Changes sought to Medicaid long-term care program

The Appropriations Committee heard testimony Feb. 9 on a measure that seeks to provide greater funding flexibility for Medicaid beneficiaries who choose to transition from institutional long-term care settings to alternative home and community-based settings.

LB1143, sponsored by Sen. Brian Hardin of Gering, would require the state Department of Health and Human Services to submit an application to the federal Centers for Medicare and Medicaid Services, no later than Dec. 31, to establish a Money Follows the Person program to assist qualified individuals in transitioning from an institutional setting to a community setting while continuing to receive long-term care.

In addition, if the department uses an amount that differs from the identified appropriation in calculating nursing facility rates for a prospective rate period, the bill would require that information to be included in the department’s annual report to the Legislature on nursing facility rate calculations.

Hardin said the bill would align with DHHS’s priority of “person-centered care” for individuals who need long-term services and would provide responsible management of Medicaid resources.

“The bottom line is that most people don’t really want to be institutionalized,” he said. “They would prefer to age in place, to age at home if they can.”

Drew Gonshorowski, director of the DHHS Division of Medicaid and Long-Term Care, testified in favor of the proposal. He said the department currently lacks discretion to direct funds appropriated for long-term care to settings other than nursing homes.

“DHHS supports a [Money Follows the Person] program, as it focuses on ensuring that patients who require long-term care are served in their preferred setting — whether at home or in a long-term care facility — so long as it is clinically appropriate,” Gonshorowski said.

Opposition focused on the portion of the bill that would allow the department to use an amount different from the identified legislative appropriation for calculating nursing home provider rates.

Heath Boddy, president of Vetter Senior Living in Omaha, opposed the bill. He said specific language was put in state law requiring rates to be set using the dollar amount earmarked by the Legislature for that purpose after approximately $30 million was appropriated for provider rates but used by DHHS for other priorities over a number of years.

Jay Colburn spoke against LB1143 on behalf of the Nebraska Health Care Association, Nebraska Hospital Association and York General Health Care Services. Also focusing on the proposed change to provider rate calculations, he said the bill would “shroud what would be a revenue grab from skilled nursing providers under the guise of a Money Follows the Person [program].”

“Before 2019 … the department would utilize funds intended for nursing home rates to fill other gaps in programs they preferred,” Colburn said. “What the Unicameral appropriated was not directed to where it was intended and the dollars were lost in the formulas used by the [department].”

The committee took no immediate action on the proposal.