TOPEKA — More seniors who rely on Medicaid may be forced to forgo assisted-living arrangements and go to a nursing home or stay home because of changes to how the state repays assisted-living centers.
The problem stems from a change initiated in September that standardized how much the state reimburses facilities for select types of services.
For example, people managing care plans have determined how long — and therefore how much money — is required to assist someone with bathing, meal preparation and other services.
That trimmed payments by an average of 14 percent, according to Sara Arif, spokeswoman for the Department on Aging.
But at least two assisted living center managers told a joint committee on home and community-based services oversight that they've had funding cut by up to 25 percent, and it's putting a strain on the balance sheets.
"There is going to be a significant access issue, and I don't think it's too far down the road," said Cindy Luxem, president of the Kansas Center for Assisted Living, a statewide trade association affiliated with the Kansas Health Care Association.
Luxem said people who can't afford to pay for assisted living on their own have few options.
"Unfortunately, the next choice is the nursing home. We're not trying to say the sky is falling," she said, but she worries about "people staying home and not getting the care they need."
The change affects assisted-living centers, which are generally apartment-style complexes where people have their own room, bathroom and kitchen; residential health care facilities, which are like assisted living but don't have a kitchen; and private "home plus" facilities, where eight or fewer people live and receive some assistance.
About 45 operators of these types of facilities responded to a survey by the state association. Most of them accept Medicaid waiver clients and about 90 percent have experienced cuts in Medicaid waivers since Sept. 1.
Roughly 15 percent of the facilities said residents have been forced to relocate. About two-thirds have limited or stopped accepting Medicaid clients.
Many communities don't have alternative resources to deal with the need, and many facilities surveyed by the association say they may not be able to continue serving elderly clients who rely on state reimbursements.
One of the assisted-living facilities said 98 percent of its clients use Medicaid.
"These cutbacks have a devastating effect on our facility," it wrote in the survey.
Another said it had relocated at least one client to another assisted-living facility and has turned away two clients who would have qualified.
"Many of those residents (I'm not sure if it is 25% or 75%) will be forced into nursing homes, where the state will pay roughly THREE times what they are paying us under the pre-September 1st system," the facility wrote. "This does not seem like sensible economics to me."
Several assisted-living facility operators told the joint committee on home- and community-based services oversight last week that they offer options for people who want to maintain some independence.
The cuts, they said, could force more people — especially in rural areas with limited options — to stay in their homes in potentially unsafe conditions or move into nursing homes where their independence and quality of life won't be what it could be.
The state is trying to resolve the issue on a short-term and long-term basis.
The Department on Aging is working with the Centers for Medicare & Medicaid Services to get a temporary 10 percent rate increase for providers, Arif said. That money would essentially boost the reimbursements for all services, though it would be slightly short of making up for the average reductions.
Case managers are also continuing to help find alternative places for people to live.
Arif said her department thinks home- and community-based services are an essential part of what consumers in Kansas have to choose from and that it wants to find better ways to reimburse providers for actual care.
"This is sort of a short-term fix," she said. "I think that we'll see a lot of changes with the Medicaid reform initiative that will be announced sometime before Dec. 22."
Anita Nance, director of client services for the Sedgwick County Department on Aging, said there may be some residents who no longer will be able to afford to stay in an assisted living center because they have to pay more out of pocket for services.
She said some centers may choose not to take Medicaid clients anymore.
The standardization went into effect Sept. 1. It's probably too early to tell what the effects might be, she said.
"At this point, we haven't found that it's a problem finding acceptable services for people," Nance said.
Debra Zehr, president and CEO of the Kansas Association of Homes and Services for the Aging, said the impact of standardization "has varied from region to region in the state. That demonstrates how there was such a lack of uniformity in the times that were being allowed for services. In some parts of the state, they really didn't see a lot of difference; in other parts of the state they have."
Her group represents not-for-profit providers of services for about 25,000 elderly Kansans. About 35 percent of the group's members provide assisted living, and half of those provide services to home- and community-based services (HCBS) clients. Reno County providers, she said, have seen "quite a bit of an adjustment in their rates."
The good news, Zehr said, is that there is an exception process.
"If providers can demonstrate that that particular client needs more time, they can get additional reimbursement," she said. "The state is processing a lot of those requests.
"We've also been told that there will be a 10 percent rate increase across the board for HCBS for assisted living. That will help close the gap, too."
Zehr said the move to standardization "was a surprise for some providers."
Not-for-profit assisted-living centers won't discharge current clients because of the cut in reimbursement, she said. However, some may not be able to take new clients.
"That's going to be the big question," she said. "They'll have to make a decision about whether they'll provide those services" to new residents.
Lisa Smading, administrator for assisted-living and memory-care residences at Catholic Care Services Inc., said because the changes just went into effect last month, she's not yet sure what the effect will be.
"Shortly we'll be getting our reports from our home office to see what the impact is," she said. "We won't ask anyone to leave because of the HCBS cutbacks.
"But we budget to allow for a certain number, and it will affect our ability to handle more residents."