Michigan to stop Medicaid funding for new hospice patients
Posted: October 8, 2013
Michigan’s 10 licensed in-patient hospices will have to turn away Medicaid patients starting Tuesday because the state Medicaid program will no longer pay for their room and board.
State Department of Community Health (DCH) officials notified the facilities on August 28 that Medicaid would no longer reimburse room and board costs due to inconsistencies in the way the state has been paying hospice providers, department spokeswoman Angela Minicuci said. Room and board charges at hospices are not covered by Medicare or most private insurance plans.
“We are looking to ensure that payments to hospice programs are consistent across all providers by looking at our payment processes, but also that we take into consideration the impact this would have on families,” Minicuci said.
Gloria Brooks, president and CEO of Arbor Hospice, which has a 26-bed in-patient facility in Ann Arbor, said hospices statewide have been working with state officials to find a solution, and had hoped the issue would be resolved by Tuesday — the last day hospices will be able to accept new Medicaid patients. The Residence of Arbor Hospice cares for about 70 patients a year, and about a third are on Medicaid.
“Our concern is that Medicaid patients who are the most vulnerable — these are the frail and the elderly — will have no place to go,” Brooks said.
State Medicaid reimbursements for hospice room and board are about $2.5 million a year. Hospice service providers contend it will cost more to care for these patients in hospital settings and nursing homes.
The state will continue to pay room and board for patients already staying at the hospices for up to one year, but hospices will not be able to accept any new in-patients after Monday. Minicuci said the department formed a committee that met this summer “to look at all of our payment processes to see the scope of what inconsistencies exist and what solutions we can find to address them.”
“We are still currently working with the hospice providers and the Hospice and Palliative Care Association to find a solution, including a potential pilot program that may continue these payments in another form. This involves 150 beds at 11 facilities. The average census is 40-50 beds at a given time,” Minicuci added.
Brooks said the state has decided that residential hospice facilities must be licensed as skilled nursing facilities and be surveyed under Medicaid or Medicare nursing home certification regulations to be eligible for room and board reimbursement.
The ratio of nurses to patients at the Residence of Arbor Hospice is about double what is required at nursing homes, due to the time intensive nature of end-of-life care, Brooks said. But licensure as a nursing home would require costly and time-consuming building changes and capital improvements — and could take years, she said.
More importantly, becoming a licensed nursing home would shift Arbor Hospice’s focus from end-of-life care to rehabilitation — and entirely change their mission. Brooks said Michigan recognized the need for facilities dedicated specifically to end-of-life care when the state developed a license for in-patient hospice facilities more than a decade ago.
“We’re imploring the state to say lets find a solution to allow us to keep the license they gave us 15 years ago,” Brooks said. “ Lets find a way.”