Column: And yet another barrier to necessary nursing home care

Published Mar. 30, 2018

The 2018 Florida Legislature made it much more difficult for Florida families and caregivers of frail elders and younger people with catastrophic disabilities who are facing long-term care decisions.

The majority of nursing home admission decisions are made during hospitalizations. Most people do not plan to go into a nursing home unless it is for a short-term rehab stay that is covered by Medicare for the elderly. The transition of a person from a hospital to a nursing home for an anticipated long-term stay may be both traumatic and frenetic.

Medicaid established retroactive eligibility as a safeguard for individuals and caregivers faced with these difficult placement decisions so they have time to understand and apply for assistance with the high cost of nursing home care that middle- and low-income people would not be able to afford for a long-term stay.

However, the Legislature voted to end the Medicaid retroactive eligibility coverage as of July 1 with a Medicaid budget cut of $38 million in general revenue through the Appropriations Act. This cut occurred without debate or any opportunity for the public to understand and respond to how this will affect people who need Medicaid-funded long-term care services.

Most Floridians do not know what this will mean for aging parents who have a stroke and don't realize they may need Medicaid-funded long-term care, including nursing home placement, until they have used up their Medicare benefit, which only covers short-term rehab stays.

Current national Medicaid policy, followed by a majority of states, allows for 90 days of retroactive eligibility so individuals have time to meet all of the application requirements for Medicaid eligibility and have their costs of care covered once their eligibility is determined. The policy ensures that vulnerable elders and younger people are provided the services they need because providers will receive payment for the care they provide while Medicaid eligibility is being determined for a period of up to 90 days before the determination process is completed.

For example, if your low-income father is recovering from a stroke and needs to be in a nursing home beyond the 120-day period covered by Medicare, he will need Medicaid to pay for the longer stay. Proving that your father is eligible for Medicaid is a complicated process that can take several days or even weeks. The 90-day retroactive eligibility provision ensured that if your father was found eligible, the costs of care provided after Medicare payments ended and before his Medicaid eligibility was officially determined would be reimbursed by Medicaid for one to 90 days.

Without this provision, however, providers will be more reluctant to care for patients who are not Medicaid-eligible upon admission to a nursing home and who are at risk of needing more care than Medicare will pay for beyond 120 days. This puts people who need long-term care at materially greater risk that they will not be able to find the care they need or that they and their families will have to pay out-of-pocket for the care that they truly cannot afford.

Floridians should be very concerned about the unmet need that will come with this policy change and about how families are going to navigate access to complex medical issues for which they will be unable to pay. Legislators need to know how this budget cut, which was included at the last minute in the state budget, will hurt many older people in the country's oldest state in the nation.

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Florida has the nation's largest waiting list for home- and community-based Medicaid services, with more than 64,000 awaiting services. This legislative action will further reduce access for needed services when older people and impaired younger people need help the most.

Florida already has one of the least adequate publicly supported long-term care programs in the country. The latest AARP comprehensive assessment of the quality of state programs (2017) ranked Florida 46th, which is lower than the state ranked in 2014 at 43rd and in 2011 at 41st. One of the main measures AARP uses for assessing quality is access to needed care. By eliminating the time period for retroactive Medicaid eligibility, Florida's policymakers have increased the chances that the next assessment will find that Florida's long-term care program has declined again in quality with only four lower rankings left to go. Florida's elderly and their families deserve far better than they are now getting from our policymakers.

Larry Polivka is director of the Claude Pepper Center at Florida State University.