The state’s mental health funding has been in the news. Writing that “jails are not hospitals,” U.S. District Court Judge Marsha Pechman recently ordered the state to stop warehousing those criminal defendants awaiting competency determinations. Both parties in the Legislature have budget proposals that would address the issue. This is both compassionate and legally necessary under Judge Pechman’s orders.
Regrettably there is not such bipartisan unanimity when it comes to serving law-abiding seniors with dementia, many of whom are served in assisted living facilities. Medicaid care in assisted living facilities has gone years without funding increases, and has actually seen funding cuts. Rates can be as low as $46.51 a day for 24/7 care, meals and housing, a decrease of 55 cents from 2011. By way of contrast, rates for the local Motel 6 are $49.99. For 2014, a study conducted for the state found that assisted living payments fell 11.4 percent short of meeting costs — that shortfall was 5.4 percent in 2011.
We at the Washington Health Care Association believe that, if anything, these findings understate the problem.
While both Gov. Jay Inslee and the House have proposed a modest 2.5 percent funding increase for assisted living, the Senate budget did not provide this funding increase. For almost 7,000 Medicaid residents statewide this simply makes no sense. It means that a state that has aggressively developed long term care alternatives to nursing homes has only succeeded in squeezing lighter-care Medicaid clients away from, or out of, nursing homes without any real investment in subsequent care.
Here in Thurston County there are nine assisted living facilities that accept the Medicaid poor — most advertise their ability to serve those with dementia. Adequate reimbursement is the key to keeping this option available. Unlike nursing homes, assisted living facilities are allowed, under their Medicaid contracts, to limit their exposure to loss in the number of Medicaid clients they admit. Thus, while more than two-thirds of nursing home patients are on Medicaid, roughly a quarter of the occupied assisted living beds statewide are filled by Medicaid clients. We need to encourage facilities to admit these clients, not deter them from doing so. It will require an investment from a Legislature that has failed to do so for a decade. This penny-wise, pound-foolish approach is backing those clients up into more costly nursing homes, a level of care to which they are entitled under federal law.
The assisted living funding crisis is overshadowed by others. We understand legislators face a real challenge in meeting the mandate of the Washington Supreme Court to fund K-12 education adequately. But those vulnerable Washingtonians in assisted living facilities have sacrificed enough. They need a funding increase. We thank Gov. Inslee and the House for their support, and hope the Senate will find the resources to fund this vital care sector. Like any Medicaid expenditure, it is a sound investment where federal tax dollars returning to Washington match the state’s own commitment.