Medicaid funding of nursing homes: A view from the pew

A former U.S. senator and vice president said, “The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.”

We have a moral obligation to care for those in the twilight of life, the elderly, whose hard work and sacrifice helped make the Big Sky Country a vibrant and healthy place to work, raise our families, retire and receive health care. Our 10 Commandments, which forms the bedrock of moral and spiritual values for Montanans who claim the Judeo Christian heritage, command us “Honor your Father and mother.”

We are not honoring our mothers and fathers when those who are most frail can’t find or afford the nursing home care they need and deserve. It is shocking that 11 nursing homes closed the past year, and blame low Medicaid reimbursement by the state of Montana for the closures.

Montana is the fifth-fastest aging state in the country by percentage. One nursing home administrator told me the number one reason nursing homes have lost staff and nurses is due to retirement.

Over 60% of nursing home residents in Montana are on Medicaid. They have outlived their finances and have less than $2,000 of net worth or income left after paying for care.

My father was in a skilled care hospice house in Billings and was paying $8,000 per month. At $96,000 annually you can see that private pay patients quickly use up all their savings and assets, and then turn to Medicaid.

Montana pays nursing homes $212 a day while nursing homes say the cost of providing care averages $350 per day. The governor’s budget proposes to increase nursing home reimbursement to $249 per day July 2023 and then drop it to $238 per day July, 2024. The governor’s own Department of Health and Human services hired a consulting firm to study reimbursements and they recommended a Medicaid rate of $278 per day. What is the governor thinking?

More nursing homes will close if reimbursement that covers the cost of care isn’t given. This means not only the loss of jobs and incomes for our communities but more importantly our most vulnerable Montanans are being shuffled from place to place and being forced to move far from family, friends and their community. They deserve better. This is a necessary service. Families have tried to care for them at home but their care needs are too high.

My daughter, a pharmacist in Spokane, and my sister-in-law, an administrative nurse at Billings Clinic, tell me the critical shortage of skilled long-term care beds greatly affects hospitals because they can’t discharge patients, resulting in longer, more expensive hospital care.

In the Bible, the book of James Chapter 1 verse 27 says, “Religion that is pure and undefiled before God the Father is this, to care for the widows and orphans in their distress.” From my perspective as a Christian we have failed vulnerable widows in Montana who rely on Medicaid for their nursing home care.

The Legislature is debating how to spend a $2 billion surplus when we are at a crisis moment for long-term care for those in the twilight of life who depend on Medicaid. We value our elderly and want to honor our fathers and mothers. How we spend our money reflects our values. I and many Montanans would gladly forego a tax rebate to make sure our senior citizens get the health care they need. As their children and grandchildren, neighbors and friends we need to speak up. Contact your legislators and let them know that our elder brothers and sisters and the nursing homes who care for them need a fair, stable Medicaid reimbursement that assures the quality of care they have earned and deserved.

The nursing home crisis jeopardizes our own health care as well as that of our parents, spouse, loved ones and neighbors. Will there be a bed available when our time or our family’s time of need comes? What do we value? Those in the twilight of life are counting on us to help them and care for them. Yes, “The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.”

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The Rev. Brad Ulgenes of Helena is a former nursing home administrator and former pastor of First Lutheran Church in Havre.