The State of Missouri is accelerating a looming crisis in long term care by not sufficiently reimbursing nursing homes for the care they deliver to Missouri’s low-income elderly and disabled populations dependent on the State’s Medicaid program.

According to Missouri’s own formula, $178 is required each day to provide care for every skilled nursing resident in the State. But Missouri pays $153. The resulting $25 per day shortfall puts the Show-Me state in a precarious - and embarrassing - position. This payment/cost gap must be closed. Losing money on nursing beds devoted to Medicaid patients is unsustainable.

Despite the fact Missouri knows the cost of care and sets its Medicaid rate accordingly, it pays just $15.26 out of its general revenue for each of its skilled nursing residents. That is not enough to provide even average care. Missouri’s neighboring states, on the other hand, pay on average $48.22 per day, more than three times the amount Missouri does. Bottom line? Missouri neglects its senior citizens and forces Medicaid providers to subsidize the cost of the State’s Medicaid program through uncompensated care.  

In the current fiscal year, the Governor and our Legislature chose to balance the State’s budget on the backs of Missouri’s elderly and disabled by cutting Medicaid provider rates 3 percent or more. While 3 percent may not seem like much, it represents several years of incremental rate increases that helped keep the payment/cost gap from growing.  This year’s rate cut sets the clock back and reverses the trend.  And for 2019, the Governor is now proposing to hold those rates in place.  This ignores the reality of the looming long term care crisis.

In response to this year’s rate cut, urban nursing homes are consolidating and closing Medicaid wings.  Other providers are moving to decertify Medicaid beds to reduce Medicaid losses.  The Little Sisters of the Poor in Kansas City – a religious order dedicated to elder care and with 99 percent of its beds devoted to Medicaid patients –  is struggling to address a nearly $200,000 revenue reduction owing to the Medicaid rate cut.  And, in northeast Missouri, subsidizing Medicaid beds for the State’s program is threatening the existence of our nursing homes. For Beth Haven this revenue reduction is nearly $120,000.  Medicaid losses are going to cause nursing homes to close.  Who will care for Missouri’s frail and elderly when they do?

What makes a bad situation even worse – and defines “looming crisis” - is the fact that Missouri is producing seniors at a faster rate than most states. With a higher median age than 28 other states, Missouri is seeing an increase in Medicaid applications. Add baby boomers to the mix, and the problem is magnified. We simply cannot afford to stay silent about the long-term consequences of our state’s neglect of the elderly.  The baby boom tidal wave is coming.  Missouri can and must improve Medicaid reimbursement if Medicaid beds are to be available for the next and future generations of Missourians.  

Admittedly, the demands for funding in our State are numerous and great.  But, Medicaid is the safety net and sole payer for approximately 24,000 Missourians in nursing homes and 60,000 Missourians able to live outside a nursing facility (at cost savings over skilled nursing care).  If Medicaid is to remain a safety net for Missouri’s low-income elderly and disabled, Missouri must cover the costs of Medicaid service providers.  It is untenable and unfair to expect Medicaid providers to subsidize Medicaid patients.  

There are no simple solutions for closing the gap between the State’s reimbursement rates and Provider costs.  But Missouri long term care providers are unified and committed to helping the State consider creative, equitable solutions.  Communities like Beth Haven are mission-driven organizations that exist to serve Missouri seniors in all income categories.  But, no mission can be delivered for long without the costs of services being fairly reimbursed.

I do not make it a habit of taking a public stance on political issues. But this is not a political issue. It’s a moral one. Anyone who feels the way I do must advocate for those who can’t. We must stand up for those who have raised us and led us and taught us. We must demand that our lawmakers reimburse Medicaid for the full skilled nursing facility amount. This is no time for Missourians to be silent.