A new bill unanimously approved by the N.C. House of Representatives will provide approximately $40 million to adult care facilities’ Alzheimer’s units, but local adult care administrators say this bill does not compensate for the state’s changes in Medicaid eligibility.
The new Medicaid eligibility, which became effective Jan. 1, mandates that recipients who are reimbursed by personal care services require assistance with at least three of five ADL’s (activities of daily living). These ADL’s include dressing, eating, bathing, toileting and mobility. Recipients can also qualify for personal care services if they need extensive assistance in two of these categories.
These coverage changes have left several of Ashe County’s elderly population without benefits.
“Our residents came to us under the belief they would get care,” said Cameron Keziah, the director of community relations for Forest Ridge Assisted Living.
“When a resident is denied care, either the family is left with the costs, the facility is left with the cost, or we have to discharge the resident,” said Keziah. “So they go from being safe and secure to worrying about getting discharged.”
“If we want to be here tomorrow, we can’t afford to pay for each resident,” said Keziah. “It makes us the bad guys.”
Not only do these assessments place a great deal of stress on the residents, it’s also stressful for their families.
Under the new policy, Medicaid recipients must be evaluated by a nurse from the Carolina’s Center for Medical Excellence (CCME) in order to maintain their coverage, which is based on the amount of “care hours” a resident requires.
However, Melissa Deskins, the executive director of Forest Ridge, said CCME nurses have shown a lack of consistency when evaluating her residences.
For example, Deskins said one of her residents was assessed by a CCME nurse, and was denied of all his care hour funding.
When Deskins appealed the assessment, the resident went from zero care hours to 80 care hours; literally from the minimum amount of hours to the maximum.
“To me, that sends up red flags,” said Deskins.
Bevin South, the executive director of Ashe Assisted Living, said she has similar experiences with two of her residents that went from zero to 65 hours and zero to 56 hours.
When meeting with Keziah, both Deskins and South said many assessors didn’t spend enough time with each resident before recommending care hours, didn’t talk to the staff or the resident’s family to help administer an appropriate assessment.
House Bill 5 will allow special care units to access a $39.7 million fund to supplement Medicaid cuts until June 30, but Keziah, Deskins and South agreed they would like to see a long-term solution.
“That’s still not a permanent solution,” said Keziah.
When adult care administrators receive a letter that states a resident is denied all care hours, administrators immediately send an appeal. Once the appeal is processed, residents receive “maintenance of service,” which will pay $600 per month for continued care until the appeal is finalized.
If the appeal is reversed, the resident will lose their care hour funding. If the appeal is upheld, the resident will still lose some of their funding compared to where they were before the PNC changes.
“There are still a lot of unanswered questions,” said Keziah.
Keziah told a story about a local man who was being held by adult protective services. While trying to locate a residence for him to stay, Keziah said they discovered the man had never filed for Medicaid.
In the old system, the man could have stayed at an adult care residence while his Medicaid application was being processed, and he would have eventually qualified. However, in the new system, a person can only stay at an adult care facility if they already qualify.
“He is getting penalized for never having filed for Medicaid,” said Keziah. “He has paid into the system for years, and now when he needs help, he can’t get it,” said Keziah.
Keziah also said this has a trickle-down effect for other services.
“Adult protective services was having to house him, and that puts a crunch on their funds,” said Keziah.
Even though South, Deskins and Keziah all said they were grateful House Bill 5 passed, they struggled to find any positives about the new guidelines for PCS funding.
“You have to hit rock bottom before you can rebound,” said Keziah, “and that seems to be the trend.”
“I wish our legislators would come and spend time at our facilities,” said South.
Deskins agreed, and said she is worried PCS funding issues will be resolved with a lawsuit.
“There shouldn’t have to be an injury or death to launch a lawsuit to change the eligibility guidelines,” said Deskins. “It’s almost like we’re saying our elderly aren’t worth anything.”
Keziah, South and Deskins eventually agreed on one positive aspect of the recent guideline changes.
“One positive is it’s forcing us to come together and talk about it,” said Keziah. He also said each adult care facility shares information with one another demonstrates they care more about their residents than making money.
“We’re lucky here because we are a small community, so we’re all connected to each other,” said Keziah.