More than 100 nursing home residents in Utah are expected to lose their Medicaid coverage when new eligibility requirements go into effect Oct. 1, but officials believe nursing homes will continue to care for them.
Medicaid provides financing for about 70 percent of the state's nursing home residents, according to Rod Be-tit, director of the Division of Health Care Financing. The division administers low-income medical programs. But a rule that goes into effect Oct. 1 places an income cap on eligibility and eliminates the current "spend-down" feature.In the past, families could pay for services themselves until the income had been lowered to an eligible level (called a spend-down), then Medicaid would take over. Eligible income was "anything below long-term care costs (about $45 a day)," Betit said.
Beginning next month, any family with an income above $1,062 a month will be ineligible for the program, and spend-down no longer exists.
Dennis McFall, executive vice president of the Utah Nursing Home Association, said, "It's been discussed thoroughly, and I know of no one who plans to put any resident out on the street. It's a difficult situation, because we've encouraged all facilities that have patients who might become ineligible to continue to provide care.
"We certainly don't want to see any arbitrary discharges, but as an association we cannot guarantee that," he said.
"This decision was not made lightly," Betit said. "It was one of a package of $13 million cut from the program. It's the expectation of the Medical Care Advisory Committee that care will continue to be provided. And while we have no authority to force facilities to keep patients, if they start dumping there will be an adverse reaction. I would certainly take that into consideration when the next cut comes."
Betit said there could be a problem if a facility had more than its "fair share" of no-longer-eligible residents. But he expressed hope that nursing homes would work together to equalize distribution, if necessary.
One very real problem, according to McFall, is the financial burden the new regulations may place on some nursing homes. "Only 16 percent of the nursing homes in the state even broke even last year," he said. "We saw Chapter 11s, reorganizations and one even closed its doors. We had to find placement for about 80 mentally retarded people.
"I wish the Legislature would look at the whole system of health-care for low-income people - it's a very fragmented and damaged system. We see continual, year after year budget cutting, but the needs of the individuals keep increasing dramatically. The pressure's on to provide care at less money, but there are limits to what can be done."