BISMARCK -- When nursing home administrators got the word last week North Dakota would cut payments for Medicaid residents starting today, they were shocked and said staff would have to be trimmed and residents would suffer.
"It's pretty short notice," said Dave Viland of Elim Care Center in Fargo. "We can't react that fast on many of our costs."
By Monday, word came that the state Department of Human Services agreed to postpone today's rate cut until January and legislators promised they would appropriate emergency money in the first weeks of the 2003 session so the cuts will not just be delayed, but forestalled completely.
"There is no alternative. We will fix this," said Rep. Bill Devlin, R-Finley.
The reimbursements drop is a result of across-the-board spending reductions the governor ordered in July for all state agencies, along with higher-than-anticipated Medicaid costs this past year.
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Devlin and two other legislators, Rep. Merle Boucher, D-Rolette, and Sen. Ken Solberg, R-Rugby, led an effort to use the state Health Care Trust Fund to pay for $1-to-$1.50-per hour raises for all nursing home workers last year.
It halted the high turnover in employees and improved care, they said. To have the homes take a cut in reimbursements now would be a step backward, the legislators said.
Sue Grove, administrator of Villa Maria in Fargo, said she found out about the cuts on Friday and thought, "Wait a minute, let's work together."
And so they will, legislators said. The lawmakers said Monday they would tap the same trust fund again to prevent the planned cuts from taking effect.
"These (residents) are the people who built this state. They deserve the quality of care they want, in a facility they want, in a community they want. They deserve nothing less, and to give them any less is unacceptable," Devlin said.
About 56 percent of the state's 6,300 nursing home residents have their bills paid by Medicaid. Federal Medicaid dollars pay about 70 percent of their daily charge, and the state makes up most of the rest.
Last week, officials at the Department of Human Services told representatives of the North Dakota Long Term Care Association they had a choice: take a $2.74-per-day cut in Medicaid reimbursement starting today, or a $4.13-per-day cut Jan. 1.
Either way, the state has to find a way to cut $850,000 in its nursing home spending by June 30.
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At the same time, the federal government announced it is cutting its Medicare payments to nursing homes by
10 percent, or $26.75 per day.
No nursing home in the state can absorb those cuts on top of recent increases in liability insurance, said Jane Kelly, director of finances and human resources at Bethany Homes in Fargo.
Nursing home representatives said staffs would have to be cut, and that would affect residents, said Shelly Peterson, president of the Long Term Care Association.
"Residents will not receive the care they deserve," she said
About 70 percent to 75 percent of nursing homes' budgets are for salaries and benefits, she said.
Kelly said she is optimistic about the legislators' commitment.
"The state has been very good to us in recent history, so we hope they'll recognize the need and give us the appropriation (from the trust fund)," she said.
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Grove said she will ask her employees to get involved in supporting the state legislation, just as she did when the trust fund was tapped for raises during the 2001 session.
Peterson and Solberg said North Dakota's congressional delegation will push a bill in Congress to reverse the Medicare cut.
Medicare pays for only about 5 percent of the nursing home patients in the state.
Nursing homes are now also getting hit with huge increases in liability insurance premiums.
Peterson said the increases are as high as 472 percent.
"We're looking at gouging," Boucher said.
He said it is time to consider allowing the nursing homes to join the North Dakota Insurance Reserve Fund, a self-insurance pool started in the 1980s for political subdivisions that were facing skyrocketing liability insurance premiums at that time.
Readers can reach Forum reporter Janell Cole at (701) 224-0830
