Michele Catinella, a Nurse Practitioner at the John Knox Village Continuing Care Retirement Community receives a Pfizer-BioNtech COVID-19 vaccine from Carmen Pi, a Registered Nurse with American Medical Response on Dec. 16, 2020 in Pompano Beach, Florida. (Photo by Joe Raedle/Getty Images)
Gov. Greg Gianforte wrote to members of the Montana Health Care Association last week to address persistent concerns among long-term care providers about the financial stability of their industry during the pandemic, but signaled that he’d not be inclined to authorize more direct financial assistance to support hiring and retention.
The open letter, dated January 14, touts several previous measures the state has taken to stabilize the long-term care sector. However, it doesn’t address requests from the industry for pandemic “hero pay” or a Medicaid rate supplement, said Rose Hughes, the executive director of the association. These are the types of measures needed to save nursing homes in Montana, she said, and other states have continued to provide this kind of support late into the pandemic, where Montana hasn’t.
“We went through the motions, through the process, have appeared in committee or given written testimony, and have been in regular contact with the governor’s office and DPHHS about the needs for resources for these workers,” Hughes said, referring to the Department of Public Health and Human Services. “As recently as Wednesday, the answer remains no. “
Gianforte’s letter acknowledges the financial difficulty long-term care facilities are facing but said the state should avoid “quick, unsustainable infusions of federal funds” and instead focus on investing in water, sewer, broadband and workforce development with American Rescue Plan Act money.
“More broadly, my administration’s core guiding principles with ARPA has been and will remain consistent: We will use ARPA funds for responsible, long-term investments to benefit future generations of Montanans,” the governor wrote.
Nursing home finances have always been a bit shaky, especially in recent years, but COVID-19 has placed a serious strain on the industry, driving some facilities to the precipice of closing, as the Billings Gazette reported this week.
“Most facilities I talk to are wringing their hands and saying we can’t sustain this,” Hughes said.2022-01-14 Gov. Gianforte Letter to MHCA Members SIGNED
Providers made their way through 2020 and 2021 to the extent possible thanks to some of the programs Gianforte pointed to in his letter, Hughes said. These include measures like an additional $40 reimbursement per Medicaid member per day, or the one-time $15 million the state approved last year to support routine activities as well as recruitment. The industry has also received around $47 million through federal provider relief payments, according to the Gianforte administration.
However, the rate adjustment, which began under Gov. Steve Bullock, ended last May, and Hughes said the $15 million that followed only covered about the five following months. There are 68 nursing homes in the state.
Beyond that, she said, providers were left with their “normal” revenues and whatever additional federal aid that was attainable. In some cases, this means trying to cover costs of $300 per patient per day with reimbursements of $211 per patient per day.
“Medicaid should be paying for the basic care in these facilities,” Hughes said, “That’s the promise the state makes when they put someone on Medicaid.”
Hughes said the critical issue is staff, and the relationship between staffing, retention and reimbursement rates. Between 65 percent and 70 percent of long-term care facility residents are on Medicaid, she said, but Medicaid rates in Montana don’t cover the total cost of care, and the costs of care have only skyrocketed under the pandemic. As a result, hiring is stilted, retention suffers and some patients have to be turned away — often the ones who need the most intensive care.
“It is such a vicious cycle,” she said.
Gianforte in his letter pointed to a few other options, such as supplemental funds for Montana Medicaid patients with behavioral disorders, traumatic brain injuries and other special circumstances, and said he’d directed DPHHS to “ensure nursing facilities are prioritized in our administration’s ongoing Provider Rate Study, as well as explore ways to support your facilities with long-term care modernization efforts and provide technical assistance on developing sustainable business models.”
The agency would also be looking at ARPA funding to improve ventilation in order to limit COVID-19 transmission in these facilities, the letter said.
But Hughes said the industry doesn’t need help at the margins — it needs direct aid in the short-term, and a reexamination of rates in the long term. Other programs, such as one launched late last year to incentivize healthcare professionals to relocate to Montana, aren’t targeted toward nursing facilities, which care for an especially vulnerable population, she said.
One repeat request has been for increased pay for frontline workers, especially those in healthcare, an allowable use of ARPA funds according to the federal government but one the state has not adopted. But the state hasn’t budged on that and other issues in talks with the MHCA, she said, even as the pandemic stretches on and the sector continues to face financial problems.
In response to questions about the MHCA’s requests and other ways DPHHS could aid the facilities, a spokesperson for the governor said the letter speaks for itself.
“The governor looks forward to continuing a productive dialogue with leaders of our long-term care industry,” said spokeswoman Brooke Stroyke.
Adam Meier, the director of the Health Department, told the Billings Gazette this week that there were no plans to issue additional direct relief to nursing homes with federal American Rescue Plan Act dollars, citing a need to not “keep kicking the can down the road.”
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