In recent years, many states have made changes and simplifications to the way they pay nursing homes through Medicaid. Florida, whose nursing home industry is massive and whose annual budget is taken up so much by Medicaid spending, wanted to do the same. Not only did they want to make the system less complicated, they also wanted to even the playing field of nursing home Medicaid payments by increasing funding for the previously least-funded nursing homes in the state and decreasing funding for their previously highest-funded nursing homes, therefore bringing all of these facilities closer to the middle of the pack in terms of Medicaid. They also wanted to transform the way these payments were made, moving from a retroactive system in which nursing homes are given Medicaid at the end of each year based on their annual costs to a system under which funds would be given at the beginning of each year based on what the state determined each facility would need based on its own formula. Before all of these changes were even implemented, the new plans raised eyebrows for the higher-quality nursing homes in Florida who would get cuts to their funding and receive that funding under a new state-devised formula.
The proposed changes would be directly on the Medicaid funding to Florida’s nursing homes. Some homes, regardless of their quality, take in more Medicaid recipients than others. Nursing homes that do house a large number of patients dependent on Medicaid need those funds in from the state government to act in place of what other patients would be expected to pay through their own insurance or out of pocket. If a high quality nursing home with a large number of patients on Medicaid were to experience drastic cuts in funding, which many of them are, they would have to alter their quality of care and/or the number of Medicaid-dependent patients they could take in, damaging the quality of good nursing homes and sending patients away to even worse ones.
In addition, there’s currently no check in place dictating that the facilities experiencing an increase in funding use that money to better their quality of care. If a nursing home with historically bad ratings gets an increase in Medicaid funding through this new system, which is meant to benefit that facility’s patients, there’s nothing stopping that nursing home from siphoning those funds to further the profit of its corporate leaders, which already happens in the realm of the large-scale nursing home industry.
In general, under this new plan many good nursing homes would see a decrease in funding that will act as a detriment to their business and their patients. Meanwhile, many subpar or worse nursing homes will see financial incentives which, possibly, will never benefit their patients.
Part of the reason a plan like this could go through in the first place is the powerful group of companies from the nursing home lobby that pushed for it. Organizations like the Florida Health Care Association and Consulate Health Care, both members of the nursing home lobby, donate to the campaigns of politicians all over the state of Florida in order to block legislation which would punish negligent behavior and celebrate actions which would help their businesses to continue operations.
Rick Scott, the former two-term governor of Florida and current Senator, who receives more funds from the nursing home lobby than any other Florida politician, is a massive proponent of the nursing home industry. But he also signed this new payment plan into law as some of the state’s best nursing homes were crying out in pain from the cuts. Similarly, Joe Negron, the former President of the Florida Senate, received hundreds of thousands of dollars from the nursing home lobby and had an FHCA award named for him after he left the State Senate. These officials could have a lot of power to block actions which would be detrimental to the state’s best nursing homes, but that would mean an end to the funds the lobby provides.
The American Health Care Association also has the power to make changes to the state of long-term care in Florida. With proof that low-rated facilities cause harm to their patients, the AHCA could shut down bad nursing homes, revoke their licenses, or dole out other punishments. Instead, they more often decide to send these facilities threats with a loss of license, which rarely go through and rarely change the nursing homes’ quality of care. For example, at one time the AHCA had sent fifty-three of Consulate Health Care’s nearly eighty facilities a threat of revoked license, but none of those threats ever went through and over the course of five years Consulate’s nursing homes received an average of two point four out of five stars.
This new system of payment is going to be detrimental to some of the best nursing homes in Florida and its patients. The system’s largest beneficiaries will most likely be the lobbyists who pushed for its implementation in the first place. But as long as those lobbyists continue to turn over part of that money as campaign contributions to some of Florida’s most powerful politicians, they will continue to get what they want, even at the cost of patients’ quality of care.