Florida’s Pending Medicaid Change Spells Trouble for Florida Nursing Home Residents

FL Medicaid & Nursing Homes

With AHCA’s suggested changes to Medicaid, Florida’s bad nursing homes win and Florida’s good nursing homes lose.

Many Florida nursing home residents fund their nursing home residency, in full or in part, with Medicaid. Although Medicaid is a federal program, it is distributed and administered through the states. In Florida, AHCA (Agency for Healthcare Administration) oversees Florida’s Medicaid program for nursing home residents.

AHCA’s Proposed Changes to Florida Nursing Home Medicaid Reimbursement

In February of 2017, AHCA proposed a radical shift in Florida nursing home reimbursement as it relates to Medicaid. The outside veneer of the Medicaid change proposal is to regulate the program, streamline reimbursements and cut costs. As usual, the effect is yet another loss for Florida’s seniors. The actual effect of the change will reward poor care facilities (1 and 2 star rated nursing homes) and punish excellent care facilities (4 and 5 star nursing homes). If the Medicaid changes go through, 143 nursing homes that are rated as 4- or 5-star homes would lose significant funding. That money would be diverted to 86 nursing homes that received a 1- or 2-star rating in the form of additional funding. This will send a message to Florida corporate nursing home owners that tight budgets, skeleton staff numbers and bad behavior means more profits.

The Current System

Right now, the Medicaid reimbursement system works to reward good facilities with money and punish those that are chronically understaffed. Florida nursing homes are rated by a 5 star system with 1 star being the lowest and 5 stars being the highest. Many factors are looked at to determine a facility’s star rating, including staffing numbers, nursing home injuries, health inspections, citations and quality measure assessments. Under the current Medicaid plan, 4 and 5 star facilities are rewarded financially for their high staff numbers and good health department inspections. Conversely, 1 and 2 star facilities are punished by receiving lower funding for their poor survey results and lack of staff. This incentivizes a nursing home corporation to appropriately staff nurses and CNA’s while trying their best to prevent resident injury. Unfortunately, if the reimbursement is ‘streamlined’ by Gov. Rick Scott, there is no longer the incentive to provide good care and enough nurses. This will inevitably result in more injuries and wrongful death to Florida’s most vulnerable patient population.

Staffing and Quality of Care

Why does nurse staffing matter in preventing nursing home abuse injuries? When one nurse or CNA is responsible for caring for an entire wing of high-risk, high-acuity nursing home residents, accidents happen. Frequent nursing home injuries that occur due to a lack of nurses are:

The nurse staffing is always determined by the corporate owners of the facility. Unfortunately, larger ‘corporate’ nursing home chains tend to have lower star ratings because their primary focus is on profits. This is why it is so critical to have a direct link between quality of care ratings and Medicaid reimbursement. These correlated payments incentivize corporate owners to staff their facilities to the needs of residents.

Nursing Home Corporations Put Profits Ahead of Residents
Larger corporate nursing homes put profits first. This is why it is so important to tether high star ratings to higher reimbursements. Otherwise, corporate nursing home chains will slash staffing and residents will suffer preventable injuries.

Understaffed Nursing Homes Lead to Nursing Home Abuse Injuries

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