Monte Marie Holds Conference on Medicaid

HOLYOKE – The realities between services offered and money received for those services was driven home by Sister Betsy Sullivan when she invited state legislators to the Monte Marie Health Care Center last Friday morning to discuss decreased Medicaid payments.

Sullivan, the center’s administrator, said that the rise in health care cost, the current economic downturn, and lowered Medicaid reimbursements, have left the facility and those like it in the state with large deficits.

State Representatives Michael F. Kane, John W. Scibak, Senator Michael R. Knapik attended the breakfast meeting and offered their view from the legislature and about the ongoing budget crisis in Massachusetts.

She said the 84-bed facility, now at full-capacity, faces a $500,000 or more budget shortfall for the current fiscal year and expects more of the same for 2010. The facility not only cares for retired lay people and clergy, but has patients from the local community and beyond.

While the facility does generate some revenue from donations and from private patient care, which accounts for close to 11 percent, a majority of the residents need the state Medicaid supplement to support their stay.

The difference, though, starts with the amount the state reimburses Monte Marie and the actual amount for care. In 2008, Medicaid reimbursed the center $181.94 per day, while the real cost came out to $215.26. That left the center with a deficit of $229,000 that year.

Even with an increase from the state of between 2.6 percent in 2007 and a projected increase of the 3 percent for 2009, the increase of acute care patients has only steadily increased, which has drained available resources. 

The federal Medicare program does offer a higher reimbursement rate, but with red tape and complicated patient qualifications, Monte Marie and facilities statewide must rely heavily on Medicaid.

Sullivan said she is concerned about the reduction in Medicaid rates over the past few years and for the upcoming fiscal year 2010.  

“Certainly we’re aware and have deep understanding for the economic situation within our state, within our country, but the concern is that our expenses far exceed our revenue and the reduction in Medicaid rates is not helping us to be able to really provide appropriately. We struggle not have a deficit in our budget,” said Sullivan.

Since the center opened to the public in 1995, Mont Marie has relied heavily on Medicaid reimbursements or 85 percent of the residents, according to Sullivan. The center is normally at full occupancy and currently has a waiting list for those seeking acceptance.

She said that patient care remains at the same level and that no nurses have been laid off. “We cut some cost here and there. We have not cut back on our staff and we do not intend to do that because that is where the quality of care and the quality of life is enriched. We will not do anything that is going to jeopardize the care of our residents.” 

Afterwards, Kane said the state faces a budget crisis not seen since World War II since the economy has soured. “How we bring those revenues up is going to be the question the legislature is going to have to make either through taxes, through fees, and is the legislature and the body ready to make those decisions yet, today. I don’t know,” said Kane.

Kane said reform of the system must occur before the state can start imposing any new taxes or fees onto taxpayers. Though he said Gov. Deval Patrick has asked for reforms, the governor has presented more plans to raise fees and revenues, instead.

He said the elderly are some of the most vulnerable groups in Commonwealth. “Government, I believe, is supposed to take care of people who can’t take care of themselves,” said Kane. “So, when you sit down with Sister Betsy and certainly her board, we would like to be there to help out and assist. When you come into these hard numbers, we’re faced with some very difficult decisions of trying to fill the budgets we filled in the past.”

Kane said the decline in capital gains tax revenues have only compounded the situation in the state. 

Knapik echoed the sentiments of Kane and said the budget forecast appears to be “grim” for anyone who has spent time either on Beacon Hill or in Washington, DC. He said the budget will be one of the most difficult in generations. “How to make the current level of services equal the money you have available to pay for it, it doesn’t match up any longer.”

He said unemployment continues to rise on an almost daily basis and that Massachusetts was slow to the recession and is now fully engulfed in the economic downturn. He said the state will probably linger in that situation long after the nationally economy recovers.

Besides the rising unemployment and the decline in revenues across the board, he said the sharp decline in capital gains, in which budgets were built around the once reliable source of revenue for the state, has all but “evaporated.” 

“The one saving grace that we have is that the congress did pass the federal recovery act with the stabilization funds, whether they’re highway monies or others,” said Knapik. “But for the purposes of nursing homes, hospitals, and others, the Medicaid dollars will be critical but they’re only good for ten quarters.”

He the challenge is to keep expectations low and try to stabilize spending versus “Draconian cuts” if the money were not available for next year and beyond.

One point brought up earlier in the meeting was the high cost of acute care for patients. It was generally agreed upon that some persons perhaps stay in their homes for too long and have not received a high quality of care. 

By the time the person enters a facility, such as Monte Marie, they are not stabilized and require acute care, which drains needed resources.

If the person entered the facility earlier, they could have received a level of care that could have been both preventative and cost effective. Knapik said their is a “tug-o-war” between staying and homing and receiving the needed care at a health care facility.

“By the time they get here, they need all that more stabilization, all that much more care to get them up to now a nursing home level,” said Knapik. “That’s going to be challenge as the population grows, especially in states in the northeastern portion of America. We got flight of the younger generations, but it’s the older, baby boomers on that are going to demand services.”

He added, “They are demanding services other than long-term care. If you’re in your fifties, sixties, now, I don’t think you’re looking at nursing homes are your first option, you’re looking at anything but. That will drive some of the policy debate.” He said there is no money to deal with that situation at the present time.

Knapik said the meeting at Monte Marie will provide a template for future discussions with what nursing homes and healthcare facilities are dealing with across the state and will be for some time.

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