FHCA Asks Gov. DeSantis to Preserve Medicaid Funding Increase When Signing State Budget

In a recent letter to Gov. DeSantis, Florida Health Care Association asked the Governno to sign a budget that retains the needed Medicaid rate increase for nursing center care to ensure Florida’s frail elders continue receiving high-quality, long term care and to support centers with meeting the challenges of COVID-19 to ensure resident and staff safety.

April 27, 2020

The Honorable Ron DeSantis
Office of the Governor
The Capitol        VIA EMAIL
Tallahassee, FL

Governor DeSantis:

The Legislature included a funding increase for nursing centers’ inflationary cost increases in HB 5001 ($28.6M General Revenue) to ensure Florida’s frail elders continue receiving the high-quality, long term care they expect and need. The impact of the COVID-19 pandemic on Florida’s nursing centers makes the need for this funding even greater.  Florida Health Care Association asks that you sign a budget that retains the needed Medicaid rate increase for nursing center care. The funds allocated to specific appropriations 225 and 226 are necessary for centers’ funding needs to meet the challenges of COVID-19 and ensure staff and resident safety.

Currently, nursing centers are operating with 2016 reimbursement rates, losing over $27.25 per day to care for each Medicaid resident before the recent cost increases associated with COVID-19. In the current environment, the lack of inflationary increase over the past four years makes it extremely difficult for nursing centers to maintain qualified staff and meet the demands of an older population with increasingly complex care needs make additional improvements in quality improvements.

The COVID-19 outbreak has exacerbated nursing centers’ financial challenges. Facilities have increased costs resulting from add-on pay for caregivers and other staff, personal protective equipment (PPE) and additional infection control supplies, as well as dietary and housekeeping costs needed to keep residents and staff. Without increased funding and stable rate predictability from one year to the next, Florida puts quality nursing center care at risk for our most vulnerable seniors and people with disabilities.

Nursing centers’ COVID-19 costs will continue to rise, even after this pandemic stabilizes for the rest of the population. While Florida’s curve for hospital admissions has plateaued, Florida nursing centers continue to see increases in the number of residents and staff testing positive for COVID-19. This is a result of the virus’ ability to be transmitted through asymptomatic carriers. Nursing centers are expected to be monitoring and caring for residents with COVID-19 for many months to come.  

Skilled nursing centers devote a full 70% of operating expenses to labor, and the level of quality care delivered is directly related to the quality talent centers can recruit and retain. The COVID-19 pandemic is resulting in increased staffing costs for nursing centers.

Centers are contracting with staffing agencies to meet resident care needs, as staff find themselves unable to work due to exposure. Pay for contracted caregivers are more than double the average employee wage that centers would traditionally pay. Centers have also increased caregiver wages to maintain current employees, including hazard pay and increased overtime.

Additionally, centers’ costs have increased as a result of added staff needed for screening and restricting visitors and employees, meeting residents’ individualized needs resulting from communal dining and activities being prohibited, more frequent monitoring of residents’ symptoms, and additional cleaning and infection preventative practices.

Florida’s Medicaid Prospective Payment System (PPS) is working to create a strong quality improvement incentive for nursing centers. Today, Florida is a national leader in quality, and residents are experiencing better health outcomes and improved quality of life. Funding must keep up with inflation or Florida’s quality gains are at risk.

Almost 46,000 frail elders and people with disabilities rely on Medicaid to cover the cost of their skilled nursing center care.  Most require 24-hour complex medical care and have cognitive impairments, such as Alzheimer’s disease or dementia. That number will continue to grow as Florida’s aging population increases. While federal CARES Act funding has helped offset a portion of nursing centers’ cost increases as a result of the COVID-19 pandemic, those dollars are not meeting the exponential costs of essential PPE and other services.

The staff and residents in Florida’s nursing centers need your ongoing support. Signing a budget that retains the needed Medicaid rate increase for nursing center care will support providers as they work to help flatten the curve of this virus and protect our state’s seniors and most vulnerable. At the same time, this funding will ensure Florida seniors have access to a viable long-term care system that delivers the quality nursing center care they have come to expect and deserve, now and well into the future.

On behalf of Florida’s nearly 700 nursing centers representing over 70,000 residents and 200,000 caregivers, I thank you for your consideration.

Sincerely,

J. Emmett Reed, CAE
FHCA Executive Director