the officer of inspector general,” Secrist said. “That’s usually if there’s spousal impoverishment, and gifting in the last five years and if they have property for sale.”

When the resident is finally approved, the county is paid in full from the date the person started receiving care from the nursing home. But Secrist said with residents signing up all the time, the process has turned into a cycle of delayed payments.

County Treasurer Robin Davis said as of the end of May, the nursing home should have gotten 50 percent of the total budgeted revenue for the fiscal year, but it has only received 38 percent and much of that is due to the Medicaid payments. Currently, there are 138 residents at the nursing home, 45 percent of which are on Medicaid.

Along with those delays, the companies the nursing home has used as part of the Managed Care Medicaid Alignment Initiative Act are not making their payments on time either.

Secrist said these companies through MMAI include “Medicare and Medicaid together, and it was all to be paid to one insurance company of their choosing.”

These companies handle payments for both Medicare and Medicaid for costs like transportation and oxygen tanks, and then reimburse the nursing home after the state pays the company.

There were only two companies, Health Alliance and Molina, that provided the service in the region when MMAI was enacted. Today it’s down to one, as Health Alliance no longer provides the service, Secrist said.

Between the two of them, the nursing home is owed $308,000, but payments have been delayed on that front as well. Davis’ records show the last time the county received payment was in March.

The County Finance Committee discussed taking legal action against these companies in its meeting this week, and could start discussing actions with the Knox County State’s Attorney’s office. County Board Member Jeff Jefferson, who chairs the county committee that handles the Knox County Nursing Home and is a finance committee member, said legal action may be the go-to option at this point.

“If we were getting paid like we used to we wouldn’t be having this conversation,” Jefferson, D-District 5, said.

Secrist also said the nursing home has tried to reduce its use of MMAI companies as several residents have switched back onto Medicare or Medicaid, but that’s “probably not an incentive for them to pay us either.”

In order to cover these shortfalls, the nursing home has had to borrow $735,000 from its referendum fund. Voters approved a 10-cent per $100 levy on their real estate taxes to help pay for maintaining the nursing home. However, when it was approved it was not set up to cover late payments from the state.

“We tend to like to use that money for like when they did the electronic nursing records…Not for daily operations,” Davis said.

It’s put us in a tough situation,” Jefferson said. “Obviously we don’t want to borrow from the referendum to keep the nursing home afloat. But unfortunately we’re in that situation right now.”

While it is borrowing the money for now, Secrist said last year it made a full payment back to the referendum fund in the amount it borrowed at the end of the fiscal year.

She hopes the nursing home will be able to do that again this year.

Marty Hobe (309) 343-7181, ext. 214;; @mhobe55

Delayed Medicaid payments hurting Knox County Nursing Home – Galesburg Register
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