Louisiana’s nursing home industry is trying to exempt itself from the final phase of Gov. Bobby Jindal’s Medicaid privatization.
The industry’s objection is stalling release of initial steps in the bidding process — called request for proposals or RFP — that would seek a private company to take over management of long-term care programs for the elderly and developmentally disabled.
Under “managed care,” the idea is to provide needed services to people at the right time and in the most appropriate and generally less expensive setting.
About 72,000 people considered elderly, developmentally disabled or disabled by an adult-onset condition are getting their care covered by Medicaid in either institutional or home-based settings. The price tag is $2.1 billion.
The Jindal administration already has contracted with private managers to handle the medical and behavioral health components of the state’s $8 billion Medicaid program. The long-term care portion is the third and final installment.
State Department of Health and Hospitals Secretary Kathy Kliebert confirmed that the Louisiana Nursing Home Association “has expressed concerns about nursing homes being included.”
Jindal’s office said he had no opinion on the exclusion of nursing homes. In a statement, Jindal said DHH should continue its “due diligence to ensure the process results in the best quality care.”
AARP Louisiana director of advocacy Andrew Muhl said managed care companies are “incentivized” to move people to home- and community-based settings if it’s suitable and less expensive.
“If nursing homes are able to carve themselves out, it’s going to fragment health care opportunities for everyone and reduce choices for seniors,” Muhl said. “It will likely result in longer wait times for people who want to live independently in their homes.”
The association is taking the fight over nursing homes to the Legislature. DHH “is closely following” what happens to determine if changes are needed in the current administration-approved RFP, Kliebert said.
Advocates for the elderly and developmentally disabled have started faxing, emailing and petitioning Jindal asking him to oppose attempts by the nursing homes to carve themselves out of managed care. There’s also a Facebook campaign organized by several groups including AARP.
The solicitation for proposals, RFPs, had been set to go out this spring — a year after the initial projected date. Then, there was an abrupt delay with no explanation.
Louisiana Nursing Home Association executive director Joe Donchess declined two interview requests.
Nursing Home Association spokeswoman Karen Miller conveyed a message after speaking to Donchess: “the nursing facility program is economical and efficient and he does not know where any additional savings would come from by reslicing the long-term care pie,” a reference to Medicaid funding which now goes primarily to institutional care settings, mainly nursing homes.
The new long-term care privatization initiative has been dubbed “Bayou Choice.”
According to a DHH concept paper, the idea is to improve care through better care coordination while serving more people at home with dollars available.
Another goal goes to the heart of an issue the state has wrestled with for decades: over-reliance on institutions for care of the elderly and developmentally disabled as the demand for community services skyrocketed, the agency said.
A newly released 2014 AARP Louisiana survey found nearly 70 percent of Louisiana voters over age 45 “strongly support” more dollars being spent on home and community services for seniors instead of nursing homes.
The DHH waiting list of developmentally disabled and elderly seeking community-based services tops 30,000 people.
Overall, 55 percent of the dollars go to institutional settings, primarily nursing homes. Breaking out the spending differences by population reveals dollars spent on aging adults is heavily slanted toward nursing homes — 29 percent community to 71 percent institutional care.
Advocacy Center compliance specialist Jeanne Abadie said there’s a reason nursing homes don’t want to be included in managed care.
“The managed care organization has every incentive for the people to stay in the community,” Abadie said. “It would seem the nursing homes would always be a loser in that.”
Nursing home reimbursement rates would not be cut under managed care, Abadie said. Nursing homes would still have the constitutional budget protection voters approved last year for their funding, she said.
“It’s not about cutting nursing home rates. It’s about letting the money follow the person in the setting they want,” said Steve Spires, health care researcher for The Louisiana Budget Project.
“For us it’s about choice, giving seniors choice,” the AARP’s Muhl said.