A new state regulation that will place an income cap on Medicaid eligibility for long-term care residents has executives of the Utah Health Care Association bewildered.
Residents with a monthly income of more than $1,062 will be ineligible for long-term care (nursing home) Medicaid benefits as of Oct. 1. The measure was part of a several million dollar budget cut in the Medicaid program approved by the Legislature last January.About 120 residents in Utah Health Care Association-member facilities are subject to losing their medical benefit, said Dennis N. McFall, association executive director, who last week was besieged with telephone calls about the cap.
"It's upsetting to patients and their families. They want to know why after their eligibility has been determined and they are receiving health care, would the Legislature change the rules," he said.
McFall said the association has asked members to continue to provide health- care services to those who are presently receiving care, and to absorb the losses involved - if possible.
"In the majority of cases, this loss is several hundred dollars for each patient, per month, and in a few instances it is higher," he said. "I don't understand how the Legislature can feel good about exposing these very ill patients to the potential loss of care.
"I also do not understand why or how they, as legislators, feel justified in shifting the cost of providing this care, for state Medicaid patients, on to the nursing home ownership."
McFall said facilities statewide are already losing money on Medicaid patients.
"Because Medicaid patients comprise 70 percent of the nursing-home population on an average, these losses are substantial," he said. "Where else but in health care does our Legislature expect to purchase services for their (state Medicaid) patients at less than cost?"
Emphasizing the acuity levels of the patients, McFall added, "If we were talking about patients who had other options, or whose care could be adequately provided in another setting, then perhaps I would not feel as I do. But the very heavy care required by these individuals dictates they receive 24-hour nursing care.
"There is no alternative."
McFall said the association knew that the income cap on Medicaid eligibility was coming but wasn't "able to do anything with the Legislature to stop it.
"Our association hopes the Legislature in January will correct this gross inequity and disservice to our citizens in need," McFall said. "Our goal is to convince legislators to reinstate the $168,000 - a small amount of money in comparison to trauma and unsettling situation occurring because of it."
Utah Health Care Association represents 86 member facilities in the state. Members include hospitals, skilled nursing, intermediate care, intermediate care for the mentally retarded and residential-care facilities. Residents range from pediatric to geriatric patients.